Case in point
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Comparison of leak-testing methodsVendor studies indicate that automated testing is more adept at finding leaks in endoscopes, which can reduce the number of expensive repairs. In no instance did a cleaning/reprocessing room using manual processes achieve less than a 15 percent incidence of undetected leaks.
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Endoscopes aren’t always the first devices that come to mind when nurses and materials managers think of high-tech hospital gear. But with their sophisticated embedded electronics and video capabilities, these essential devices represent a substantial, if sometimes overlooked, portion of a facility’s equipment budget.
In fact, a moderately sized hospital with a collection of 50 endoscopes costing $25,000 can see its investment rise to $1.2 million or more. “I tell my nurses and technicians that each endoscope probably costs more than their car, so be very mindful of them,” says Judy Dauer, R.N., endoscopy resource specialist at St. Mary’s Health Center, St. Louis.
Time pressure and errors by technicians responsible for cleaning and maintaining endoscopes can put those investments in jeopardy. Traditional leak testing performed after each procedure may fail to uncover tiny holes and cracks that can form from normal wear and tear or as a result of being accidentally dropped.
When that happens, liquid enzymatic cleaning solutions can seep into the tubes and destroy internal electronics, leaving the hospital with an expensive repair bill.
“There’s no such thing as a fender bender with these scopes,” says Terry Bader, CEO of Verimetrix, a Clayton, Mo., vendor of automated testing equipment. If fluid invades the scope, repair costs can range from $1,000 to $8,000, depending on the extent of the subsequent damage, Bader says.
St. Mary’s has been using Verimetrix’s Veriscan automated testing equipment since last February. Its ability to perform leak tests without liquids and its accuracy rates have had an impact on endoscope technicians. “It brings a calm not only to the technicians, but also to the RNs (who sometimes perform tests). It has reduced the stress levels,” Dauer says.
Leak threats
Endoscopy protocols, including guidelines from the Society of Gastroenterology Nurses and Associates, Chicago, pushes hospitals to be vigilant about the threat of fluid invasions in endoscopes.
Not only do leaks create the potential for expensive equipment repair costs, they can threaten patient safety if bacteria or disease use tiny openings to lodge into crevices that are difficult to sterilize within the flexible endoscope tubes.
Manual leak testing that relies on technicians to visually inspect the endoscopes can be inaccurate. “The old way of testing endoscopes for leaks is to put an airtight cap on the video pin at one end and then you push air through the scope,” Dauer explains. “You then put it under water and twist the angulation knobs. [The manual process] requires a good technician who can evaluate the scope and look for bubbles.”
But with perhaps 30 or 40 procedures occurring each day at a hospital “every few minutes another scope comes in, so there’s a lot of rushing” by technicians, Bader says.
Based on a two-year survey conducted by Verimetrix that analyzed 2,500 repair orders, the company concluded that one-third of problems were due to undetected leaks after traditional testing. About 1 percent of the time leaks were significant enough to cause damages that required significant repairs totaling thousands of dollars. “So if you do 10,000 procedures in a year, you are going to have somewhere around 100 such leaks that need to be caught,” Bader says.
The consequences of undetected leaks snowball when the scope is submerged in chemical disinfectant solutions. “If there is any leak, crack, split or loose seal or gasket, those chemicals are going to get into the interior of the scope to all the mechanics and lighting components,” Bader says. “That’s where a huge percentage of the damage occurs.”
Dauer has seen fluid move into casings that protect the fiberoptics within scopes and eventually break down the material. When that happens, “the repair price just escalates,” she says. Other vulnerable components include embedded computer chips, mechanical assemblies subject to rust, wiring and lubricants that become gummy from too much moisture.
Prior to any repairs, the scope interiors must be thoroughly dried by an outside service, which typically charges between $450 and $750 per scope depending on how extensive the leak. Then, if the leak necessitates a scope overhaul, OEMs often charge a flat rate of $8,700 for the service, Dauer says.
Damage control
Automated testing systems are designed to uncover leaks without submerging scopes in water. The dry testing method, plus higher leak identification accuracy, significantly reduces the chances of fluid invasion, Bader says.
With Veriscan, a technician enters his or her identification and information about the individual scope being tested into the testing system’s control panel. The device and technician documentation feed testing reports that hospitals can store in anticipation of JCAHO audits to verify that all necessary endoscope processing has been completed. “Otherwise, there is no way to (record the procedures) other than to write them down in a notebook,” Bader says.
Next, the tester pumps air into the scope to inflate it so a Veriscan cable equipped with electronic sensors can check for leaks. A series of audio beeps from the tester cue technicians when to move angulation knobs to check for loose gaskets and washers. Because much of the testing process is automated, training to use the system is minimal, Dauer says.
When the test is complete, the scope deflates and the control panel displays a pass or fail result. Scopes that pass the test are safe to be cleaned. Problem scopes shouldn’t be cleansed in chemical baths because that may cause further damage.
“When an endoscope fails, our technicians print out the failure notice and send it to the company that does our scope repairs,” Dauer explains. The report “demonstrates to them what the failure was.”
Bader says his testing device achieves accuracy rates of about 98 percent, compared with the 65 percent levels his research identified as commonly found among manual testing methods.
Price considerations
A Veriscan device costs $17,500 to buy or $460 a month for a lease. Bader estimates that a single device can work fast enough to accommodate up to 5,000 procedures a year.
He reasons that a hospital can more than recoup its costs for the tester if it’s able to avoid three major fluid-intrusion repairs. “A hospital that does 10,000 procedures a year is going to have about 100 leaks, and they’re going to miss about 35 of them,” he says.
“We tell hospitals we are going to reduce (the misses) enormously ... and the repair costs will plummet. So if a [hospital] is spending $125,000 a year on scope repairs, our device is going to drop that down to anywhere from $50,000 to $75,000 on average.”
Dauer doesn’t believe the automated testing system has a significant impact on helping St. Mary’s avoid fluid-intrusion problems because she boasts that her technicians, many of whom have years of experience, are particularly adept at spotting leaks.
“If you have people who aren’t all that familiar with cleaning scopes or if your staff has a high turnover rate, it’s better to have automated testing equipment that’s more foolproof than humans,” Dauer says.
“You are improving your services by having a product like this because it takes awhile to get people up to the skill level of doing good leak testing the wet way.”
Nevertheless, she believes Veriscan offers benefits for St. Mary’s, including peace of mind that the possibility for human error is reduced in the busy hospital environment. “The machine tells the technicians, ‘You don’t want to put this scope in water; you want to send this out for repair.’ That gives everyone a sense of security.” She adds that technicians also no longer idle away the minutes they used to spend waiting for endoscopes to soak in water prior to manual leak testing.
Now, while the testing machine performs its duties, technicians perform other tasks such as cleaning the baskets in which endoscopes arrive.
“It does allow technicians to do additional work,” Dauer says.
Alan Joch is a freelance writer based in Francestown, N.H.
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