Benefits of process change in the care and handling of rigid endoscopes - Clinical Innovations

AORN Journal, August, 2002 by Jean Workman, Cheryl Vrabel

The proper care and handling of rigid endoscopes in surgery can be a tremendous challenge. Improper care and handling of rigid endoscopes costs health care providers thousands of dollars annually. (1) Health care providers constantly search for ways to reduce costs to remain competitive in the market. At the same time, there is a desire to provide the best quality endoscopes possible for surgical procedures. There are many things to consider in the care and handling of endoscopes. These include storage, sterilization, transporting, intraoperative handling, and decontamination, as well as education of staff members and physicians involved in handling the endoscopes.

Approximately four years ago, the surgery department at Morton Plant Hospital, Clearwater, Fla, was faced with the challenge of replacing video equipment. At that time, it was decided to replace rigid endoscopes in orthopedic, general surgery, and gynecology services. The advantage of replacing the endoscopes would be twofold. It would provide a completely new optical chain, which consists of the rigid endoscope, camera, and video equipment, and would offer the opportunity to develop a new process for the care and handling of rigid endoscopes.

TOTAL QUALITY MANAGEMENT

Morton Plant Hospital is one of four community hospitals in the Morton Plant Mease Health Care Alliance, which is part of the BayCare Health System. It is a 697-licensed bed, not-for-profit hospital.

One of the philosophies adopted by BayCare Health System is total quality management (TQM), which consists of meeting the needs of customers, focusing on processes, and using continuous process improvement. The users of a process are encouraged to identify the needs of customers and are empowered to improve the process through the use of a systematic quality assessment method. Improvement is accomplished as a group activity, resulting in empowerment of team members.

The surgery department consists of 19 OR suites in which approximately 18,000 procedures are performed per year. Approximately 9,500 of the procedures performed annually are within the orthopedic, general surgery, and gynecology services. Minimally invasive surgery is performed in approximately 1,900 cases, or 20% of the total number of surgeries performed within these services.

One of the responsibilities of level three clinical nurses in orthopedics, general surgery, and gynecology is to lead these services in developing processes to achieve continuous improvement. Among the goals was decreasing cost and incidence of repairs by developing a better process for the care and handling of rigid endoscopes.

PROCESS IMPROVEMENT

For years in the surgery department, rigid endoscopes were disinfected using glutaraldehyde. Although that method was accepted as the standard of practice, the department chose to switch to a peracetic acid sterilization method when it became available. Sterilization always is the preferred method for items that enter tissue. (2)

The endoscopes were placed in a tray that also contained the camera, light cord, and any other nonsteam sterilizable items necessary for a procedure. Following the procedure, these items were cleaned, disinfected, terminally sterilized, and stored in the same trays. This method was convenient for staff members because items needed for particular procedures were kept together in a central location and easily could be placed in the peracetic acid sterilizer when needed. This process kept room turnover time to a minimum; unfortunately, it also resulted in costly and frequent repairs of endoscopes. The endoscopes were mobile and unprotected within the tray, and they were handled by numerous team members whose priority and main focus were preparing for the next procedure.

It was identified in the surgery department's monthly repair budget that a large portion of repair dollars were being spent on rigid endoscope repairs. Therefore, the processes related to the care of endoscopes were identified as a priority for process improvement.

Purchasing new scopes. During this same time period, new endoscopes were being purchased. These endoscopes would have the capability to be steam sterilized. Although flash sterilization is a form of steam sterilization, it is not recommended for rigid endoscopes. Flash sterilization requires very quick temperature changes, which cause expansion and contraction of the metal and glue and does not allow the rod lenses within the scope to cool properly. (3)

It is desirable to avoid flash sterilization, so it was decided to purchase enough endoscopes to avoid reprocessing and excessive handling between procedures. The number of each type of endoscopic procedure done per day was determined by reviewing the daily surgery schedule. This helped determine the number of each type of endoscope to purchase to avoid reprocessing. Having enough endoscopes available enables staff members to individually wrap and sterilize each endoscope. A sterile endoscope then can be taken from the shelf and opened onto the sterile field before the procedure. Individual sterilization containers that include silicone endoscope holders to stabilize and protect each endoscope were selected and purchased.