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16 www.NationalNursesUnited.org tamination on reusable endoscopes marked ready for use on patients. One hospital met the current guidelines for cleaning and disinfecting scopes, while the other two committed numerous breaches in protocol. Nevertheless, 62 percent of the disinfected scopes at the top-performing hospital tested positive for bacteria, including potential pathogens. It was even worse at the other two — 85 and 92 percent. The study painted a troubling picture at the two lower-performing hospitals, which were well aware researchers were watching. Among the safety issues: Hospital technicians wore the same gloves for handling soiled scopes fresh after a procedure and later, when they were disinfected and employees wiped down scopes with reused towels. Storage cabinets for scopes were visibly dirty and dripping wet scopes were hung up to dry, which is a known risk because bacteria thrive on the moisture left inside. The two hospitals also turned off a cleaning cycle on a commonly used "washing machine," known as an automated endoscope reprocessor, to save time. "It was very disturbing to find such improper practices in big health systems, especially since these institutions were accredited and we assumed that meant everything would have been done properly," said Ofstead, chief executive of the medical research firm Ofstead & Associates. Ofstead and her co-authors recommended moving faster toward sterilization of all medi- cal scopes using gas or chemicals. That would be a step above the current requirements for high-level disinfection, which involves manual scrubbing and automated washing. A shift to sterilization would likely require significant changes in equipment design and major invest- ments by hospitals and clinics. In their current form, many endoscopes aren't built to withstand repeated sterilization. Some also have long, narrow channels where blood, tissue and other debris can get trapped inside. In some cases, disposable, single-use scopes are an option, and new products are starting to gain acceptance. In other instances, certain parts of a scope might be disposable or removable to aid cleaning. The Joint Commission, which accredits many U.S. hospitals and surgery centers, issued a safety alert last year about disinfection and sterilization of medical devices in response to a growing rate of noncompliance. In 2016, the Joint Commission cited 60 percent of accredited hospitals for noncompliance and 74 percent of all "immediate threat to life" citations from survey- ors related to improperly sterilized or disinfected equipment. Michelle Alfa, a professor in the department of medical microbiology at the University of Mani- toba, said accreditors may need to conduct more frequent inspections and endoscopy labs should be shut down "if they don't get their act together. These results are totally unacceptable." This story was produced by Kaiser Health News, which pub- lishes California Healthline, a service of the California Health Care Foundation. https://khn.org/news/study-nearly-three-quarters-of-com- monly-used-medical-scopes-tainted-by-bacteria/ As you read in the article, researchers visited three hospitals and examined endoscopes that had been marked ready for use on patients. Only one hospital met guidelines for cleaning and disinfection. We could stop there and say that the solution must be better training and surveillance of workers who are cleaning the scopes to ensure they do a more thorough job. That is what the authors of this article do when they say "…the intricate design of many endoscopes continues to hinder effective cleaning and those problems are compounded when health care workers skip steps or ignore basic protocols in a rush to get scopes ready for the next patient." But that is not the whole picture. Not by a long shot. And it effectively blames health care workers for cost-cutting decisions made by their employers and the medical device manufacturers. If workers are understaffed and under so much time pressure to meet demands that they cannot follow protocols and still get their jobs done, then the problem—and responsibility to fix it—lies with the employer. Olympus did not conduct real-world studies to determine whether the scopes they had designed, manufactured, and sold could be effectively cleaned in health care facilities. This is a common tactic used by industry for decades—if you do not do safety research, then there must be no problem. But that is not true. Is There Any Hope? Solutions and Next Steps Patients are at their most vulnerable when seeking care in a hospital. Hospitals should be places of healing, where nursing care can be provided safely. But when hospitals neglect infection prevention, more patients suf- fer from infections acquired during their hospital stays. These infections complicate existing conditions, create new illness and disease, and can cause pre-mature death. It also means that nurses are at higher risk for exposure and infection. Such hospital-acquired infections can be prevented through robust infection prevention programs that incorporate a wide range of protocols, staffing, effective sterilization of surgical instruments and other

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