DS 38 - Rapid Cleaning Verification (RCV) of Endoscopes with “just in Time” Staff Education to Decrease Test Failure Rate and Expense

Background: Since 2013, Centers for Diseases Control (CDC), Federal Drug Administration (FDA) and other bodies have prioritized improving patient safety by reducing patient pathogen exposure risk from improperly processed scopes following an association of multi-drug resistant organisms and duodenoscopes. Scope processing errors are still frequently cited by the Joint Commission. Prior to August 2022, Infection Preventionists (IP) monitored four scopes at one of three hospital system Endoscopy Departments by culturing four patient ready scopes monthly. Each culture cost $27.00 for supplies and required two IPs to perform. Between 2016 to 2021, the positive culture rate) was consistent at 12.9%.

Methods: In August 2022, scope culturing was replaced with RCV validation using test strips that identified residual contaminants without lab testing. Results are available within 90 seconds. If there is a failure, staff are immediately re-educated, the scope re-cleaned and RCV repeated. Scopes are tested at each site monthly, tripling the number of tests.

Results: The rollout was initiated in August 2022 with 14 scopes tested. Four failed initial cleaning tests, and three scopes passed their second test after staff re-education. The fourth scope failed two additional times and was removed from service. In September 2022, three of fifteen scopes failed their initial cleaning test but passed retesting after staff-re-education. In October 2022, only one scope failed initial testing, but passed re-testing following staff re-education. The revised process costs $2.50/scope for supplies and required only one IP to complete.

Conclusions: Compared to culturing, RCV validation combined with “just in time” staff education results in fewer improperly reprocessed scopes, reducing the risk of patient pathogen exposure. Staff skill and engagement is increased because they receive immediate feedback. Expense and labor burden is decreased due to lower supply costs and the use of only one IP resulting in more monthly scope tests.