K. C. Kelley1, T. Bennett1, R. C. Castillo1, B. A. Hoey1, J. J. Lukaszczyk1, S. P. Stawicki1 1St. Luke’s University Health Network,Bethlehem, PA, USA
Introduction:
The borescope is a semi-rigid fiberoptic device originally developed as an “inspection camera,” with which the operator can look down small spaces and cavities. During World War II, soldiers would employ long optical devices in order to inspect the inside “bores” of their guns for defects, hence the origin of the name “borescope.” The development of the flexible borescope – based on fiberoptics – allowed users to view out-of-reach areas in real time, thus enabling medical applications. Adding cameras and later video technology to the device further increased the utility and versatility of this instrument. At our institution, the borescope was introduced as a tool to inspect surgical instruments after our Sterile Processing Department (SPD) discovered that internal lumens of some surgical instruments contained post-sterilization biological residue (e.g., skin, bone, blood, rust) as well as internal damage that would not have been otherwise detected. We hypothesized that implementation of a borescope-based SPD inspection protocol would result in improved overall process quality, and potentially fewer surgical site infections (SSI).
Methods:
We performed an IRB-exempt review of our institution’s SPD Scorecard reports and all reported SSIs between Jan 2018 – Jun 2019. After the Healthmark Flexible Scope (Fraser, Michigan) was introduced in our SPD (Aug 2018) the instrument cleaning process was modified to include the following steps: (a) initial decontamination of instruments; (b) initial borescope examination; (c) borescopic determination of cleaning adequacy; (d) additional cleaning (e.g., brushing / air and sterile water flushing); and (e) re-inspection with the borescope to ensure complete cleaning before final sterilization. Results are presented utilizing descriptive statistics, focusing on comparisons of pre-/post-borescope periods (8 and 10 months, respectively).
Results:
Preliminary findings after implementation of the borescope (Aug 2018) show a decrease in the percentage of dirty instrument trays identified by Operating Room (OR) staff (0.0003% vs 0.0002%) and a decrease in reported SSIs (5.9/month vs 3.0/month). Pre- and post-borescope results, expressed as the percentage of dirty trays identified by OR staff, are shown in Figure 1a.
Conclusion:
In the 10-month period since its implementation, the borescope has shown promise in reducing the incidence of post-processing soiled instruments at our institution. Identification of soiled instruments in the operating room leads to greater resource consumption and potential time delays. Furthermore, if soiled instruments are not accurately identified and flagged, patients may ultimately be at greater risk for SSI. Consequently, we pose that the borescope should be a tool utilized more widely in SPDs, and the incidence of post-decontamination and refractory instrument soilage should be tracked as an important quality and patient safety measure.
