Now, in response to the above question, ST91 states that &#;at a minimum two sinks or one sink with two separate basins should be used. &#; One sink or sink basin should be designed for leak testing and manual cleaning and the other only for rinsing.&#; Therefore, based on the terminology used, this is a recommendation&#;and rightly so. We do understand, however, that limitations do exist (e.g., lack of physical space, volume of endoscopes or probes processed). Again, when this is not possible, we see the true importance of disinfecting your sink after every use.
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Must is used for external constraints. It describes unavoidable situations, including those that are mandated by the government. The word must is not an alternative for shall.
Shall and shall not are used to denote requirements. When this term is used, it is to be followed strictly in order to conform to recommended practice.
Before answering this question, it is necessary to discuss the importance of word meanings. In this instance and throughout many AAMI guidelines and standards, terms are used to indicate a requirement, an option, or a recommendation. The following terms are defined in ST91:
Here's another situation where we need to consider the sink/tubing manufacturer's IFU for frequency of disinfection and proper method of disinfection. Some sinks have manifolds with detachable adapters/tubings used for flushing that require cleaning and disinfection. Another consideration is that some sinks have internal piping that will never come in contact with disinfectants and, in some instances, can require disinfection on a regular basis. Moreover, IFUs can change at a moment's notice, regardless of whether the sink in your SPD has been upgraded or received an addition, so make sure you have the most updated IFU versions available. In some instances, sink manufacturers may call out routine maintenance (e.g., daily, weekly), which requires a more in-depth internal disinfection process outside of the surface disinfection. If this is the case, such routine maintenance should be documented according to your current documentation practices.
Considering the sink manufacturer's instructions for use (IFU) for frequency of disinfection, as well as approved disinfection methods, is important in this area. We clean and disinfect scopes and probes after each use&#;or should be doing so&#;and only after being used on one patient. Disinfecting the sink that was used to process that scope or probe, each and every time, also is essential. Rinsing off the additional detergent remnants is insufficient. (That would be similar to getting in a bubble bath, then simply rinsing off the bubbles, without also engaging in proper cleaning!) ANSI/AAMI ST91: states that &#;sinks should be cleaned, disinfected, and rinsed between uses&#; Although the word term should is used, it is best practice to disinfect the sink every time. 1 (Note: The importance of terminology is discussed in greater detail below.) In a report from Stjärne Aspelund et al., 2 the authors noted: &#;Pseudomonas aeruginosa may colonize water systems via biofilm formation. In hospital environments, contaminated sinks have been associated with nosocomial transmission.&#; Such findings underscore the importance of cleaning and disinfecting decontamination sinks after each use.
The condition of decontamination sinks, in particular those in an endoscope processing area, has been a frequent topic of conversations during the past few years. This article focuses on improving understanding of what is needed for sterile processing department (SPD) professionals' decontamination sinks.
The authors have found that having a brief refresher training during staff meetings or department huddles can be very helpful, especially with end-user department staff, who may need a brief reminder. As mentioned at the beginning of this article, it is wise to remember that no matter the job, career, or direction you go in life, some degree of training will be involved.
Training should begin upon initial hire and reassessed at least annually thereafter. Training and competency verification should also be done when new equipment or products are brought into one's setting. However, training does not have to stop there; it should include ongoing education and in-services.
As noted in ST91, &#;Personnel providing orientation, education training or competency verification for personnel processing flexible endoscopes should maintain the confidence necessary to provide education including the effective use of technologies to optimize practice and adhere to hand hygiene practices.&#; This underscores the importance of trainers being capable of demonstrating their competence. All trainings and competency verifications should be documented and placed in employee files.
A highly skilled, trained, and/or certified department manager, supervisor, or coordinator should conduct the training program. An educator also could perform the training, but only if they are very knowledgeable in endoscope processing.
Every training program should include a description of what the training entails and what is expected of the trainee. The training program may also include timelines. It should include a review process to ensure that knowledge and skills have been retained, as well as competency verification in &#;all aspects of endoscope processing prior to the first assignment to perform these tasks independently&#; (from ST91). This of course would apply to the scopes that will be processed by the employee.
First, we would want to consider exactly what it is that we do in our department or areas of work. We want to see if we have policies and procedures in place. If policies already exist, then they will inform the foundation of our training program. If policies are lacking, now is the time to inventory what types of endoscopes we have, review manufacturers' written IFUs, and look at current guidelines to see how we can appropriately build our policy based on what we have and what we do. These tasks should be carried out by a multidisciplinary team consisting of, but not limited to, staff from the operating room, gastroenterology, sterile processing, infection prevention, risk management, and safety.
Rather than simply teaching, this notion involves facilitating the retention of information in employees' memory banks. As is fundamental to the well-known concept of &#;developing critical-thinking skills,&#; a training program will help to explain the why behind what we do. In essence, a training program provides a rationale.
What is behind a training program? One article describes a training program as &#;a planned sequence and combination of activities designed to equip employees with knowledge and skills to become better professionals&#; that is &#;aimed at achieving specific business goals&#;&#;goals that typically have a long-term aim. 3 In ANSI/AAMI ST91:, Flexible and semi-rigid endoscope processing in health care facilities, training also is defined as a &#;process or organized activity designed to help an individual attain the necessary skill or behavior required to perform or improve an individual's performance of a particular task.&#; 1
No matter the job, career, or direction you go in life, some form of training and education always is involved. Even in parenting, the parent trains and educates the child, and in essence, a training program is used.
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Preparing for an accreditation survey from The Joint Commission (TJC) or another accreditation body can be a nerve-racking experience for all parties involved, from hospital administrators all the way down to frontline staff, including those in the SPD.
Along with the anxieties of preparing for a survey is the idea that surveyors are only there to find &#;the wrong&#; in a healthcare facility and close its doors, so to speak. That's far from the truth. We should all look at the survey process as a way to show others how well we are doing compared with the previous survey. It also gives us the opportunity to have an extra pair of eyes to review our processes.
To illustrate this idea, consider an individual who has to wear glasses in certain situations having an &#;extra pair of eyes." Having an outside source definitely is as beneficial as wearing glasses when needed. If we are being honest with ourselves, we can admit that all too often, we in the healthcare setting can become complacent in our processes. Truth be told, many became comfortable, especially during the uncertain years of the pandemic, when a lack of personal protective equipment (PPE) caused many to reuse single-use PPE. Also, during that time, all surveys were put on hold, causing many to become lax in their processes. It's like the old saying, &#;When the cat's away, the mice will play.&#; Now, things are getting back to the new normal and surveyors are back.
Because endoscope reprocessing breaches or shortfalls are still on the forefront and the focus of surveying bodies such as TJC, we should always be &#;survey ready.&#; The emphasis here is on patient safety. There's an old adage that says, &#;If you stay ready, then you don't have to get ready.&#; Some like to call this &#;continuous readiness.&#; Well, where does the readiness begin?
The readiness should begin upon initial hire. This could include transferring from one department to another or even from one hospital to another, even if it's the same organization. Another old adage in healthcare is, &#;If you've seen one hospital, you've seen one hospital,&#; as no two hospitals are 100% alike, even under the same leadership. The need and value of education, training, and competency verification cannot be understated.
In the authors' experience, from the moment a surveyor walks in the door, immediately following a greeting, they are likely to be on the lookout. But for what are they looking? You should expect that any and everything can prompt a conversation.
For example, a surveyor may want to talk to staff and not management. Why? For some, it's obvious that leadership would know how things operate, but they also understand that at times, certain information about updated guidelines and processes does not trickle down as it should. When dealing with instruments, endoscopes, or probes, storage is a huge thing. A surveyor wants to know and see how items are being stored. Are they being stored according to the manufacturer's written IFU? Is there a quality control system put in place to monitor and retrieve expired/damaged packaging? They also may ask whether that process is written out in the organization's policy. They may ask what your process is after a device is used on a patient. What steps do you take (e.g., point-of-use treatment, transport)? They also may request to review your policy&#;if they have not already done so. They may want to know how familiar you are with current updated guidelines.
Surveyors are better equipped than ever before. Now is the time to prepare.
The SPD is where the authors have witnessed the greatest anxiety regarding accreditation surveys. During the last few years, the focus on endoscope and probe processing has intensified. Gone are the days of the 15-minute surveys in the SPD world. In our experience, the length of time surveyors spend in the SPD has increased to a minimum of one hour. And it may sound a little odd, but we appreciate that level of thoroughness. Why? Because we put so many hours into maintaining compliance. We spend so much time educating and performing competency verification on employees, and we want our work to be noticed. We prepare our physical environment and quiz staff on knowledge retention. Conducting mock surveys with leadership, infection prevention, and the quality department helps us to ensure everyone is prepared and ready for action.
Although it may seem easier to shy away from surveyors: don't! Welcoming them into your department with open arms is important. During a recent survey, the surveyor observed, from start to finish (i.e., inspection, leak test, manual cleaning, high-level disinfection, drying, storage), the process of cleaning an endoscope. While the observation was going on, the surveyor continued to ask the employee to explain what he was doing in the process and to give a rationale. Let's just say that no stone was left unturned.
Surveyors are also concerned about who is performing the training on the individuals doing the job. Similar to what they may ask an end user, surveyors may request the endoscope or probe processing policy. They may compare that with the most current guidelines for processing, as well as compare it with the manufacturer's written IFU. They do this to ensure that your policy reflects the IFU and that you are in fact following your own policy.
Competency verification, as mentioned previously, is of utmost importance. As noted in ANSI/AAMI ST91::
&#;All personnel performing endoscope processing shall complete formal training and competency verification in all aspects of endoscope processing prior to first assignment to perform these tasks independently. &#; Personnel involved in endoscope processing shall be provided education, training, and complete competency verification activities related to their duties upon initial hire; annually; at designated intervals; or whenever new endoscope models, new processing equipment, or products such as new chemicals are introduced for processing.&#;
This competency verification is not solely for SPD staff. End users will have to be retrained upon initial hire, annually, and when new scopes/updates become available.
In conclusion, what should we expect when expecting TJC or other accreditation survey? Expect them to spend time with you. Expect an interchange of knowledge between parties. Expect them to learn from you as you learn from them. At the end of it all, expect an accreditation report that tells your leadership and, more importantly, your patient community that they are receiving the best care possible&#;and that they are in good hands when they walk into your facility.
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