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ISSUE TWO—2011  

EVOTECH® Endoscope Cleaner and Reprocessor Helps MedCentral Health System Deliver Excellence

MedCentral Health System in north central Ohio was faced with a challenge. Its two acute care hospitals were looking for alternative reprocessing methods for flexible endoscopes as they completed the transition from the STERIS System 1* to a legally-marketed alternative device as directed by FDA. Their search led them to Advanced Sterilization Products (ASP) and its EVOTECH® Endoscope Cleaner and Reprocessor (ECR). Now, more than one year after the EVOTECH® ECR systems were installed, MedCentral’s two hospitals (Mansfield Hospital and Shelby Hospital) are achieving superior results, including consistently cleaned and high-level disinfected flexible endoscopes and optimized instrument availability due to a decrease in instrument repairs.

David Narance, RN, BSN, CRCST, manager, sterile processing at MedCentral Health System in Mansfield, Ohio, said he was pleased to learn about ASP’s leading flexible endoscope reprocessing technology and felt it was a good fit with the hospitals’ focus on providing high-quality patient care. “We received outstanding reviews on the EVOTECH® ECR from current users, as well as an independent nonprofit organization that researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care,” Narance said. “We want the absolute best for our patients, and we love our EVOTECH® ECR systems because they help us deliver excellence.”

Efficiency & Piece of Mind
The EVOTECH® ECR is the first commercially available automated endoscope reprocessor to eliminate manual cleaning when a cycle containing a wash stage is selected. (It does not eliminate bedside pre-cleaning.) With a safe, fast, and fully automated process, it makes labor-intensive and time-consuming manual endoscope reprocessing a thing of the past. The system eliminates brushing, consistently automates critical process steps, and performs complete monitoring of critical parameters including minimum effective concentration, block detection, temperature, and pressure every second of the cycle. The system utilizes CIDEX® OPA-C Solution and CIDEZYME® XTRA Multi Enzymatic Detergent and is specially formulated for cleaning and high-level disinfection of heat-sensitive (>60° C) endoscopes.

According to Narance, MedCentral’s experience with the EVOTECH® ECR has been positive. “We have four EVOTECH® ECR systems in our Endoscopy Units—two at Mansfield Hospital and two at Shelby Hospital,” he said. “Together, the hospitals have 351 beds and 42 bassinets. We offer complete cardiac care, comprehensive neurological services, a walk-in medical center and industrial health and safety services, and Mansfield Hospital is a Level II Trauma Center. As a result, we appreciate all the benefits associated with the EVOTECH® ECR. Importantly, this includes an automated approach that delivers endoscopes that are consistently cleaned every time, eliminating the variation associated with manual brushing.”

Decreased Instrument Repair Costs
In addition to consistently cleaned and high-level disinfected endoscopes, MedCentral has benefited from a decrease in equipment repairs since adopting the EVOTECH® ECR—critical because it recently invested in all new flexible endoscopes. “One endoscope alone can cost $40,000–$50,000, and we want to protect our investments,” Narance said. “Endoscopes are complex devices that are difficult to clean and maintain. With the STERIS System 1,* we had more issues with damaged lenses due to deteriorating epoxy and infiltration of liquid, as well as accelerated aging of the bending rubber. It wasn’t unusual to have an endoscope down every week. Now, with the EVOTECH® ECR, we may have an endoscope out only once a month, and typically it is related to routine maintenance. CIDEZYME® XTRA Multi Enzymatic Detergent and CIDEX® OPA-C Solution get the job done but are gentle, extending the lives of our endoscopes.”

The detergent and high-level disinfectant also are gentle enough that they can be discharged down the hospitals’ drains without concern, he added. “Our waste drains are monitored monthly by the city. When we notified them about the CIDEZYME® XTRA Multi Enzymatic Detergent and CIDEX® OPA-C Solution, they gave us their blessing.”††

Other EVOTECH® ECR features such as integrated computerized monitoring allow tracking of critical cycle parameters and help with quality assurance efforts. Narance and his staff can track exactly which endoscopes were processed, the cycle parameters, and the technician who operated the machine. This information helps answer questions if any issues arise or an endoscope requires maintenance or repair. Staff members also like the color coding of the connection kits, which are intuitive to work with. The transition to the EVOTECH® ECR was quick and straightforward, according to Narance. Most central service technicians were up to speed after 1–2 days of training.

David Narance, RN, BSN, CRCST, manager, sterile reprocessing at MedCentral Health System, and his staff
love their EVOTECH® Endoscope Cleaner and Reprocessor.

“We Love Our EVOTECH® ECR!”
Narance said that since the adoption of the EVOTECH® ECR, staff members are volunteering to work in the Endoscopy Unit, rather than avoiding it as had occurred in the past. “My team came up with the phrase, ‘We love our EVOTECH® ECR!’ because they are thrilled with the technology,” he said. “If asked whether they would go back to what they were previously doing, hands down they would say they want to stay with the EVOTECH® ECR.”

MedCentral has experienced similar benefits from using ASP’s STERRAD® Sterilization Systems, which use low-temperature, hydrogen peroxide gas plasma technology to sterilize instruments and medical devices safely and effectively, protecting instruments, users, patients, and the environment in healthcare facilities. “Our partnership with ASP helps us provide outstanding patient care,” Narance said.

The hospitals also receive excellent ongoing customer service and support from ASP. “They listen to users on the front lines and share our experiences so that other users across the country can benefit,” he said. “I appreciate that they are receptive to my professional feedback and recommendations.”

Now, more than 12 months after installing the first EVOTECH® ECR, the systems have become cornerstones for flexible endoscope reprocessing at MedCentral, with an average of 500 cycles run each month between the two hospitals. Consistently cleaned flexible endoscopes and reduced instrument damage are key benefits associated with the automated system. “There has been a dramatic improvement,” Narance said. “Our cleaning errors have gone down significantly and more endoscopes are available. We no longer have to worry about getting through the day with three endoscopes out for repair. In the end, we want to provide the best product to patients because we know our reputation is on the line. And guess what—our commitment to service excellence has never been stronger since we began using the EVOTECH® ECR.”


*STERIS System 1 is a registered trademark of STERIS Corporation.
Does not eliminate bedside pre-cleaning. Manual cleaning of medical devices (endoscopes) is not required prior to placement in the EVOTECH® ECR when selecting those cycles that contain a wash stage.
Local regulations may vary, but generally the solution can be discarded with running water into an ordinary drain. Facilities should be sure to check the requirements in their areas.

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Study Shows CIDEX® OPA Solution Does Not Damage Endoscopes

In light of the impending deadline to transition from the STERIS System 1* processor to a legally-marketed device as directed by FDA, many facilities are reviewing alternative reprocessing options. Clinical studies may help with the decision-making process. For example, a 2007 study published in the Journal of Endourology demonstrated that CIDEX® OPA Solution from ASP does not damage endoscopes, but STERIS System 1* sterilization rendered them unusable after repeated reprocessing.1

Independent researchers at the University of California evaluated the effects of CIDEX® OPA Solution and STERIS System 1* reprocessing on flexible ureteroscopes. Since the research involved a lab study, there were no differences in how the scopes were used between high-level disinfection (HLD) cycles. In the study, two new, identical ureteroscopes were reprocessed
200 times each—100 times in each system.

Researchers concluded that, “After 100 cycles, the STERIS 1 system rendered the flexible ureteroscopes unusable, whereas HLD with CIDEX® OPA Solution had minimal adverse impact.”1

The researchers suggested that STERIS System 1* may damage scopes due to pressure, the chemical effect of the acid, and high temperature. The damage to the scopes, which included tears, damaged fibers, and significantly impaired resolution, required expensive repairs. Damage was seen in STERIS System 1*-processed endoscopes after just 17 reprocessing cycles.

  Results for Tests on Scope 1 Results for Tests on Scope 2
# Cycles Solution Used Impact on Scope Solution Used Impact on Scope
17 (17 Total) STERIS
System 1*
The scope developed a 12-millimeter tear CIDEX® OPA Solution N/A
50 (50 Total) STERIS
System 1*
The scope had more than 70 fibers damaged CIDEX® OPA Solution Less than 10 fibers were damaged
50 (100 Total) STERIS
System 1*
297 fibers were damaged, and there was a 37% drop in resolution CIDEX® OPA Solution Only 10 fibers were damaged, and there was no change in resolution
100 (200 Total) CIDEX® OPA Solution

CIDEX® OPA Solution produced no additional damage

System 1*

The subsequent
100 reprocessing cycles in STERIS System 1* resulted in damage to 167 fibers

As the industry standard for high-level disinfection, CIDEX® OPA Solution offers rapid, reliable results. Benefits of CIDEX® OPA Solution include:

  • High standards for purity when used for manual or automatic reprocessing
  • Quick disinfection for improved productivity—more endoscopes can be processed in less time
  • A broad spectrum killing power, even in the presence of human serum

Click here for more information.

1. Abraham J, Abdelshehid C, Lee H, et al. Effects of Steris 1™ sterilization and CIDEX® ortho-phthalaldehyde high-level disinfection on durability of new-generation flexible ureteroscopes. J Endourol. 2007;21:985–992.

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© Ethicon, Inc. 2011

*STERIS System 1 and 1E are trademarks of STERIS Corporation.

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