Sterile reprocessing of flexible endoscopes is also a very physically demanding job, leaving many technicians suffering from job-related chronic health problems such as back, hand, wrist, and feet pain.
In fact, according to Jim Davis, a senior infection prevention analyst with the ECRI Institute, ergonomics is top of mind for more technicians during sterilization auditing.
“Your main focus can’t be on the equipment when you’re in pain,” Davis told Gastroenterology and Endoscopy News in a recent Q&A about ergonomics in reprocessing. “What can we do to get these reprocessing technicians as comfortable as they can be in their daily tasks so the environment poses no obstacles to their work? That’s a main component of patient safety in reprocessing.”
Ergonomics is described by the U.S. Department of Labor Occupational and Safety Health Administration (OSHA) as fitting a job to a person. Proper fitting helps reduce job-related musculoskeletal disorders (MSD) and increases productivity.
OSHA reports that MSDs are the most frequently reported reason for lost or restricted work time. The agency also reports MSDs are commonly caused by repetitive motions.
When it comes to reprocessing endoscopes, the 50 to 100-step disinfection process requires several physically demanding tasks to be successful.
For example, during the manual clean phase, endoscopes are required to be scrubbed while fully submerged in a sink. This task may be more backbreaking for some, depending on the height of the sinks relative to the technician.
Audits reveal that many reprocessing rooms are damp, dark, cramped, and lack windows, Davis told Gastroenterology & Endoscopy News. Reprocessing personnel are also required to wear a lot of personal protective equipment, which can make it even harder to navigate tiny workspaces with equipment at suboptimal heights, he said.
In addition, reprocessing personnel may be cooped up in an area no bigger than a child’s bedroom cleaning up to 30 flexible endoscopes per day.
Common ailments reported by reprocessing personnel include respiratory problems from foul odors and back, neck, leg, feet, arm, and hand pain. This is according a survey of technicians across five institutions conducted in 2010. Lead author Cori L. Ofstead presented these findings during a fall 2019 FDA hearing about duodenoscope-associated infections.
Ofstead and her coauthors concluded in their study that human-caused nonadherence to reprocessing guidelines results from the challenging work conditions in reprocessing suites. Throughout the observation period, the authors found only one of 69 endoscopes had been reprocessed correctly using manual methods.
The 2010 study noted that some employers shifted work schedules and provided physical therapy for technicians who reported MSDs on the job. Some also adjusted sinks and added floor cushions to reprocessing rooms.
Other recommendations include adjustable sinks, adjustable assembly and inspection tables, and quality anti-fatigue mats, according to Hank Balch, the founder and host of the Beyond Clean podcast. In a 2019 episode about ergonomics and sterile processing, Balch said most instruments needing sterile processing today include a manual cleaning step, so it is incumbent on institutions to invest in the health of sterile processing technicians.
“We cannot continue to cut corners and save dollars when we know there’s products out there like adjustable tables,” Balch said.
Davis recommends institutions do a thorough audit of reprocessing space and consider if a redesign is appropriate. In addition, automating some manual steps may help alleviate physical demands on technicians, he said.