How Patients Are Being Coached To Question Their Hospital’s Scope Cleaning Practices

With the numerous reports coming out lately about the difficulty in cleaning endoscopes and ensuring complete disinfection, the mainstream media has started to coach patients on how to select a hospital that’s right for their scope-related procedures. With the concern for scope safety increasing every day, facilities must now prepare to answer tough questions about their scope-related infection rates and disinfection practices from potential patients.

A recent article by Emily Bazar of the Sacramento Bee shined the spotlight on the risks that patients take by blindly trusting their care provider to conduct a safe scope-related procedure. As the article explains to readers:

“Physicians use a variety of reusable medical scopes to peer into the body — and they can pose a deadly infection risk when not cleaned properly.

Complicated scopes called duodenoscopes, used to inspect and treat problems in the bile and pancreatic ducts, have been linked to at least 35 deaths in the U.S. since 2013, including three at the UCLA Ronald Reagan Medical Center.

But less complex scopes also pose contamination risks — and they’re used on far more people: Each year in the United States, doctors perform more than 15 million colonoscopies and 7 million endoscopies of the upper GI tract.

Two recent studies underscore the threat: A paper published in March found that 71 percent of reusable medical scopes deemed ready for use on patients tested positive for bacteria at three major U.S. hospitals.

Then a May study concluded that infection rates are far higher than previously believed after colonoscopies and upper GI endoscopies. For instance, the infection rate within seven days of a routine colonoscopy at an outpatient surgery center is roughly 1 in 1,000, the Johns Hopkins University study determined.

It was previously thought to be about 1 in a million.

Susan Hutfless, senior author of the May study and an assistant professor at Johns Hopkins, says she was “very surprised” by the findings, adding that patients must start grilling doctors about treatment options and the cleanliness of the scopes.

You shouldn’t do it as I did at my first colonoscopy in January: I was on the gurney, waiting to be rolled into the operating room when I asked the doctor, “Your scopes are clean, right?”

You can guess what he said.

I might have asked earlier but, as Hutfless says, “the more people ask, the more cleanliness will improve.”

No matter which scope procedure your doctor recommends, start by applying a risk-benefit analysis to your situation, experts say.

In the case of colonoscopies, which can detect colon cancer, many experts believe the benefit outweighs the risk of infection.

“Colonoscopy saves lives,” says Dr. James McKinnell, assistant professor of infectious disease at UCLA and the LA BioMed research institute. “The benefit is a reduction in the risk of death.”

Besides, most infections related to scopes are treatable and short-lived, adds Sylvia Garcia-Houchins, director of infection control for the Joint Commission, which accredits many U.S. hospitals and surgery centers.

As part of your deliberations, consider discussing potential alternatives with your doctor, says Lisa McGiffert, former director of Consumers Union’s Safe Patient Project and now a member of the Patient Safety Action Network. “I would say, ‘Is there another procedure that you could identify that’s not invasive?’”

If there isn’t, start asking questions.

First, make sure you’re seeing a reputable provider with lots of experience. Ask how many procedures he has performed. If yours is the first, or among the first few, consider going elsewhere or asking for someone to supervise the procedure.

You can also ask your doctor if she knows the facility’s infection rates, says McGiffert, who is based in Austin, Texas. “If they say no, I would say ‘Why not? Why aren’t you keeping track of this?’”

If your doctor gives you an infection rate but it’s confusing, remember: “The closer to zero the better,” McGiffert says.

Next, ask about the facility’s scope-cleaning process. McKinnell offers some questions: Do you clean and reprocess your scopes? Do you hang them to dry in a place that is clean? After they’ve been cleaned, do you check them for contamination?

Without wading into every scientific detail, you want to get a general sense that the doctor or facility has an established cleaning process.

“I want to know there’s a person cleaning the scopes who’s dedicated to cleaning the scopes. If they are, they’ve got the system down pat,” Garcia-Houchins says.

You can also research whether a hospital or surgery center in your area uses single-use endoscopes, which are becoming more accepted and prevalent. Ultimately, trust your gut.

“If you don’t feel comfortable and those alarms are going off, you need to stop the bus,” Garcia-Houchins says. “You just have to do it.”

Damare agrees. After her bout with sepsis in August 2016, which she says sucked the life out of her for a year, she doesn’t plan on getting a colonoscopy again. But if you do, remember that you — not the doctor — are in charge, she advises. “This is your whole life,” she cautions. “You have to feel really good about what your choice is.”

Read the entire article here: Time for that colonoscopy? Ask your doc first on how the scopes are cleaned

The infection risk with flexible endoscopes continues to be a major worry for patients and hospitals alike. Facilities must ensure staff are trained on general infection control principles and must adhere to reprocessing best practices, and they must be prepared to discuss the risks of endoscope-related procedures with their patients. To ensure that your staff is following reprocessing best practices on every scope they disinfect, install additional checks and balances into your workflow so that you can document that your staff is following the same process each time. Software systems such as iRIScope have been introduced in recent years to help hospitals and surgery centers ensure that each of their flexible endoscopes is reprocessed the proper way each time, and documentation of their reprocessing is kept electronically using advanced RFID technology. These systems safeguard the scope disinfection process by employing machine-based data processing to determine of scopes are adequately reprocessed before their next use. With these systems in place, staff and patients can be more confident that their endoscope-related procedure won’t result in an infection.