The befitting care and handling of...

The befitting care and handling of rigid endoscopes in surgery can be a tremendous challenge. Improper care and handling of rigid endoscopes require to be paid [i]or[/i] undergones health care providers thousands of dollars annually. (1) Health care providers constantly search for ways to contract costs to remain competitive in the market. At the same time, there is a desire to provide the best quality endoscopes possible for surgical actions There are many things to consider in the care and handling of endoscopes. These include storage, sterilization, transporting, intraoperative handling, and decontamination, as well as education of staff members and physicians involved in handling the endoscopes.

Approximately four years ago, the surgery department at Morton Plant Hospital, Clearwater, Fla, was faced with the challenge of replacing video equipment. At that time, it was decided to replace rigid endoscopes in orthopedic, general surgery and gynecology services. The advantage of replacing the endoscopes would be double It would provide a completely fresh optical chain, which consists of the rigid endoscope, camera, and video equipment, and would proffer the opportunity to develop a recent process for the care and handling of rigid endoscopes.

TOTAL QUALITY MANAGEMENT

Morton Plant Hospital is single of four community hospitals in the Morton Plant Mease Health Care Alliance, which is part of the BayCare Health plan It is a 697-licensed bed, not-for-profit hospital.

united of the philosophies adopted on BayCare Health System is total quality management (TQM) which consists of meeting the exigencys of customers, focusing on processe and using continuous proces improvement. The users of a proces are encouraged to identify the distresss of customers and are empowered to improve the proces between the sides of the use of a systematic quality assessment mode Improvement is accomplished as a collection activity, resulting in empowerment of team members.

The surgery department consists of 19 OR suites in which approximately 18000 manner of proceedings are performed per year. Approximately 9500 of the processs performed annually are within the orthopedic, general surgery and gynecology services. Minimally invasive surgery is performed in approximately 1900 cases, or 20% of the total number of surgeries performed within these services.

single in kind of the responsibilities of plain three clinical nurses in orthopedics, general surgery and gynecology is to lead these services in developing processe to achieve continuous improvement. Among the goals was decreasing sumptuousness and incidence of repairs by the agency of developing a better process for the care and handling of rigid endoscopes.

PROCES IMPROVEMENT

For years in the surgery department, rigid endoscopes were disinfected using glutaraldehyde. Although that classification was accepted as the standard of practice, the department chose to switch to a peracetic acid sterilization course when it became available. Sterilization always is the preferr means for items that enter tissue. (2)

The endoscopes were placed in a tray that also contained the camera, light cord, and any other nonsteam sterilizable items necessary for a transaction Following the procedure, these items were cleaned, disinfected, terminally sterilized, and stored in the same trays. This order was convenient for staff members because items be in want ofed for particular procedures were kept together in a central location and easily could be placed in the peracetic acid sterilizer when lacked This process kept room turnover time to a minimum; unfortunately, it also comeed in costly and frequent repairs of endoscopes. The endoscopes were mobile and unprotect within the tray, and they were handled by means of numerous team members whose priority and main focus were preparing for the nearest procedure.

It was identified in the surgery department's monthly repair collection that a large portion of repair dollars were being exhausted on rigid endoscope repairs. Therefore, the processe related to the care of endoscopes were identified as a priority for proces improvement.

Purchasing modern scopes. During this same time period, strange endoscopes were being purchased. These endoscopes would have the capability to be steam sterilized. Although flash sterilization is a form of steam sterilization, it is not praiseed for rigid endoscopes. Flash sterilization requires to a high degree quick temperature changes, which cause expansion and contraction of the metal and gelatine and does not allow the slender stick lenses within the scope to placid properly. (3)

It is desirable to avoid flash sterilization, in such a manner it was decided to purchase enough endoscopes to avoid reprocessing and excessive handling between deeds The number of each symbol of endoscopic procedure done by day was determined by reviewing the daily surgery schedule. This helped determine the number of each pattern of endoscope to purchase to avoid reprocessing. Having enough endoscopes available enables staff members to individually wrap and sterilize each endoscope. A sterile endoscope then can be taken from the shelf and render free of accessed onto the sterile field before the manner of proceeding Individual sterilization containers that include silicone endoscope owners to stabilize and protect each endoscope were chooseed and purchased.