Flexible Scopes

Endoscopes

Tracking, and Traceability of Flexible Scopes

Start

Trends with Scopes and Infections

The incidences of patient infections resulting from gastrointestinal endoscopy procedures, due to unclean flexible endoscopes, are increasing.

Did You Know: If CRE enters the blood stream, approximately 50% of people who get an infection of this type will die.

What Does this Mean for the Patient?

Carbapenem-Resistant Enterobacteriaceae (CRE), have evolved to the point that no known antibiotics can kill them. The carbapenems are the last resort, and if they do not work, patients face a disheartening situation.

What Does Traceability Have to do with Infections?

Read more

Traceability and Infections

• Capturing the Olympus Flexible Scope serial numbers are a regulatory requirement, and are critical to have when a recall occurs, or investigating an incident.
• We need to be able to trace the specific scope back to the specific patient it was used on!

Traceability and Infections - Your Role

Additional documentation within the EHR during intra-procedure point-of-care should include minimum data required to verify the sterilization of the scope and associate with the patient and procedure in the event of recall or alerts.

• How Do We Capture the Data?
• In order to capture and track serial numbers, flex scopes have to be documented in the IntraOp equipment section.

• Why Do We Capture the Data?
• Only the equipment section allows us to capture the serial number, which can directly link the individual Flex Scope, to the patient, procedure, and date of service.

• Does CensiTrac Capture the Data?
• Although Censitrac contains some data, it ties the flex scope to the CSN (case number), not directly to the patient.

Instructions: Click each magnifying glass to learn about each step in the documentation of the scope used in the eStar Equipment section

Documentation Flowsheet

How To: Document and Care for the Flexible Scope

• Endoscopes are pre-cleaned immediately after use in the OR to remove gross contamination and prevent drying and hardening of secretions.
• Endoscopes must be transported IMMEDIATELY for reprocessing (within 1 hour). If not, this will lead to the build up of biofilm which leads to delays in reprocessing and turnover of the scopes.
• Manufacturer instructions for use (MIFU) should be followed for pre-cleaning steps.

• Note: Do not reuse a scope during a case if it has sat idle for longer than 30 minutes.

• Flexible scopes with no pan do not go in your case cart after the procedure. Instead, they should go in the Endoscope buckets (for most flexible scopes) that are assembled by an ORTA.
• If missing from your case cart, call Dispatch to request.

• Wear gloves when handling (before and after use).

How To: Document and Care for the Flexible Scope

When Returning A Used Scope:

• Place a patient identification sticker on the colored side of the scope tag, along with the date used, time it was removed from the patient and the time pre-cleaning was performed.
• Return scope and colored tag to dirty endoscopy for reprocessing.

+ info

Documentation Q+A

Question: Why do we need to document the serial number in "Equipment" rather than in "Instruments"? Answer: The "Instruments" section does not have a spot for the serial number (SN). For other vendor scopes like Storz, you can manually type in the SN number however, it does not allow for these scopes to be tracked and traced easily. This is why flexible Olympus scopes MUST be captured in equipment ( for tracking purposes). Documenting the Olympus flex scopes in equipment, will capture the correct information.

Documentation Q+A

Question: Why is it so important to capture this data about the scope and which patient is was used on? Answer: Because only the equipment section allows us to capture the serial number, which can directly link the individual Flex Scope, to the patient, procedure, and date of service. This helps the hospital communicate with patients if they are impacted by a recall on the scope, or if there is concern about potental unclean flexible endoscopes and use on patients.

References

• Centers for Disease Control and Prevention. Healthcare Infection Control Practices Advisory Committee. Bolyard EA, Tablan OC, Williams W, et. al., Guideline for infection control in health care personnel, 1998. Accessed August 3, 2015.
• Healthcare Infection Control Practices Advisory Committee. Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings – Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC)pdf icon [12 pages]. 2017. Accessed August 3, 2016 prior to publication.
• Association for the Advancement of Medical Instrumentation. Technical Information Report 34: Water for the Reprocessing of Medical Devicespdf iconexternal icon. 2014; Accessed July 29, 2016.
• Association for the Advancement of Medical Instrumentation. ST91 Flexible and semi-rigid endoscope processing in health care facilities 2015.
• Van Wicklin SA, Spry C, Conner R. Guideline For Processing Flexible Endoscopes. In: Connor, R,. ed. AORN Guidelines for Perioperative Practice: AORN; 2016.
• American Society for Gastrointestinal Endoscopy Standards of Practice Committee, Banerjee S, Nelson DB, et al. ASGE Standards of Practice Committee Statement: Reprocessing failure. Gastrointest Endosc.2007;66(5):869-871.
• Weber DJ, Rutala WA. Assessing the risk of disease transmission to patients when there is a failure to follow recommended disinfection and sterilization guidelines. Am J Infect Control.2013;41(5 Suppl):S67-71.
• US Food and Drug Administration. Infections Associated with Reprocessed Flexible Bronchoscopes: FDA Safety Communicationexternal icon; Issued September 17, 2015. 2015; Accessed June 14, 2016, 2016.
• Rutala WA, Weber DJ. ERCP scopes: what can we do to prevent infections? Infect Control Hosp Epidemiol. 2015;36(6):643-648.

Documentation Tip #1

Traceability means scanning and documenting the instrument path from patient use through the phases of sterilization to the shelf. In the Timeout section, we as a surgical team verify that the equipment we use on the patient are sterile! This process of scope cleaning starts with you in the operating room.

• In the IntraOp Navigator under the Procedure section, click on Equipment.

• When the screen opens, enter the type of flexible scope first, such as Bronch, Colon, Gastro, or Sigmoid, and click add.

Do you have an idea?

With Genially templates, you can include visual resources to leave your audience speechless. You can also emphasize a specific phrase or fact that will be etched in the memory of your audience, and even embed external content that surprises: videos, photos, audios... Whatever you want!

• Vendor name
• Model number
• Serial Number

Documentation Tip #2

The vendor name, model number, and serial number are easily identifiable on the scope. When looking at the scope, the information can be found at the connector section of the scope. The connector section connects the endoscope with the video system center through the universal cord.

• Colonoscope is now visible as an equipment type.
• Click the magnifying glass to search a list of available colonoscopes and serial numbers.
• Check your colonoscope’s serial number against the list that appears.
• Click on the scope with the same serial number, complete the remaining documentation, and click accept.

• OpTime will group the flex scopes in this order: the vendor name, type of scope, model number, and serial number all on one line in the “Equipment” field.
• Ensure that when you find the scope you are using, you hit "Accept" to add it to Equipment