SPD endoscope reprocessing quality performance hinges on practice, procedure – not product
When it comes to Sterile Processing & Distribution (SPD) striving for and ensuring high-quality reprocessing performance improvement the strategies and tactics needed to deliver those outcomes remain rather consistent.
Practices and procedures matter much more than product types, which means switching to disposable/single-use devices for all or selected procedures or switching to hybrid devices that contain disposable/single-use components likely won’t trump four other overarching concerns, two of which remain consistently at the top as most important for five consecutive years running.
Hence, practice and procedure continue to outweigh product by widening margins.
Even though media coverage of healthcare-associated infections likely linked to substandard reprocessing may be blamed on technique and/or technology, industry experts point to improving technique as a more effective countermeasure than redesigning technology to compensate. As minimally invasive and standard medical/surgical devices become more complex with nooks, lumens and components that can be hard to clean, which then makes them hard to disinfect and sterilize, some may believe that disposing rather than reprocessing those devices make more sense for patient safety even at the expense of the budget.
But not everyone thinks the same way. Instead, others point to education, training and performance tracking as more effective, efficient and relatable options.
For the fifth consecutive year, Healthcare Purchasing News surveyed a small group of sterile processing subject matter experts on seven potential – but likely scenarios – that may direct and redirect how SPD navigates the 2020s from a quality standpoint. HPN asked the executives from device manufacturers and reprocessing product companies to rank the seven strategies (1 being the most important or influential; 7 being the least important or influential).
To show the trends year over year, HPN publishes the aggregate respondent data from 2021 through 2018, with rather consistent results. In fact, the top two strategies this year echo the top two last year, which had represented a transposition of the top two the year before that. Essentially, the top two strategies – fundamental in their own right – have remained consistent for five consecutive years. Curiously, the third and fourth choices also remain consistent, albeit transposed from last year but widening the gulf between the top four and bottom 3, all of which are technology-related.
1. Thoroughly educating, training, vetting and certifying SPD staffers on proper and effective cleaning techniques
2022 average score: 1.5
2021 average score: 1.7
2020 average score: 2.43
2019 average score: 2.5
2018 average score: 1.5
2. Demanding, receiving and following validated instructions for use (IFUs)
2022 average score: 1.8
2021 average score: 2.6
2020 average score: 2.64
2019 average score: 1.9
2018 average score: 2.5
4. Comprehensively monitoring and tracking all steps in the process with sensors and video technology
2022 average score: 3.2
2021 average score: 4.5
2020 average score: 4.85
2019 average score: 4.7
2018 average score: 3.4
3. Holding staffers accountable/responsible for endoscope cleaning “violations”
2022 average score: 3.7
2021 average score: 4.0
2020 average score: 4.23
2019 average score: 4.8
2018 average score: 2.8
5. Switching to disposable/single-use-only endoscopic devices for selected endoscopic procedures only (e.g., bronchoscopy, etc.)
2022 average score: 5.2
2021 average score: 5.3
2020 average score: 4.46
2019 average score: 4.3
2018 average score: n/a
6. Switching to endoscopes that contain disposable/single-use-only components that can be discarded or swapped out after use
2022 average score: 5.4
2021 average score: 4.8
2020 average score: 3.62
2019 average score: 4.1
2018 average score: n/a
7. Switching to disposable/single-use-only endoscopic devices for all endoscopic procedures
2022 average score: 7.0
2021 average score: 6.6
2020 average score: 4.77
2019 average score: 6.1
2018 average score: 4.8
HPN invited respondents to explain their perspectives and even offer alternatives. Here’s what they shared.
Melinda Benedict, Director, Infection Prevention and Control, Olympus Corporation of the Americas, reiterated that, “Single use for certain patients and procedures is recommended by the FDA, whose guidance is of utmost importance.”
Meanwhile, Gregg Agoston, Vice President, Business Development, SPD Transformation Services, SpecialtyCare, emphasizes staff education, training and even specialization as paramount for mastering this process and not redesigning the products.
“There are many complex instruments in hospitals that the SPD/GI units must be able to properly clean and sterilize/[high-level disinfect],” he noted. “Unless there is a clear advantage, e.g., cost, impact on environment or technology advancement, I do not believe that disposable endoscopes are the correct answer. We only have to look at the increase in medical waste to see the impact of single-use devices. I believe that the key to success is to allow for specialization within the hospital for endoscope reprocessing.
“There should be dedicated staff, who are highly trained and paid commensurate with the skills needed to perform the work, which in the case of GI flexible endoscopes is very high,” Agoston continued. “There are over 100 pages of instructions in the IFU on the proper procedures to reprocess a flexible GI endoscope. Each step in the process must be performed correctly to render the endoscopes safe to use on a patient. The staff must be trained, certified with annual or more frequent competency evaluations. Pay must be commensurate with the work and expectation that all IFU processes will be performed on every endoscope.
“The SPD typically rotate staff through each processing area. Given the current challenges in finding qualified SPD staff, the rotation practice results in every technician processing complex instruments,” he said. “This results in significant variability due to skill sets and the fact that the technicians do not process the devices on a frequent enough basis to become expert. No manufacturer puts inexperienced technicians on their most technical jobs. Hospitals should not do this either.”
