The Pulse | Thursday, October 3, 2019

6 Key Attributes for a ROBUST Infection Prevention Program

Betty McGinty, MS HAS BS RN CGRN

During her time treating patients in the Crimean War, Florence Nightingale, founder of modern nursing, discovered that more patients were dying from infections than from the wounds they had sustained.    She role modeled the impact that nursing measures can have in regard to infection prevention practices and became a reformer and advocate for public health. 

Like Florence Nightingale, GI nurses and associates play a key role in ensuring patient safety through infection prevention. Patients are entrusted to these professionals’ care, and with that comes meticulous attention to reusable instrument and accessory reprocessing. This can be supported through the development and maintenance of a ROBUST reprocessing program.

A ROBUST program is one that is rooted, organized, better and better, unequalled, scrupulous and tenacious. What follows is a breakdown of these key descriptors, to help GI units build such programs.

Rooted

A robust reprocessing program becomes rooted by performing an annual gap analysis that measures facility practice against best practice. This is followed by a risk assessment based upon any gaps identified, and an action plan to facilitate improvements in order of priority.

Essential to the rooting process includes development and maintenance of a solid relationship with infection prevention colleagues. An excellent way to do this is by participating in the SGNA Infection Prevention Champions Program. This program helps foster a bond between infection prevention and endoscopy as current infection prevention practices are assessed, best practices are implemented and optimal standards are maintained.

Rooting is additionally accomplished through the development of policies and procedures that govern a facility’s reprocessing program. Stakeholders should be involved, including physicians, nurses, reprocessing personnel and infection preventionists. The content should include comprehensive aspects of reprocessing:

• Transportation
• Reprocessing
• Storage
• Documentation of adherence to reprocessing steps
• Physical environment parameters
• Quality assurance procedures
• Education/training and competency assessment
• Protocols for handling failures or breaches
• Management of “loaner” scopes

Additionally, these documents should be in compliance with regulatory agencies, accrediting bodies and professional organizations.

Reference to resources regarding standards, guidelines and position statements further prepares the rooting ground for a reprocessing program. It is important to be knowledgeable of the various organizations’ views, as well as the main one you choose to follow. These include: SGNA, ASGE, CDC, FDA, AAMI, Joint Commission, AAAHC, AORN and Department of Health and Human Services (CMS).

A final, essential element in the rooting of reprocessing involves the development and maintenance of an endoscope inventory. This is a key step to help protect assets, as well as track the scope’s lifespan, follow repair history and support replacement equipment. It may currently be performed by the biomedical engineering department; however, it offers an opportunity for the endoscopy reprocessing department to be in control of their property.

Organized

A hallmark of an ideal reprocessing space is one that it is systematically arranged. It is bright, without clutter and well-lit, avoiding unnecessary shadows. The room temperature is set between 60-73 degrees Fahrenheit, and comfort is further enhanced through soothing wall coloring, aesthetic finishes and (as an option) relaxing background music.

The space must be functional to prevent infection during endoscope reprocessing. Details include:

• Durable, easy-to-clean surfaces that inhibit microbial growth
• Distinct division between dirty and clean areas
• Ergonomic design for staff (height adjusted sink, counter and workspace, anti-fatigue mats, to name a few)
• Mounted equipment preferred to keep counters clear and cords off the floors
• Adequately sized sinks (16x30 inches, 8-10 inches deep)
• Access to emergency power

Finally, the space requires a high level of cleaning at all times — floors and horizontal surfaces at least daily, other surfaces on a regularly scheduled basis and, as needed, light fixtures/covers weekly or monthly.

Better and Better

A robust reprocessing program is one that continues to improve and reaches for a higher standard and beyond. Striving to be a reliable organization through standardization and anticipation of potential problems aids in preventing catastrophic consequences. A quality assurance program that encompasses both quality control measures (traceability, cleaning verification, HLD process monitoring, documentation) and quality improvement opportunities (compliance audits) assist in measuring this state.

Unequalled

A robust program is one that is at the head of its class. It is second to none other, matchless and incomparable. It has its own signature and is “best practice.” It has earned “bragging rights,” is clean, safe, efficient and tour-worthy. 

Scrupulous

A robust program that is described as scrupulous implies descriptors such as meticulous, conscientious and honest. These are descriptors of cleaning with attention to detail, following every step, every time, guided by standards and manufacturers’ instructions for use. Reprocessing staff in this program have easy access to these resources, either through online or print versions. They must be up to date on current issues related to endoscope reprocessing and can find these through SGNA, as well as access current events and outbreak information via Beckers and Healthcare News. Reprocessing staff certification supports a scrupulous reprocessing program, as well. There are currently two certifications: CFER is available through CBSPD and CER, the endoscope reprocessor certification, through IAHCSMM.

Tenacious

A ROBUST reprocessing program is tenacious, defined as being persistent, tireless and unwavering. The owner of a ROBUST program parents it through nurture, support and active involvement. It is branded with a family name, protected and defended. Growth is allowed, supported and encouraged.

A ROBUST reprocessing program upholds Florence Nightingale’s legacy of infection prevention. It assists in fulfilling her pledge, OUR pledge, to “devote myself (ourselves) to the welfare of those committed to my (our) care.”

Additional resources and tools related to policies, inventory, repair and maintenance, gap analysis and auditing for reprocessing programs can be found on the CDC website.