Human touch in endoscopy: the everlasting role of reprocessing staff and the importance of training

I often describe endoscope reprocessing as a complex process of many interconnected cogs in a machine. Factors such as endoscopy design, procedures and workflows, and logistics, all influence one another during the reprocessing cycle. If one of these cogs falter, then others may be impacted too. Staff members are arguably at the heart of this metaphorical machine, which is why I believe fondly in their proper training and upskilling.

Reports about endoscopy associated infections and Multidrug-Resistant Organisms (MDRO) have only strengthened this belief, as human errors still emerge as a contributing factor in endoscope contamination. These include non-compliance with guidelines and manufacturers’ recommendations, but also aspects such as insufficient hand hygiene (Kovaleva et al., 2013; Kola et al., 2015). Simultaneously, I am hearing concerns from my peers in the reprocessing room about increasing time pressures, physically strenuous processes and insufficient knowledge about specific protocols. Structured training can equip these staff members with sufficient skills to deal with these concurrent pressures and complicated reprocessing protocols.

The indispensable role of structured training

There is a notable difference in the level of required qualifications amongst European reprocessing staff. In a study ESGENA conducted amongst membership countries, we found that the required training in Ireland lasts around 1.5 hours, whereas German technicians must complete around 1200 hours of training. This begs the question: how can we further standardize these trainings, and ensure that the standard of care is upheld throughout European hospitals?

New staff members should complete an induction program that is followed by a competency assessment, to ensure that theory and skills were truly internalized (Antonelli et al., 2023). ESGENA developed one such program in 2019; a European curriculum on endoscope reprocessing. Thereafter, staff members would move to their formal training in endoscope reprocessing, which is specified per skill-level (nurses and central sterile service department members vs. non-qualified staff). This formal training should be concluded with a competency assessment, to ensure that all qualified staff members have obtained a minimum level of knowledge and expertise.

Throughout this process the importance of internal and external audits must not be overlooked. The former serves as a useful control mechanism to ensure that head nurses actively assess the quality of the endoscope reprocessing, recognize any possible skill gaps and address these. The latter, external audits, usually take the form of official bodies assessing that all staff members are formally trained. Notably, since the introduction of these external audits in Germany, the percentage of all staff members who completed formal trainings in endoscope reprocessing went up by 37% (Beilenhoff, 2022).

Continuous and collaborative refinement of training

Once staff members have become formally trained, refresher courses become fundamental to ensure that the knowledge remains top-of-mind and nurses are up to date with the latest innovations. As new technologies enter the market, the content of reprocessing training must be refined. For example, automated endoscope reprocessing (AER) standardizes steps in the reprocessing cycle, but the handling is different and specific training is needed for this. With single-use components the cleaning process will be somewhat simplified, but specific training is still needed to properly remove and dispose those components. This responsibility not only lies with the healthcare institution, but also with the industry. Easily understandable Instructions for Use (IFUs) must be provided by endoscope manufacturers to ensure that staff members fully understand how to properly clean that specific piece of equipment. Moreover, the industry should also provide regular inhouse trainings or external workshops, to ensure that any questions can be addressed, and the highest standard of reprocessing safeguarded.

Providing structured trainings, with regular refinement, industry insights and audits, ensures that the central cog, namely reprocessing staff, remains well-oiled and that it can continue working at the heart of this metaphorical machine.

PENTAX Medical is dedicated to excellence in endoscopy training and education, with a focus on ensuring high standards of hygiene and reprocessing. Our commitment extends to training our personnel, ultimately contributing to improved patient outcomes.

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