Prevention Strategies

Addressing Competency in HLD and Sterilization

Recent updates to ANSI/AAMI ST91 guidelines call for the sterilization rather than HLD of high-risk flexible endoscopes. These scopes include duodenoscopes, bronchoscopes, ureteroscopes, and cystoscopes, among others.

When a healthcare organization including approximately 250 ambulatory clinics hired an infection preventionist in 2020, a rounding assessment tool made an alarming discovery.

Nearly half of the clinics were not performing high-level disinfection (HLD) on endocavity ultrasound probes and those that did were not following the manufacturer’s guidelines for doing so, according to a poster shared in June at the APIC 2022 Annual Conference in Indianapolis. “Further investigation” delivered similar findings for HLD of endoscopes and sterilization using tabletop autoclaves.

The findings resulted in the immediate halting and correction of “broken processes.” Three competency programs were also developed for HLD and sterilization. These included online modules, webinars, hands-on training for endoscopes, and competency checklists. New logs were also created and distributed to all practices, as were lists of all the items needed for compliance.

Recent updates to ANSI/AAMI ST91 guidelines call for the sterilization rather than HLD of high-risk flexible endoscopes. These scopes include duodenoscopes, bronchoscopes, ureteroscopes, and cystoscopes, among others.

Researchers from the organization performed a gap assessment, collected data on current processes, and created a device inventory. They also performed a cluster analysis, which revealed the infection rate among potentially affected patients over the previous three years to be “within the expected range.”

At the time the abstract printed, 64 percent of staff had completed the competency training. Those unable to complete it by the deadline became unable to perform that skill. This will be a required annual competency moving forward, according to the poster.

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