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Elective Surgery is Essential - August 2020 - Subscribe to Outpatient Surgery Magazine

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A U G U S T 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 5 9 In mid-April, six medical societies jointly issued best practice recommendations for the proper handling, reprocessing and storage of endo- scopes during the COVID-19 pandemic (osmag.net/AA6Hvv). "Based on available evi- dence, standard manual cleaning followed by [HLD] should be effective at eradicating SARS- CoV-2," the organizations stated. "No changes to the reprocessing of GI endoscopes are recom- mended." The organizations said at the time some of the suggestions in the document might need updating as more evidence emerged, but they remained the same as of late July. The organizations, nonetheless, added "spe- cific new guidance." They suggested facilities consider limiting the number of reprocessing staff who handle scopes and limiting reprocess- ing to experienced staff members with docu- mented competency. For enhanced safety, they also reminded centers of their existing recom- mendation that all endoscopes undergo full standard reprocessing before they're returned to the manufacturer for maintenance. Among other points the organizations stressed: • Pre-cleaning should commence in the proce- dure room per protocol, by staff already in the room. • Reprocessing staff should don gloves, gowns, face shields and masks. The data doesn't sup- port a requirement for the use of N95 respira- tors, but the organizations said their use should be considered, depending on availability. • Use fully enclosed and labeled containers to transport scopes to the decontamination room, as per institutional policy. • There is no evidence that endoscopes used in known COVID-19 positive patients require spe- cial handling. • No changes are recommended to the handling and storage of fully reprocessed scopes after HLD. However, the groups emphasized the importance of keeping scopes dry to prevent outbreaks of waterborne organisms, suggest- ing use of drying verification systems. • Dry the scope exteriors using a clean lint-free cloth, and the interiors with a prolonged flow of medical-grade air through all accessible channels for at least 10 minutes. Staffers transferring reprocessed scopes to storage or a drying cabinet should wear clean gloves. • Perform "meticulous cleaning" of endoscopy rooms after each procedure, including disin- fection of all surfaces. Staff who clean rooms should wear head covers, gowns, surgical masks, eye protection and gloves. • Ensure high-efficiency particulate air (HEPA) filters in reprocessing rooms are replaced as per instructions for use. Confirm all routine maintenance is up to date and ensure ample supplies of detergents and accessories are always on hand. • If you're reopening a center after the shut- down, the groups say that reuse "within 21, and perhaps even 56 days of appropriately reprocessed, dried and stored flexible endo- scopes appears to be safe." The essential message is this: If you're clean- ing and high-level disinfecting your scopes prop- erly, residual COVID-19 should not be an issue. — Joe Paone POLICY UPDATE Proper Endoscope Care During the Pandemic GEAR UP It's vital for the safety of your reprocessing techs that they are outfitted in proper PPE.

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