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  • 1.  ENT scoping and reprocessing

    Posted 05-01-2024 08:12

    Does anyone perform rhinolaryngoscopy in their outpatient clinics?  We have historically high level disinfected our scopes per our manufacturer's instructions for use, but our system's accreditation team is now guiding us that "per the CDC and FDA" if a semicritical device is approved for sterilization (as an option) that we are required to sterilize instead of high level disinfect. With 5 locations across our metro area performing scoping this would be a significant cost to change our processes and purchase new machines, so I'm curious what other organizations do with their scopes? Thanks in advance for any feedback!



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    Brandy Williamson MSN RN CPN
    Director, Ambulatory Nursing, Quality and Education
    Children's Healthcare-Atlanta
    Atlanta GA
    (404)785-8978
    brandy.williamson@choa.org
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  • 2.  RE: ENT scoping and reprocessing

    Posted 05-02-2024 07:13
    Good morning, 
    Shortly prior to COVID the facility I worked for converted from high level disinfecting (HLD) to central sterile processing (SP) for all items. I drove the process from the ENT clinic perspective and practice. 

    Every aspect of scope management and care changed- the numbers increased, there were purchasing decisions on sterilization containers, courier systems, numbers of scopes. Additional training and record keeping was necessitated by the changes. Not all scopes can be sterilized and certain types required HLD, but it was now going to be centralized and performed under sterile processing. The sterile processing turn around time had to be assessed and contingency plans put into place. The storage facilities had to be redesigned, expanded, and processes put into place for rotations, date monitoring, and inventory. Instead of freeing up the former HLD area for other uses it was needed for dirty scope staging prior to transport to SP. In general, scopes require immediate bedside clean, packaging into sterilization containers, and prep before they can be transported to SP. I recall definitive cleaning and processing needed to be initiated within a 60 minute window. The process required significant time and additional staff to manage, coordinate, and monitor from the clinical side.

    The first step, in my opinion and experience, is to fully map out what is involved in your current process. Include all ancillary services and personnel- leave nothing and no one out, no matter how minor the role. Include any after hours use of equipment and use. Bring in all of the stakeholders from the beginning- from all levels of care. Expand from there and do not underestimate the growth needs this will require of your organization. This process change will not free up valuable time for your staff rather it will increase everyone's obligations and time devoted to the same process. Feel free to reach out to me directly. 

    Maria S. Burke, BSN, RN-BC, AE-C




    Original Message


  • 3.  RE: ENT scoping and reprocessing

    Posted 05-03-2024 08:52

    Thank you Maria for this insight! I agree that a change in process of this level is a significant undertaking and will need a robust and well thought out project. I may reach out for advice as we move to that point. 

    Thank you!



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    Brandy Williamson MSN RN CPN
    Director, Ambulatory Nursing, Quality and Education
    Children's Healthcare-Atlanta
    Atlanta GA
    (404)785-8978
    brandy.williamson@choa.org
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    Original Message


  • 4.  RE: ENT scoping and reprocessing

    Posted 05-03-2024 08:39

    In my organization we originally did HLD for our scopes as well. We converted to STORZ disposable scope for all offsite locations as it was more cost effective than utilizing a courier and trying to ensure the scopes made it back to the locations without any damage. 



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    Laura Tassin BSN RN CPN
    Regional Ambulatory Director
    Childdren's Hosp of New Orleans
    Covington LA
    (985)317-6000
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    Original Message


  • 5.  RE: ENT scoping and reprocessing

    Posted 05-03-2024 08:55

    Laura, this is one of the options that we are investigating as well, and we currently use Karl Storz as our main scope line. We're finding that they only offer 3.5 size flexible scopes which is not acceptable for the large population of smaller kids we see (per our physicians). I see you're at a pediatric institution as well, does this create a barrier for some of your patients? We also worried that with the volumes of scope we use in our neighborhood/offsite locations (sometimes 30-40 scopes a week), disposables are not a sustainable solution. I'd love to hear more about how this works for you! Would you mind if I reach out directly and set up a quick call to discuss? 

    Thanks again for weighing in! 



    ------------------------------
    Brandy Williamson MSN RN CPN
    Director, Ambulatory Nursing, Quality and Education
    Children's Healthcare-Atlanta
    Atlanta GA
    (404)785-8978
    brandy.williamson@choa.org
    ------------------------------

    Original Message


  • 6.  RE: ENT scoping and reprocessing

    Posted 05-03-2024 09:45
    Thank you for the contribution to this thread. We considered the disposable scopes and ultimately decided to reserve their use for inpatient scoping when the patient certain infectious conditions. The providers generally found the disposable scopes to be of little practical use. The ENT practice saw all ages and types of patients- from cleft to facial trauma to head and neck cancer. The scope decision was very complicated and multifaceted. Ultimately, increasing the par levels of various scopes and ensuring its placement in the sterilization and transport container to prevent inadvertent damage  was the best clinical decision. 

    --
    Maria S. Burke, BSN, RN-BC, AE-C
    505-948-2043



    Original Message


  • 7.  RE: ENT scoping and reprocessing

    Posted 08-31-2024 18:27

    We have 2 ENT clinics who perform scopes utilizes both rigid and flexible ENT scopes. One has a full scale processing room with the ability to HLD with codex, sterilize with Sterrad, and sterilize with an autoclave. The other clinic doesn't currently have that onsite but is attached where they can yea sport to the SPD. We plan to implement drying scope cabinet for our flexible ent scopes at that location. We have already implanted the use of the drying ent scope cabinet at the clinic with onsite reprocessing. Onsite was determined to be optimal due to the distance between the offsite clinic and the hospital's SPD. The utilization of couriers and transport requirements, the volume of use (instruments/scopes), outweighed the benefit of transporting to a centralized location for reprocessing. 

    I coordinated with our organization's quality dept, and infection preventionist, to ensure we are meeting at regulatory requirements. Many ent scopes have parameters to sterilize both flexible and rigid scopes utilizing the Sterrad if your organization requires that process. 



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    Olivia Burden, BSN, RN, CIC
    Clinical Staff Operations Manager
    OHIO COUNTY HEALTHCARE
    Provider Practices
    Hartford, KY
    oburden@ochcares.com
    270-298-5210
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    Original Message


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