ISSUE ONE—2011  
 


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Common Mistakes in Instrument & Device Reprocessing

Improving Infection Control Practices in Ambulatory Surgery Centers

ASP Launches the Fastest Low-Temperature Sterilization Cycle on the Market

Literature Update

Reprocessor Q&A

Helpful Hint

Faces of ASP

 
 


Charles Roberts, MS
Director of Research,
Microbiology &
Chemistry, ASP


Barbara Trattler,
RN, MPA, CNOR, CNA

Director of Clinical
Education, ASP


Candy LeBlanc, BSN, RN
Senior Manager
Global Training, ASP

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ASP Launches the Fastest Low-Temperature Sterilization Cycle on the Market

ASP recently announced the availability of the 24-minute EXPRESS Cycle for the STERRAD® 100NX® System—the fastest low-temperature sterilization cycle validated for surface sterilization of da Vinci® 3D endoscopes, rigid telescopes, rechargeable batteries, and many other devices. The new shorter cycle is a feature upgrade that customers can purchase for their new or existing STERRAD® 100NX® Systems. The 24-minute EXPRESS Cycle joins the 42-minute FLEX and 47-minute STANDARD cycles on the STERRAD® 100NX® System platform, creating an unrivaled range of sterilization options. Click here to learn more.

 

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For More Information
To learn more about ASP and the topics featured in this issue, or to let us know what you’d like to see covered in future issues, please call 888–783–7723 or e-mail frontiers@aspus.jnj.com.

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Common Mistakes in Instrument & Device Reprocessing

In order to prevent infections in patients due to inadequately processed medical devices and surgical instruments, sterilization and disinfection guidelines and standards must be meticulously followed. However, time constraints, limited staffing, insufficient training, and increasingly complex medical devices, among other factors, can lead to infection control process lapses. As part of a commitment to best practices in instrument sterilization and disinfection, Frontiers in Infection Prevention is launching a new series of articles that will examine common mistakes in instrument processing and offer practical solutions.

Mistake #1: Packaging a Wet Instrument for Sterilization
While some central processing and operating room staff members think that moisture left on instruments to be sterilized is acceptable, the reality is that moisture on a device may interfere with the ability of any sterilization process to successfully sterilize it. READ MORE



Improving Infection Control Practices in Ambulatory Surgery Centers

Adhering to infection control standards and guidelines is important in any clinical setting. This includes busy ambulatory surgery centers (ASCs), which performed more than 6 million procedures in 2007.1 A study published in the June 2010 issue of JAMA, however, found that lapses in infection control practices in ASCs were common.2 The study, led by Melissa Schaefer, M.D., of the Centers for Disease Control and Prevention (CDC), assessed compliance with basic infection control practices, as well as with other Medicare health and safety standards.

Between June and October 2008, 68 ASCs were assessed in Maryland, North Carolina, and Oklahoma. Surveyors focused on compliance with infection control practices in five areas: environmental cleaning, equipment reprocessing, hand hygiene, handling of blood and glucose monitoring equipment, and injection safety and medication handling. READ MORE



Study Shows EVOTECH® ECR is the Superior Cleaning Choice for Flexible Endoscopes

A study published in the July 2010 issue of BMC Infectious Diseases demonstrated that the EVOTECH® Endoscope Cleaner and Reprocessor (ECR) from ASP provides an automated approach superior to the manual cleaning required when using traditional AERs.1 The combination clinical-use and simulated-use study was led by Michelle Alfa, Ph.D., medical director, Microbiology Discipline Diagnostic Services of Manitoba (DSM), St. Boniface General Hospital Site, and funded by ASP. The study showed that the EVOTECH® ECR cleaning cycle provides reliable organic and bioburden removal from all channels and surfaces of bronchoscopes, duodenoscopes, gastroscopes, and colonoscopes.1

The EVOTECH® ECR is the first commercially available endoscope reprocessor to eliminate manual cleaning when a cycle containing a wash stage is selected (does not eliminate bedside precleaning). The independent data confirm previous data showing that the automated cleaning cycle of the EVOTECH® ECR provides results that are comparable to those of manual washing and brushing,2 and also show that the EVOTECH® ECR cleaning cycle is superior to optimal manual cleaning even for the most difficult-to-clean channels such as elevator guidewire channels.1

The study showed that:

  • The EVOTECH® ECR cleaning cycle offers an effective automated approach that provides greater assurance that flexible endoscopes are adequately cleaned.
  • The EVOTECH® ECR cleaning cycle provides effective removal of both organic material and bioburden from all channels and all surfaces of the flexible endoscopes evaluated.
    • The overall compliance of EVOTECH® ECR cleaning with all benchmarks for surfaces and lumens was greater than 99 percent.
    • In the in-use study, 75 patient-used endoscopes were evaluated post-cleaning, with 98.8 percent of surfaces and 99.7 percent of lumens meeting or surpassing cleaning endpoints for protein, hemoglobin, and bioburden residuals.
    • In the simulated-use study, 100 percent of the colonoscopes, duodenoscopes and bronchoscopes evaluated met or surpassed all benchmarks for protein and bioburden residuals (hemoglobin not evaluated).
  • The in-use study showed residuals for protein, hemoglobin, and bioburden in the suction channel (L1) after EVOTECH® ECR cleaning are substantially better (99.7 percent met all benchmarks) compared with manual cleaning.

Click here for more information about the study.

Reference
1. Alfa M, DeGagne P, Olson N, Fatima I. EVOTECH® Endoscope Cleaner and Reprocessor (ECR) simulated-use and clinical-use evaluation of cleaning efficacy. BMC Infectious Diseases. 2010;10:1–14.
2. EVOTECH® Product Monograph. Irvine, Calif.: Advanced Sterilization Products;2008.

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CLEANASCOPE System Enhances Endoscope Transport & Handling

Want to learn how to increase efficiency and standardization in the endoscope reprocessing cycle? ASP recently published an article titled “CLEANASCOPE System Enhances Endoscope Transport & Handling: System Helps Minimize Risk of Cross Contamination, Improve Efficiency & Reduce Repair Costs.”

With the number of endoscopy procedures growing around the world, it is vital that endoscopes are processed correctly in order to protect patients and staff from the spread of infections.1 Along with adhering to rigorous cleaning and decontamination practices, proper transport, handling, and storage of expensive, delicate endoscopes are crucial to ensure patient and staff safety and maintain optimal function. To address the many challenges associated with the handling of endoscopes, the CLEANASCOPE System was designed as a unique storage and transportation system that reduces the risk of cross contamination and offers easy visual identification of clean versus contaminated endoscopes. Benefits of the CLEANASCOPE System include improved reprocessing safety and efficiency, as well as the potential for reduced instrument damage and lower instrument repair costs.2 Click here to read the article.

Guidelines for Transporting & Handling Flexible Endoscopes

A number of agencies and organizations offer guidelines for the safe transport and handling of flexible endoscopes. Highlights include:

  • AORN recommends that endoscopes be transported “…in a manner that preserves the sterilization/disinfection status of the endoscope.”3
  • SGNA recommends transporting endoscopes in closed containers to avoid chances for cross contamination. Its guidelines state that, when transporting an endoscope to the reprocessing area, an enclosed container will prevent escape of airborne and droplet contaminants. It is important to consider both the protection of the apparatus and the environment during transport.1,4
  • CDC guidelines state that, “A protocol should be developed that ensures the user knows whether an endoscope has been appropriately cleaned and disinfected,” and endoscopes should be stored “in a manner that will protect them from damage or contamination.”5
  • The United Kingdom National Health Service’s National Endoscopy Programme guidelines require that “endoscopes are transported to the decontamination area in a covered receptacle that is of an appropriate size as to avoid contaminating the environment,” and when transporting an instrument to and from the endoscopy unit, “endoscopes are transferred in a receptacle with a hard lid that completely encloses the endoscope.”6

References
1. Society of Gastroenterology Nurses and Associates Inc. (SGNA). Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes. 2007.
2. Expert Insights: CLEANASCOPE System Enhances Endoscope Transport & Handling. Irvine, Calif.: Advanced Sterilization Products;2010.
3. Endoscope Transport & Handling. Irvine, Calif.: Advanced Sterilization Products.
4. Thomas L. Transporting the endoscope. Gastroenterol Nurs. 2005;28:145–146.
5. Rutala W, Weber D. HICPAC Guideline for Disinfection and Sterilization in Healthcare Facilities: Atlanta: Centers for Disease Control and Prevention; 2008.
6. National Endoscopy Programme: Decontamination Standards for Flexible Endoscopes. Leicester, England: Joint Advisory Group on GI Endoscopy; 2009.


ASP has completed a series of educational Webinars to help facilities navigate the transition from the STERIS SYSTEM 1® (SS1). This issue of Reprocessor Q&A highlights some of the frequently asked questions from the Webinars. To view the Webinar archive, click here.

I have been using the SS1 for almost 20 years, and I’m confused about the difference between a sterilizer, which is what my critical devices require, and the new SS1E system. 

These are confusing times for healthcare facilities—the FDA has cleared the STERIS System 1E™ (SS1E) as a liquid chemical sterilant processing system. But is it a sterilizer? At ASP, we believe there are clear distinctions between terminal sterilization and just-in-time processing. We provide legally marketed alternatives with the STERRAD® NX® System for sterilization. Our suite of low-temperature STERRAD® Systems is founded on the principle of terminal sterilization, which is the gold standard of sterilization. For high-level disinfection, ASP offers the EVOTECH® Endoscope Cleaner and Reprocessor (ECR). It's up to you to decide how you will transition from the SS1, but we are doing everything we can to bring you the education and the technology you need to make the best decision for your patients and facility. For nearly 20 years, ASP has developed innovative products that are used in thousands of healthcare facilities around the world—products that provide safe environments for patients, their families, healthcare workers, and the community. Additional assistance from ASP Customer Service and Support is only a phone call (888-783-7723) or mouse click (aspserve@aspus.jnj.com) away.
 

When should I use terminal sterilization for my flexible scopes?

You should check with the instructions for use from the endoscope manufacturer first, but you should minimize patient risk by following your hospital’s standard of care policy for use of surgical endoscopes in a sterile environment. Terminal sterilization always provides best practices for most institutions.

Why should I completely change systems when it seems easier to just move to an alternative model of our SS1 system?

Making a change does require time and effort. Instead of thinking of this change as a problem, however, you should really be thinking of it as an opportunity for process improvements. For example, you can take this time to consider options to upgrade from a wet, “just-in-time” system to terminal sterilization. Moisture may harbor contaminants, which may present a patient safety issue. Also, from an efficiency standpoint, with a device processed in a wet system, if a case is cancelled or there is another reason to not use the device, you have to process the equipment again because you can’t maintain its sterility. If the device is not used immediately, it must be reprocessed, thereby incurring additional time and processing costs. With terminal sterilization, you have the flexibility to use the device immediately or store it for later use because it is wrapped.

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Do you have a question for Reprocessor Q&A? 
E-mail us at: frontiers@aspus.jnj.com.

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Frontiers in Infection Prevention has featured numerous Helpful Hints over the years. Click below to revisit past topics:

Have a helpful hint to share with your colleagues? E-mail us at frontiers@aspus.jnj.com.



Jess Kuhl
Territory: West Virginia
Years with ASP: 5

After the sudden loss of his daughter, ASP Account Executive Jess Kuhl found there was support available for his wife, but very little for him as a father. Like many dads in this situation, he tried to deal with the sorrow and loss on his own. Dads are supposed to be the “rock” of the family.

Four years later, Jess published a book titled Sometimes the Rock Must Crumble. “I needed to do something to help other men,” he said. “So I wrote the book from a dad’s perspective to let them know they are not alone in what they’re feeling.”

Jess and his family also started the Maura Rae Kuhl AED Foundation, and every dollar from book sales goes toward placing an automated external defibrillator in local schools.

Jess’ experiences also have affected how he serves others. “I have more compassion for people and value my relationships more,” he said. “When it comes to helping others work through problems, I give them a different perspective. I take a step back and don’t push the panic button too quickly.”

Jess believes in developing long lasting relationships both in his professional and personal life. “When I go out to see people, I don’t focus on selling them something. I really want to walk away feeling like I have added significance to their life.”

For more information, visit www.jesskuhl.com and www.mrkaedfoundation.org. Click here to read an article about Jess in Repertoire magazine.

 
 
 

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