Tech World: The Importance of Drying Flexible Endoscopes

February 1, 2020

Categories: AAMI News, Health Technology Management, Medical Device Manufacturers, Medical Device Manufacturing, Sterilization, Sterilization Professionals

Mary Ann Drosnock is director of clinical education at Healthmark Industries in Fraser, MI, cochair of AAMI ST/WG 84, the working group responsible for endoscope processing, and member of the BI&T (Biomedical Instrumentation & Technology) editorial board.

Damien Berg is regional manager of sterile processing for UC Health. Berg cochairs AAMI ST/WG 12 and ST/WG 86, the working groups for instructions for reusable device reprocessing and quality systems for device reprocessing, respectively, and is member of the BI&T editorial board.

Several recently published studies and guidelines have highlighted the need for complete drying of flexible endoscopes to reduce the risk of microbial recontamination in reprocessed devices and to improve patient outcomes. Lingering moisture in endoscope channels can provide a breeding ground for any bacteria that survived disinfection procedures. These bacteria can reproduce exponentially in a short period of time, presenting serious health risks to patients.

Mary Ann Drosnock addressed the importance of drying of flexible endoscopes in a recent AAMIBlog post and in episode 32 of the AAMI Podcast, where she and fellow sterilization professional Damien Berg further discussed key standards guidance and other challenges facing sterile processing departments.

Ensuring Endoscope Dryness

“Previously, facilities did not have the ability to inspect internal channels of endoscopes to verify that their drying process was working, nor could they test to see if a scope was dry,” said Drosnock. Now that industry is aware that endoscopes are not being dried adequately (even when following the endoscope manufacturer’s and/or automated endoscope reprocessor manufacturer’s instructions for use) many more options are available to dry the scopes.”

These options include:

  • Flushing the endoscope with instrument-quality compressed air.
  • Flushing the endoscope with a drying pump validated specifically for this purpose.
  • Placing the endoscope in an active drying cabinet that contains forced air sources that connect directly to the scope channels.

Endoscope dryness can be assessed with commercially available drying tests or with borescope inspection.

Both Berg and Drosnock cited ANSI/AAMI ST91, Comprehensive guide to flexible and semi-rigid endoscope processing in health care facilities, during the podcast as a valuable tool for sterile processing departments. The standard applies to flexible endoscopes in all healthcare settings. “Even though ST91 is currently being revised,” said Drosnock, “there’s still a great amount of information in the 2015 edition.”

Berg added ANSI/AAMI ST90:2017, Processing of health care products—Quality management systems for processing in health care facilities, as another valuable standard for sterile processing departments. “ST90 gives sterile processing staff a blueprint or outline for creating their own quality system. The standard guides them through identifying and implementing process steps.”

Drosnock agreed: “We must build quality into our processing to ensure we have the best outcomes for our patients.”

Training the Technicians

In addition to published studies and standards, Berg and Drosnock, who are both sterilization managers, emphasized the importance of properly training the people who are cleaning and reprocessing endoscopes. Said Berg, “These published studies and standards answer an important question for my staff: Why do we have to do this? As managers, we need to give our staff not just the tools to do their jobs, but also an understanding of the reasoning and research behind why they need to follow these protocols.”

Drosnock added, “You get much higher rates of compliance when you tell technicians why it is important to complete all the reprocessing steps in the exact same way each time.”

Recent Studies and Guidelines that Address Drying Reprocessed Flexible Endoscopes

  • Barakat MT, et al. Comparison of automated and manual drying in the elimination of residual endoscope working channel fluid after reprocessing (with video). GIE. Vol 89. Jan. 2019
  • Kovaleva J. Endoscope Drying and its Pitfalls. J Hosp Infect. 201 ;97(4):319–328
  • Ofstead et al. Simethicone residue remains insidegastrointestinal endoscopes despite reprocessing. Am J Infect Control. 2016;44(11):1237–1240
  • The Society of Gastroenterology Nurses and Associates. Standards of Infection Prevention in Reprocessing Flexible Gastrointestinal Endoscopes. 2016