Verification Is a Critical Step in the Cleaning Process

endoscope sterilization endoscope verification instrument cleaning processes

Sterilization Verification“But how do you know when it’s actually clean?” In today’s fast-paced, high-stakes world of healthcare, where practitioners are tasked with providing both quality and quantity, that’s an important question to ask. Surgical instruments, endoscopes and other devices must be clean, or patients’ health and even lives may be at risk. Verification is critical. 

“An instrument can be clean without being sterile, but it can’t be sterile without being clean,” said Noreen Costelloe, director of marketing for Ruhof Healthcare, in a December 2018 article for Healthcare Purchasing News. “This statement supports the well-known fact that cleaning—the removal of organic and inorganic debris from an instrument or device—should precede all disinfection and sterilization processes. Failure to do so can interfere with microbial inactivation and can compromise the disinfection or sterilization process, placing patients at serious risk. 

“Therefore,” she continued, “one key area that CS/SPD professionals must address as part of their quality assurance plan for sterilization is the monitoring of and verification that instruments and devices have been properly cleaned.”

In addition to protecting patients, verification enables the reprocessing team to monitor, document and improve instrument cleaning processes. Verification methods should be:

  • Quick
  • Easy to perform
  • Sufficiently sensitive
  • Accurate
  • Replicable by all concerned staff
  • Achievable in reprocessing areas

The quickest and most common method is visual inspection, preferably with a lighted magnifier. However, lingering contamination may be invisible to the eye or hide on inaccessible surfaces inside the scope. Infection Control Today reported in April 2017: “Current techniques used to clean endoscopes for reuse are still not consistently effective, according to a recent study published in the American Journal of Infection Control whose findings support the need for careful visual inspection and cleaning verification tests to ensure that all endoscopes are free of damage and debris before they are high-level disinfected or sterilized and used on another patient.”

The Infection Control Today report offered three takeaways for healthcare businesses that reuse endoscopes:

  1. Review the problem of bioburden found in reprocessed flexible endoscopes.
  2. Explore studies in the literature that demonstrate the need for improvement.
  3. Learn about visual inspection and scope cleaning verification processes.

Borescopes—narrow, flexible tubes inserted into endoscopes—can help find hidden debris, fluid and damage. Ruhof’s Visual Inspection Borescope (VIB) system includes a state-of-the-art camera and intuitive software that provides high-resolution images of interior surfaces.

Visual inspection cannot detect biofilm or microbial growth. Further verification is necessary to ensure patient safety. Culturing for microbial growth is another possibility, but the lengthy incubation time makes it impractical for immediate verification. In addition, scopes would be out-of-service pending the results of the culturing.

Testing for proteins, on the other hand, takes only minutes. A test sample is placed in a solution that changes color if proteins, which indicate microbial growth, are present. The test indicates only the presence of proteins, however, not the quantity.

Testing for residual adenosine triphosphate (ATP), the energy molecule found in the cells of all plants, animals and microorganisms, can provide a quick indicator of how much contamination is present. Ruhof’s ATP verification system uses a handheld device to read a sample swab, indicating the amount of ATP present. In just 15 seconds ATP Complete verifies the efficacy of cleaning protocols on all non-critical surfaces, surgical instruments and endoscopes.

Ruhof, the pioneer in instrument and scope care, is committed to helping you meet and exceed your decontamination and materials management challenges. From cleaning chemistries and instrument and scope reprocessing products to cleaning verification and detergent delivery systems, Ruhof can serve as a valuable resource for your team. And because it understands that ongoing education, training and mentoring are critical to the success of any clinical department, Ruhof offers a program of free accredited continuing education for nurses and CS/SPD techs at both local facilities and national association trade shows.

To request samples and/or contact a sales rep for more information, visit


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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