CLEANASCOPE System Enhances Endoscope Transport & Handling

Expert Insights
CLEANASCOPE System Enhances Endoscope
Transport & Handling
System Helps Minimize Risk of Cross Contamination,
Improve Efficiency & Reduce Repair Costs
With the number of endoscopy procedures
growing around the world, it is vital that
endoscopes are processed correctly in
order to keep patients and staff safe from the spread
of infection. Along with adhering to rigorous cleaning
and decontamination practices, proper transport and
storage of expensive, delicate endoscopes are crucial
to ensure patient and staff safety and maintain optimal
function. To address the many challenges associated
with the handling of endoscopes, the CLEANASCOPE
System from Advanced Sterilization Products was
designed as a unique storage and transportation
system that reduces the risk of cross contamination
and offers easy visual identification of clean versus
contaminated endoscopes. Benefits of the CLEANASCOPE
System include improved reprocessing safety and
efficiency, and a reduction in equipment repair costs.
Improving Endoscope Handling
According to Libby Thomson, formerly the lead nurse
in the Bowel Cancer Screening Centre and nurse
endoscopist at a leading hospital in the United
Kingdom, hospitals are increasingly focused on
patient and staff safety and providing the highest
level of care. This includes minimizing the risk of
infection associated with endoscopy procedures.
During clinical use, endoscopes are contaminated by
multiple microorganisms, and failure to appropriately
reprocess and handle endoscopes—both contaminated
and clean—can result in nosocomial outbreaks and
serious infections. However, these efforts are
sometimes hampered by insufficient endoscope
handling and transportation practices such as
hospital staff members using open containers to
move dirty endoscopes to the decontamination room.
“Handling practices vary widely,” Thomson said. “For
example, in some facilities endoscopes are transported
in open buckets or other containers, which is
inadequate. There is the potential to contaminate
the environment by allowing secretions to fall to the
floor or contaminants to become airborne because the
containers aren’t covered. In addition, because it often
is difficult to hold the container, some staff members
might carry it close to their faces, potentially exposing
them to the risk of infection from contaminated
endoscopes. Similarly, when moving clean endoscopes
back to procedure rooms in open containers, there is
the potential for contamination of the disinfected
instruments.”
To address these problems, hospitals are turning to
the CLEANASCOPE System from ASP, an industry
leader in infection prevention. The CLEANASCOPE
System provides a high level of standardization for
the handling of endoscopes and other delicate
equipment and fills an important gap in the endoscope
reprocessing cycle—offering a total GI solution
when used in combination with manual or automated
reprocessing systems (See Figure 1).
Figure 1. The CLEANASCOPE System helps
improve the safety and efficiency of the endoscope
reprocessing cycle.
Total GI Solution Endoscopy
Procedure
Transport
Manual/Automated
Cleaning & HLD
Pre-cleaning
Transport
1

“The liner system is one of the most important reasons why many facilities
are adopting the CLEANASCOPE System—the color-coded liners take the
guesswork out of endoscope reprocessing.”
According to Thomson, the CLEANASCOPE System
quickly resolves endoscope transport problems. The
closed, reusable transport trays, carts, and liner
system reduce the risk of cross-contamination from
droplet or airborne contaminants and allow secure
transportation to and from decontamination rooms.
“With the CLEANASCOPE trays and mobile cart,
instruments are safely contained, and it is no longer
necessary to carry around soiled equipment in open
containers,” she said.
Eliminating the Guesswork
The CLEANASCOPE System helps ensure that patients
are not inadvertently exposed to infection risks. The
patented, single-use liner system offers a protective
environment for a disinfected endoscope and provides
clear identification for staff of whether the equipment
is clean or contaminated. After a patient procedure,
the endoscope is wiped down, flushed, and placed in a
CLEANASCOPE tray. A red liner cover then is placed
over the tray, ensuring that the endoscope can be
Red & Green Liners Identify Clean
Versus Contaminated Endoscopes,
Improving Patient Safety
The CLEANASCOPE System’s unique colored liners
improve patient safety by signaling to staff whether an
endoscope is clean or dirty. A contaminated endoscope
is placed in a tray and covered with a red liner,
indicating that it is contaminated. Once reprocessed,
the endoscope is covered with a green liner, letting
staff know that is safe to use.
2
Benefits of the
CLEANASCOPE
Liner System:
• Reduces risk
of crosscontamination
• Offers a protective
environment for
endoscopes
• Provides clear
identification
of whether
equipment is clean
or contaminated
• Protects patients
and improves the
efficiency of the
reprocessing cycle
safely and hygienically transported back to the cleaning
room—and alerting staff members that the endoscope
is contaminated. Once the endoscope is reprocessed,
it is placed in a CLEANASCOPE tray, with a clean liner,
and covered with a green liner cover, signaling to staff
that it is safe to use for procedures. This unique
liner system helps protect patients and improve the
efficiency of the endoscope reprocessing cycle. (See
Sidebar: Red & Green Liners Identify Clean Versus
Contaminated Endoscopes, Improving Patient Safety)
According to Thomson, it can be difficult to differentiate
between clean and dirty endoscopes when a facility
uses open containers. “Equipment can be placed in a
receptacle that isn’t easily identifiable as being dirty,”
she said. “In a busy endoscopy environment, there is
the potential risk of someone picking up that scope
and using it on another patient. Now with the
CLEANASCOPE System, there is a fail-safe way of
telling whether scopes are clean or dirty, and staff can
make sure instruments are in the appropriate area—
especially important in hectic endoscopy departments.”
The CLEANASCOPE System also contributes to
increased efficiency. “The ability to quickly, easily, and
safely transport instruments from the procedure room
to the decontamination area and back greatly improves
efficiency,” she said.
“The system works very well. Facilities can place
carts near the endoscopy rooms stocked with clean
endoscopes, and clinical staff members will know
exactly where to go to find what they need. When a
procedure is complete, scopes can be immediately
transported in a covered, color-coded tray to the
decontamination area. Everyone will know what they
are doing, and people in the decontamination room
can quickly see what needs to be cleaned. The liner
system is one of the most important reasons why
many facilities are adopting the CLEANASCOPE
System—the color-coded liners take the guesswork
out of endoscope reprocessing.”
Cutting Repair Costs
Thomson said that another key feature of the
CLEANASCOPE System is its reusable trays, which
guard against costly equipment repairs by protecting
endoscopes from accidental damage during transport.

This benefit is especially important as hospitals
face growing financial pressures and must safeguard
expensive instrumentation, including flexible
endoscopes, which are prone to handling damage
and costly to repair. According to the literature:
• At least half of endoscopes in hospital settings may
be unavailable for use because of repair needs. 1
• Damaged endoscopes can be expensive to repair,
disrupt a facility’s capacity to provide endoscopy
services, and potentially compromise patient safety. 2
• Approximately 70-90% of endoscope damage may be
attributed to improper handling. 3–5
• Proper endoscope care and handling can dramatically
improve the lifespan of an endoscope. 3
According to Thomson, the CLEANASCOPE System
trays help reduce endoscope damage. “The trays
are well-sized, so you don’t need to tightly coil the
endoscope for transport, reducing damage,” she said.
“Also, having endoscopes safely in individual covered
trays prevents accidental damage during transport to and
from the decontamination area. That’s very important in
busy endoscopy departments. Facilities have experienced
less repair time and cost for endoscopes since they
started using the CLEANASCOPE System.”
This is critical, Thomson said, as the instruments are
expensive, with endoscopes costing from $20,000 to
more than $80,000 each. 3,6 The financial impact is
exacerbated because damaged endoscopes can lead to
canceled procedures and delays in patient treatment.
Focus on Standards
According to Thomson, the positive experience of
hospitals with the CLEANASCOPE System is
indicative of a growing focus on instrument processing
standards and infection prevention in the United
States, Europe, and around the world.
Many professional organizations, hospitals, and endoscopy
centers have developed guidelines to govern the transport
and handling of these fragile, high-priced instruments.
Professional organizations in the U.S., including the
Association of Perioperative Registered Nurses (AORN)
and the Society of Gastroenterology Nurses and
Associates (SGNA), have issued guidelines or recommended
practices calling for the transport of endoscopes
in a covered receptacle at all times. 7,8 In the United
Kingdom, the Joint Advisory Group (JAG) on GI Endoscopy
also has issued similar standards regarding the
transport of endoscopes. 9 (See Sidebar: Guidelines for
Transporting and Handling Flexible Endoscopes)
In the United Kingdom, Thomson served as a JAG lead
nurse advisor and said that in recent accreditation visits
to facilities, there has been an increased concentration
on reviewing and improving decontamination practices,
including endoscope transport and storage. “When we
started decontamination assessments, things were not
in good shape,” she said. “Now, most units have made
significant investments to improve their practices, and
standards are rapidly rising. Endoscopy departments
worldwide are spending the money to improve services,
and there is more emphasis on using equipment such
as the CLEANASCOPE System.
“With endoscopy, we must be vigilant to prevent
putting patients and staff at risk,” Thomson continued.
“As a result, we want to always minimize exposure to
infections, and the CLEANASCOPE System provides a
key solution. Every time there’s an infection outbreak
in a hospital, there is an investigation. When you
have solid procedures in place so staff can look at
an endoscope and know it is clean with a visual sign,
you can reduce the chance that a contaminated
endoscope is the cause. If the scopes are clean,
you’re not transporting infections. Guidelines have
been a big driver for change, and it’s a small price
to pay to get something like this into place” ■
Guidelines for Transporting &
Handling Flexible Endoscopes:
• AORN recommends that endoscopes be transported
“…in a manner that preserves the sterilization/
disinfection status of the endoscope.” 7
• SGNA recommends transporting endoscopes
in closed containers to avoid chances for cross
contamination. Its guidelines state that, when
transporting an endoscope to the reprocessing
area, an enclosed container will prevent escape
of airborne and droplet contaminants. 8 Experts
emphasize that it is important to consider both the
protection of the apparatus and the environment
during transport. 10
• CDC guidelines state that, “A protocol should be
developed that ensures the user knows whether
an endoscope has been appropriately cleaned and
disinfected,” and endoscopes should be stored
“in a manner that will protect them from damage
or contamination.” 11
• The UK National Health Service’s National
Endoscopy Programme guidelines require that
“endoscopes are transported to the decontamination
area in a covered receptacle that is of an appropriate
size as to avoid contaminating the environment,”
and when transporting an instrument to and from
the endoscopy unit, “endoscopes are transferred
in a receptacle with a hard lid that completely
encloses the endoscope.” 9
3

References
1. Leiner D. Implementing cost-effective ways to reduce endoscope repair expenses. Biomed Instrum Technol.
2003;37:201–204.
2. Dix K. Scope cleaning and repair: top 10 ways to keep scopes happy. Infection Control Today. 2008.
http://www.infectioncontroltoday.com/articles/scope-cleaning-and-repair.html. Accessed June 26, 2008.
3. Dilulio R. Service solutions: protecting your endoscope investment. 24X7. October 2006.
http://www.24x7mag.com/issues/articles/2006-10_05.asp. Accessed June 26, 2008.
4. Ellis K. Endoscope cleaning and repair: keeping valuable scopes fit for duty. EndoNurse. 2006.
http://www.endonurse.com/articles/2006/11/endoscope-cleaning-and-repair.aspx. Accessed April 30, 2009.
5. Ellis K. Endoscope repair: perspectives and advice from industry experts. EndoNurse. 2005.
http:/www.endonurse.com/articles/521feat1.html. Accessed June 26, 3008.
6. Dix K. Scope leak testing. EndoNurse. 2007. http://www.endonurse.com/articles/07aprfeat2.html. Accessed
Sept. 24, 2009.
7. Conner R, Reno D. AORN Standards, Recommended Practices and Guidelines. Denver, CO: AORN; 2006.
8. Society of Gastroenterology Nurses and Associates Inc (SGNA). Standards of Infection Control in Reprocessing of
Flexible Gastrointestinal Endoscopes. 2007.
9. National Endoscopy Programme: Decontamination Standards for Flexible Endoscopes. Leicester, England: Joint
Advisory Group on GI Endoscopy; 2009.
10. Thomas L. Transporting the endoscope. Gastroenterol Nurs. 2005;28:145–146.
11. Rutala W, Weber D. HICPAC Guideline for disinfection and sterilization in healthcare facilities, 2008: Centers for
Disease Control and Prevention;16, 87.
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