One of the most common causes of costly repairs is fluid invasion. This happens when fluids such as water, detergent or reprocessing chemicals enter areas of the scope where they shouldn’t be. The impact on the scope is damage to electronic components, optical and angulation systems and other internal elements. The end result is downtime with all its associated costs.

So how does fluid invasion happen? And what can you as a nurse, physician, technician or other scope handler do to prevent it?

The causes for fluid invasion can happen anywhere in the cycle of performing a procedure, including during transport, handling, room setup, the procedure itself, reprocessing and storage. Reducing the risk of damage is a team effort. Continuous education, training and implementation of proper processes for scope care and handling will go a long way in preventing fluid invasion and its associated repairs.

 Similar principles applies to the care and handling of your endoscopes. Each member of your team should understand the "whys" and "hows" relative to their particular scope responsibilities in order to appreciate their role in minimizing repair expenditures.

In an environment that is in a constant state of change with new technologies, responsibilities, turnover, etc., ongoing education and training becomes even more challenging.

Handle with care

Here are a few always-timely tips for avoiding scope damage, which can lead to fluid invasion.

• Avoid coiling insertion tubes too tightly.

• Avoid stacking scopes with accessories or other scopes during transport.

• Use care when handling scopes around sharp objects and metal surfaces.

• Examine condition and size-compatibility of accessories to avoid damaging channels.

• Inspect and test scopes prior to each procedure to catch damage early on.

• Regularly check caps, pistons and visible seals for wear and tear to ensure the scope is watertight.

• Take care when picking up the instrument or putting it down.

• Avoid exerting too much force on buttons, switches, angulation cables or the control grip during use to avoid punctures, cracks and buckling.

• Inspect each EndoTherapy device before inserting it into the channel. Stop when you encounter a restriction and don’t attempt to advance the device while the scope is angulated.

• Make sure the device is in the field of view before opening or engaging; good communication between nurse and physician is critical.

• Avoid stacking a scope on its own distal tip.

• Do not reprocess scopes together unless using a reprocessing machine specifically designed for reprocessing two scopes in a single basin.

• Check sinks, drains and countertops for sharp edges; remove unnecessary objects nearby.

• Ensure reprocessing staff has adequate reprocessing time. Don’t rush.

1. Bedside Cleaning

• Check integrity of water resistant cap and make sure it is dry.

• Put the cap on before cleaning at beside.

• Clean at bedside before bioburden hardens to avoid aggressive cleaning later.

2. Leak Testing

• Leak test before manual cleaning.

• Use a sink that is large enough to avoid crimping the instrument.

• Post the appropriate OEM leak testing instructions. (For scopes that fail leak testing, see www.olympusamerica.com/ damagedscopes for instructions on cleaning and high-level disinfection or sterilization of the damaged endoscope prior to shipment to a service center for repair.)

3. Manual Cleaning

• Avoid undue chemical damage by adhering to OEM instructions for reprocessing time, temperature, and concentration using recommended detergents and high-level disinfectants/sterilants.

• Follow the detergent manufacturer’s instructions to ensure the proper detergent concentrations.

• Use appropriate cleaning brushes that are in good working condition.

4. High-Level Disinfection (HLD) or Sterilization

• Follow the scope manufacturer’s approved protocols for high-level disinfection or sterilization.

• Follow manufacturer’s instructions for use of automated endoscope reprocessors (AER) and high-level disinfectants/sterilants.

• Use only endoscope-compatible liquid chemical germicides recommended by the scope manufacturer that have been tested for material compatibility.

• Store scopes in a clean, ventilated and uncluttered cabinet (not in carrying case).

• Hang scopes vertically with valves and caps removed and with locks in the "free" position.

• Regularly check endoscopic equipment and accessories for wear.

• Ensure scopes are repaired to OEM specifications.

• Retire outdated equipment and keep active scope inventory levels on par with patient volumes.

• Keep appropriate staff trained on handling, operating and reprocessing protocols.

-HPN