It’s not something we look forward to – hospital procedures of any kind can elicit some anxiety.
Most of us don’t get super jazzed about being poked and prodded and looked at from within. But we do it, because we know that knowledge is power, and we usually choose knowing and taking action over not finding out and taking a chance.
With any procedure, it’s important for us to be our own best advocate and know the right questions to ask to ensure the safest experience possible. Such is the case with the endoscopic examination.
Doctors use many types of specialty endoscopes – small, flexible long tubes with lights and cameras – to get a close-up look at different parts of our bodies, including our lungs (bronchoscopes) and our ears (otoscopes). The most familiar specialty endoscope is likely the colonoscope, which is used to look inside the colon during a colonoscopy. Endoscopes have a light source, biopsy needles and other tools that can be used to take tissue samples.
Most endoscopic procedures are minimally invasive and typically painless, and we usually leave the hospital later the same day feeling just fine. A little groggy from the sedative, maybe, but relieved it’s over and eager for the results.
Then, we read the national newspaper headlines about inadequately reprocessed flexible endoscopes – or endoscopes that aren’t effectively cleaned and disinfected after each use – and the danger this poses to patients. We find out that even when a hospital goes to great lengths to do everything correctly, some bacteria can still remain, and the transmission of dangerous pathogens from one person to another can still occur.
This includes Carbapenum Resistant Enterobacteriaceae (CRE), a particularly perilous family of bacteria that are difficult to treat because of their high levels of resistance to antibiotics.
“Endoscopes are tricky because they are very long – a meter or more – and have very narrow channels that are one to three millimeters in diameter,” says Janet Prust, Director, Standards and Business Development, 3M Infection Prevention. “There is a channel for the surgeon to view through, and a separate one that’s used to pass surgical instruments through and draw fluids and blood. It’s these long, narrow channels, the tiny connection ports with complicated shapes and the multiple accessories that make these instruments difficult to clean.”
Today, the most common way to rid flexible endoscopes of dangerous pathogens is through cleaning followed by high level disinfection using liquid chemicals.
But even that doesn’t guarantee a safe endoscope.
“Based on what we know today and the solutions that currently are available,” said Janet, “two additional steps can be taken by facilities to help safeguard their patients – the use of a rapid cleaning indicator and terminal sterilization with ethylene oxide.”
3M offers solutions that address these additional steps. The 3M Clean-Trace ATP Monitoring System uses optical science and bioluminescence to detect, identify and record the presence of organic soil on a surface. And the 3M Steri-Vac EO Sterilizers use ethylene oxide gas – a sterilant that’s lethal even to highly-resistant microorganisms – to penetrate the complex geometries of medical devices.
Here’s what you can do. If your doctor recommends a procedure involving a flexible endoscope, ask about the facility’s reprocessing protocols. The FDA recommends a cleaning verification test as part of the reprocessing protocol. And industry experts are starting to recommend sterilization for some of the most complex flexible endoscopes because it provides a higher margin of safety than the traditional practice of high level disinfection.
“Confirm the technician or nurse is trained specifically to reprocess endoscopes,” said Janet, “and ask how they monitor their reprocessing procedure for quality and effectiveness. Additionally, after the cleaning step, do they use high level disinfection or sterilization? There is a big difference between the two methods.”