Mapping the Flexible Endoscope Disinfection Cycle indicates the Need for Risk Reduction Strategies for Task Complexity and Environmental Stressors

Abstract

Introduction

Endoscopes carry a significant infectious risk if not properly sterilized. We mapped the total tasks required to properly sterilize an endoscope and conducted theoretical risk modeling to define tasks at greatest risk for error in this process.

Methods

observations were conducted on a hospital campus in the following spaces: operating room, sterile processing pre-washer side, sterile processing post-washer side, and storage. The total number of tasks and the stress level in each space were determined. Each task was assigned an error rate based on a complexity scale in Smith's textbook Reliability, Maintainability and Risk, 7th Ed. Tasks in low stress spaces were assigned the lowest possible error rate per task type and those in high stress environments were assigned the highest error rate per task type. Risk of error score (RES) for each space and an overall RES was calculated by adding up all the assigned task error rates.

Results

observations were conducted on 22 flexible endoscopes. Seventy-five tasks were identified. Each was performed by a human. Fifty-two tasks were performed in sterile processing which had the highest stress score and highest number of complicated, non-routine tasks. The aggregate RES per endoscope. was 3.0832 The majority of risk (94.%) mapped to sterile processing (RES of 2.918).

Conclusions

proper sterilization of endoscopes involves 75 tasks. The majority of the RES maps to the high stress SPD environment. Strategies that reduce stress levels and the complexity of tasks in this space would significantly reduce the risk of errors in sterilization.