Infection Control Today

FEB 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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30 ICT January/February 2019 and therapeutic procedures. We've recently seen the introduction of ultra-high defnition cameras, 3-D images, and other technologies intended to improve diagnostic performance. Yet, it appears that designing these devices to enable easy and effective reprocessing has always come secondary to clinical functionality. This makes sense given the infuence physicians have on endoscope selection. As endoscopes exist today it may not be possible to simply make design revisions to address the repro- cessing issues. Changing these instruments to make them easy to reprocess may require starting over and introducing revolutionary changes. In a highly competitive market where there are only a few endoscope manufacturers and the barriers to entry are high, there is not much of a business incentive to invest the considerable time and research to radically change a well-established technology." "However, this may be changing," Lavanchy adds. "A few companies are emerging in this market with a different approach and introducing single-use, disposable scopes. The challenge is designing an instrument that offers the same level of clinical function as a reusable version and at a cost that isn't prohibitive. We are beginning to see some disposable scopes entering the market, but adoption has been slow in part because of concerns that the single-use products might have more limited utility. Our studies have also shown that they may be cost-effective only for a narrow range of usage levels. We are hopeful though that as more affordable and effective disposable scopes emerge, and as market pressure compels reusable scope manufacturers to develop more practical reusable models, we will soon see less need to include this topic in our annual Top 10 list." To mitigate these issues, L avanchy recommends, "For endoscope reprocessing, ECRI Institute monitors where problems are detected through our review of the literature and through our own investigation into incidents where reprocessing was ineffective. From these sources and discussions with outside experts, we identify emerging issues and best practices to mitigate the risk. This year we chose to focus on post-disinfection endoscope handling because there is evidence that this has been an overlooked aspect of reprocessing that may be contributing to contaminated instruments." As we have seen, one additional issue found by the ECRI is the overzealous cleaning that can lead to damage of electrical equipment As the report states, "Improper cleaning of electrical equipment can result in equipment malfunction, damage, or fre. Medical devices and other electrical equipment used in healthcare facilities must be cleaned and disinfected to prevent cross-contamination between patients and curtail the spread of infectious organisms. However, some cleaning practices can present risks. The use of cleaning or disinfectant wipes that are dripping with excess fuid, or spraying liquids directly onto powered medical devices and equipment, can cause fuid to enter electrical components such as plugs, sockets, or power supplies. Repeated fuid ingress, and the residue it leaves behind, can create errant current pathways around the electrical component. These additional currents can eventually generate suffcient heat to cause a device failure, or worse. ECRI Institute is aware of multiple instances in which cleaning fuid seeping into electrical components has led to equipment damage or fre. Incidents have involved infusion pumps, OR tables, infant warmers, and electrical equipment such as light switches and power supplies." When cleaning electrical equipment, ECRI Institute recommends that staff should follow manufacturer instructions, they should avoid spraying fuids directly onto the equipment, and they should use appropriate cloths, wipes, and sponges (squeezing out excess liquid before use). "To reduce the risks of equipment damage and fres from cleaner fuid ingress in electrical medical devices and equipment, ECRI Institute recommends following the equipment manufacturer's cleaning recommendations," Sivek emphasizes. "Excess cleaning fuid should be squeezed out of cloths, wipes, or sponges prior to applying to equipment. Staff who work with fuids around electrical medical devices and equipment should be regularly trained, which includes reviewing the method(s) of notifying clinical/biomedical engineering if fuid ingress occurs during cleaning." Collaboration is Key For all of the issues, increased collaboration between healthcare professionals, infection preventionists and risk managers can go a long way toward helping address these hazards. "To reduce the risk of our 2019 Top 10 Hazard #2, risk managers can verify that the pads/chucks and disposable or launderable mattress covers used in their facility are compatible with their facility's mattresses and mattress covers," Sivek says. "Infection preventionists can require that mattress cover suppliers specify effective, compatible antimicrobial products to use after a cover is exposed to blood, body fuids, bacterial spores, and Candida auris. Environmental services (EVS)/ housekeeping managers can train their staff to recognize mattress cover problems (e.g., tears, cracks) and verify that relevant cleaning checklists include both recommended procedures and materials for cleaning mattress covers and steps for inspecting mattresses and covers. Clinical/ Biomedical Engineers should track the service lives of mattresses and mattress covers and consider implementing electronic tracking of mattress and mattress cover IPM schedules, service lives, and time until replacement." Sivek continues, "To reduce the risk of our 2019 Top 10 Hazard #9, IPs can review the instructions for use of medical devices and equipment to identify the manufacturers' recom- mended cleaning and disinfection methods. EVS managers should add this information to relevant room cleaning checklists if needed. Risk managers may help coordinate the training of EVS/housekeeping, nursing, and respiratory therapy staff to learn the risk of equipment damage and fres resulting from cleaning fuid ingress, how they can prevent this damage, and should fuid ingress occur during cleaning, how they should treat affected equipment and notify Clinical/Biomedical Engineering. As for the reprocessing challenges, "Healthcare facilities today can help address these issues by encouraging reprocessing staff to diligently follow recommended reprocessing procedures and by following guidance coming from organizations like the CDC and ECRI Institute that monitor emerging problems with reprocessing practices," Lavanchy says. "Being aware of the concerns is an important frst step and a major component in prevention." The full hazards report, accessible to ECRI Institute members, provides detailed steps that organizations can take to prevent adverse incidents at their facilities, not just respond to them. The 2019 Top 10 Health Technology Hazards executive brief is available for complimentary download at Reference: ECRI Institute. 2019 Top 10 Health Technology Hazards. Executive Brief. Ò To reduce the risk of our 2019 Top 10 Hazard #2 , risk managers can verif y that the pads/chucks and disposable or launderable mattress covers used in their facility are compatible with their facility's mattresses and mattress covers. — Amanda Sivek, PhD

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