Endoscope Storage

Storage for the flexible endoscope should revolve around three basic safeguarding principles: ownership, device safety, and infection control.  

An up-to-date endoscope inventory listing by make, model, and serial number is a basic function of asset management. This list will assist you if you have to document ownership of the equipment. Control the access to protect your expensive endoscope inventory from those who do not have ownership of or responsibility for the devices. A keyless entry system or locked cabinetry is sufficient. Complete inventories have been stolen from endoscopy facilities, rendering the facility non-productive until supplemental scopes could be obtained. 

Unprotected inventories are also vulnerable to unauthorized facility personnel who may misappropriate endoscopes and supporting supplies. These activities may result in missing equipment and costly unnecessary damages.

Proper storage arrangements provide physical protection of endoscopes from their environment and from themselves. While storage closets may be used in some facilities, cabinets are more common. Closets or small rooms may limit or control access to scopes. Cabinets limit compression damage to the scopes from other equipment and supplies, while at the same time storing them out of range from the housekeeper’s mop. 

Carrying cases should not be utilized for endoscope storage. Over time, a memory can develop within the structure of the endoscope which leads to tube buckling and angulation issues. The lining of carrying cases may also afford a damp, dark environment for bacteria to grow.

The material that lines the walls of the cabinet or storage area should be made of a soft material that will not cause distal tip damage. Consideration when selecting lining materials should be toward materials that are non-porous and can endure repeated and frequent exposure to germicidal chemicals. Often, the lengthy light guide and insertion tubes sway when employees stretch to hang the scope. When storage is tight or multiple scopes are on one hanger or in close proximity to others, inadvertent compression against surfaces or other scopes occurs. When employees are rushed, contact of the scope against other surfaces may not be gentle. The presence of noticeable ding marks in the walls is evidence that this is occurring. However, the correlating damage to the distal end of the scope may not be as apparent. A review of endoscope repair invoices may list previous preventable repairs such as scratched or broken objective lenses, shattered light guide lenses, chipped distal end caps, and bent air/water nozzles in addition to broken glue joints or dislodged “O” ring seals.  

Commercially-available as well as facility-crafted hooks, used for support of endoscopes, need to be reviewed with regard to endoscope safety. Hooks that suspend the scopes should be inspected for damaging materials such as cracked or broken Lucite™, splintered wood, or worn plastic materials that are not smooth. 

Keeping the reprocessed dry endoscopes in a clean environment is the final storage consideration. Guidelines and recommendations from multiple professional societies encourage clean inventory to be stored in well-vented cabinets so that water borne pathogens do not multiply on or in the cleaned endoscopes. Suspend scopes vertically to promote ventilation and reduce the potential for contamination by trapped residual moisture. Removal of buttons, valves, and biopsy port covers allow for easy airflow. Fiberoptic scopes and some video scopes (review endoscope’s users manual) should be stored with venting (EtO) caps on. The caps will open to circulate air appropriately through these types of scopes.  

Many endoscopy suites occupy areas not designed specifically for these procedures, therefore ventilation may not be as controlled as it is in some newly designed areas. Consequently, space allocation has scope storage in less than optimal locations. Storage facilities in areas other than procedure rooms or decontamination areas may be more protective from a ventilation perspective. Stored endoscopes should be restricted from the flow of airborne pathogens that are pervasive among the population of patients served in patient care areas. Contaminated equipment should be completely submerged below the fluid level of the enzymatic solution when cleaning activities are carried out. This will prevent unsafe release of aerosols caused by scrubbing, thus contaminating stored scopes. It is important to follow this principle should it be necessary to store scopes in the reprocessing area.    

Reusable spongy distal tip protectors or endoboots are commonly used to protect scopes from compression damages. Should these be a part of your protocol for use, a critical review of who places the tip protectors on, and who removes them, as well as when and where these activities occur should be studied. Recontamination may occur when the person who handles these protectors is contaminated. The porous protector can then become a medium for bacteria growth. A method of cleaning reused protectors needs to be devised before their reuse. It is most important to protect the tip during its cabinet placement, retrieval, and/or movement. Waiting to protect the tip until the scope is hung, hardly minimizes the risk. 

Fluid stains on the bottom of storage cabinets or puckered toweling lining the floors are indications that scopes are hung before they are completely dry.  Colored fluid stains indicate residual chemicals ineffectively removed from the reprocessed scopes. These markers should alert you to review your rinsing and/or drying effectiveness.

The Association of perioperative Registered Nurses (AORN) and the Association for Professionals in Infection Control and Epidemiology(APIC) recommend to reprocess flexible endoscopes so they are not stored for longer than 5 or 7 days respectively.

Focusing on your area of practice, critically review your scope storage environment as it relates to this list of considerations:    

• Do you have an accurate inventory?
• Do you have endoscope storage cabinets?
• Are the cabinets ventilated?
• Where is storage located?
• What are the cabinets lined with?
• Are the hangers constructed to safely support the endoscope?
• Can each scope hang independently?
• Is there a drip collector at the bottom?
• Are there fluid stains on the floor?
• Are the control body and light guide tube supported without stress?
• Is there stress on any of the stress relief boots?
• Are there any impact marks on the wall?
• Are there chips to the distal end cap or other distal tip glue joints?
• Are video scopes stored with their fluid resistant caps off?
• Are video scopes stored with their venting caps on?
• Are fiberoptic scopes stored with EtO caps on?
• Are other supplies and materials stored with the scope?
• Are there distal tip protectors used during storage?
• Is the inventory secured with a lock?

 

Next Page: Endoscope Transport

Proper storage provides protection of endoscopes from their environment and from themselves.