DS 04 - Tracing High-level Disinfection in Physician Practices to Improve Safety with Single-use Disposable Flexible Endoscopes

Background: Physician practices are commonly performing invasive procedures; however, this requires personnel to perform advanced high-level disinfection (HLD) procedures in environments unconducive to device reprocessing. This study aimed to review HLD procedures in physician practice settings within a large healthcare organization spanning across Central Florida and improve patient safety.

Methods: From April 2021 to October 2022, sixteen HLD tracers were completed in physician practices assessing the use of reusable flexible cystoscopes and hysteroscopes. The tracer tool, developed between infection prevention and accreditation, assessed workflows, environment, point of use, transport, decontamination, HLD steps, storage, documentation, and education and training. The tool was based on standards, national guidelines, organizational policies, and manufacturer’s instructions for use (IFU).

Results: Results revealed all practices (100%) completed decontamination, disinfection, and storage in the same room without separation between dirty and clean. Over half failed to follow manufacturer’s IFU for point of use cleaning (68.8%) and decontamination (56.3%). Higher compliance of HLD and quality control measures was observed with automated reprocessors compared to those performing manual HLD (71.4% vs. 33.3%). 68% improperly transported used scopes throughout the practice and only one practice (6.3%) had a proper cabinet for endoscope storage. All practices (100%) lacked formal training, education, and competency validation.

Conclusions: This study identified multiple instances of non-compliance with manufacturer’s IFU and national standards for device reprocessing. Results of this study have been used to transition four practices to single-use disposable flexible endoscopes with the remaining practices in the planning phase of transitioning. As outpatient procedures expand, this study supports stricter adherence to HLD efforts, dedicating resources for surveillance, and universal utilization of single-use disposable scopes to ensure patient and staff safety.