When instruments are cleaned with the most commonly used disinfectant, ortho-phthalaldehyde (OPA), they’re supposed to be used for a minimum of 12 minutes. But in a 2012 study in which flexible endoscopes were contaminated with S. aureus and Candida albicans and then cleaned in a variety of ways, researchers found that even a 30-second scrub with OPA and isopropyl alcohol eliminated all of the staph and Candida (Arch Otolaryngol Head Neck Surg. 2012;138:119–121).
Explore This IssueApril 2017
At his center, he said, cleaning practices vary, depending on the unit. But at the main hospital, he said, one of the key parts of the process—which also includes passing cleaned parts through a small window to the “clean” area for drying—is the enzymatic wash that’s done immediately after use. “This is probably, in my view, the most important part of the whole process,” he said. “This is how you eliminate the bio-burden.”
State and Federal Regulations
Sigsbee Duck, MD, an otolaryngologist at Memorial Hospital of Sweetwater County in Rock Springs, Wyo., said his research into the oversight of instrument cleaning across states found that centers generally follow manufacturer recommendations, often with government hoops involved.
In New York, some practices have “Article 28” status, which gives them higher reimbursement after they’ve gone through a rigorous, complex process of certification. But, in the end, this designation doesn’t appear to mean much in terms of how instruments are cleaned, he said. “When you get through all the layers, it depends on the facility as to how you sterilize your scope,” he added. “You either use manufacturers’ recommendations or you use gas sterilization.”
In California, Title 22 is used on a state level in conjunction with federal regulations. In the end, he found, centers tend to simply follow manufacturers’ recommendations. But at Stanford, where instruments used to be sterilized in house, university policy dictates that couriers pick up scopes needing to be cleaned and then return them to the center, a process Dr. Duck said was described to him as “very costly.”
In Wyoming, as everywhere, a policy for instrument cleaning is required by the Joint Commission. Dr. Duck’s center follows the standard four-step method of clean-disinfect-rinse-dry. Essentially, they’re just following manufacturers’ recommendations, he said. “Everybody does the same thing but in a different way,” Dr. Duck said.
Will Harrill, MD, president and CEO of Carolina Ear, Nose and Throat in Hickory, N.C., said his experience in private practice is a lot different than those found in hospitals regulated by the Joint Commission. As an employer, the clinic is overseen by the Occupational Safety and Health Administration (OSHA). Every year, his center performs a mock OSHA inspection because “that’s the standard of care we believe in.”