Infection Preventionists Using Borescopes: New Discoveries in Ortho- and Neurosurgery Instruments

Session Description: Sterilization is not reliably effective when instruments are dirty, and studies show microbes can even survive steam sterilization when there is residual tissue such as bone or fat. Infections have been linked to the use of dirty surgical instruments. Due to recent lawsuits and accreditation issues, there is heightened awareness of the need to ensure instruments are clean and in good repair. Sterile processing personnel commonly use tiny cameras called borescopes to inspect the inside of flexible endoscopes to identify those that require recleaning or repair. Most facilities are not routinely using these tools to inspect lumened surgical instruments. Researchers in a large academic medical center used borescopes to inspect lumens of surgical instruments used for orthopedic, neurologic, or ear-nose-and throat surgery. During 117 inspections of 39 unique arthroscopic shavers, orthopedic drills and attachments, and ultrasonic aspirators, they found 100% had visible defects requiring recleaning or repair. Recleaning in accordance with manufacturer instructions for use (IFU) failed to remove the residual soil or rust. Participants will see videos showing how researchers harvested samples of residual soil that remained even after three rounds of more rigorous brushing and extended soaking. Speakers will explain challenging aspects of IFU and share photographs of device architecture that prevent effective cleaning. They will also describe what happened when the issues were reported to the manufacturers and the Food and Drug Administration. Infection preventionists will receive tips for engaging with their sterile processing departments, along with a template to guide inspections of lumened devices. They will also learn strategies for leveraging findings and engaging internal stakeholders to improve quality in their facility and bolster their ability to advocate for improvements in device design and sterile processing IFU to reduce risks for patients and the providers and institutions that provide care for them.