Proper Point-of-Use Pre-cleaning Is Critical to Endoscope Reprocessing

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endoscope cleaning
In the real estate business, the key to success is location, location, location. For thorough endoscope reprocessing, the key is pre-clean, pre-clean and … pre-clean.

“Even if endoscope reprocessing is delayed, pre-cleaning should always be performed at the bedside immediately after use, according to current standards of practice,” write Hyun Ho Choi and Young-Seok Cho in a study published in Clinical Endoscopy.

Pre-cleaning helps prevent the buildup of potentially infectious bioburden and biofilm on endoscopes. “Bioburden” is a mixture of blood, tissue, mucus, feces and other bodily substances left behind on the internal and external surfaces of endoscopes after a procedure. 

Bioburden is defined as the “population of viable microorganisms on a product and/or a sterile barrier system,” which is measured as “the total count of bacterial and fungal colony-forming units (CFUs) per single item,” according to ANSI/AAMI ST79:2017. 

Biofilm is a mass of microbes and organic material that adheres tightly to almost all moist solid surfaces, soft organic tissues and liquid-air interfaces. The microbes form a structure protected by a polysaccharide “shield” that resists cleaning efforts.

Biofilm prevents thorough disinfection or sterilization, and if not removed, can create patient safety risks such as toxic reactions and potential infection transmission.

Endoscope design makes these devices vulnerable to both bioburden and biofilm development. The long, thin channels and tubes inside endoscopes can trap and hold bioburden and promote biofilm development. 

Pre-cleaning inhibits the formation of bacterial biofilm, which can start forming within minutes. This is why “bedside” pre-cleaning—in the procedure room—is so important in ensuring thorough reprocessing.

The following steps for pre-cleaning endoscopes are based on recommendations by The Society of Gastroenterology Nurses and Associates (SGNA), and by the International Association of Healthcare Central Service Materiel Management (IAHCSMM).

  1. Everyone involved in pre-cleaning should wear appropriate personal protective equipment (PPE).
  2. Begin pre-cleaning immediately after the procedure. Wipe down the insertion tube with a sponge saturated with enzymatic detergent to remove as much soil as possible.
  3. Aspirate enzymatic detergent through the scope’s channel systems.
  4. Following the manufacturer’s instructions for use (IFU), clear the air and water channels and lumens (light channels). Use sterile water. Do not use saline, which can cause corrosion.
  5. Detach reusable, removable components such as the air/water valve, suction valve and biopsy port cap and soak in detergent solution. Minimize patient risk by utilizing single-use disposable valves when possible which eliminate the need for manual cleaning and reprocessing reusable valves.

Ruhof offers several convenient options for bedside pre-cleaning. Ruhof’s Endozime SLR Phase One Bedside Kit contains everything needed to effectively pre-clean the outside sheath and inside channels of endoscopes.

Endozime SLR with Bioclean technology is the only enzymatic detergent that displaces synthetic lipids at a molecular level so they can be rinsed away, while also dissolving blood, fat, carbohydrates, starches and protein. It is pH neutral, non-abrasive and biodegradable.

Packed in a 250 or 500 milliliter plastic jar, the one-use Endozime SLR Bedside Kit includes a specially contoured sponge pre-saturated with Endozime SLR to remove gross soils from the sheath. It also includes Endozime SLR enzymatic solution for suctioning through the channels.

The Ruhof ScopeValet CleanStart Bedside Kit includes the same items as the Phase One kit in a convenient disposable pouch. It is also available in 250- and 500-milliliter sizes.

Packaged in a biodegradable tray, Ruhof’s ScopeValet ECO Bedside Kit is the only “green” bedside care kit that can remove synthetic lipids. It contains a bagged contoured sponge presaturated with 1-ounce of Endozime SLR enzymatic solution. Just add the desired amount of water (250/500mL) according to the instructions and suction through the endoscope’s channels.

Additional contoured Endozime Sponges pre-saturated with Bio-Clean Technology are available separately.

Finally, the single-use ScopeValet™ Guardian Disposable Valve Set, for use in Olympus 140/160/180/190/240/260 Series Endoscopes, prevent cross contamination by eliminating the need for reprocessing reusable valves. Each set contains a disposable air/water valve, suction valve, biopsy valve, and auxiliary water connector.

Pre-cleaning takes time, but with so much on the line, it’s a critical investment in patient safety. 

Please visit Ruhof at if you have questions about products or procedures.

Ruhof is offering continuing education courses at this year's virtual AORN Global Surgical Conference & Expo May 1 - July 31. We will be presenting "Endoscope Reprocessing: Why the Critical Steps are Critical" and "Instrument and Scope Reprocessing: A Closer Look at Proper Cleaning and Verification," each worth two credits.

AORN members can find our courses by clicking Exhibitor Education in the Expo Hall. Not an AORN member? Register for access to this year's Expo virtually. 

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