Ensuring Patient Safety and Optimizing Efficiency During Gastrointestinal Endoscopy

Abstract

The volume of outpatient gastrointestinal (GI) endoscopy has grown dramatically in the past three decades, fueled by advancing technologies and evolving payment policies. This magnifies the need to ensure high-quality, safe, and cost-effective endoscopic services. In recent years, publicized breaches in standards of care for GI endoscopy have intensified the focus on patient safety. Because of these patient safety concerns and changes in regulatory policies, some ambulatory surgery center surveyors and inspectors have held GI endoscopy suites to the same standards as hospital ORs. The American Society for Gastrointestinal Endoscopy and other endorsing organizations drafted the Guidelines for Safety in the Gastrointestinal Endoscopy Unit, which published in January 2014. These safety guidelines relevant to sedation, infection control, staffing, training, technical equipment, traffic patterns, and personal protective equipment differ from other published guidelines for the outpatient surgical setting.

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

“…(1) Compliance with this instruction may require: (A) proper maintenance and replacement of a water filtration system, if one is used; and (B) routine monitoring of the rinse water to confirm its lack of bacteria [64] 5 Consider using sterile water in the water bottle for lens cleaning and irrigation during GI endoscopy, especially during ERCP [15,65] 6 Terminally dry all of the GI endoscope's internal channels (including the ERCP elevator wire channel, if it is exposed) using 70% alcohol and forced air [5,66] 7 Store the GI endoscope with its insertion tube hanging freely and vertically in a clean, dry, and well-ventilated area or cabinet [66,67] (1) Consider reprocessing the GI endoscope again before its reuse if it has been stored for more than 5 d [68] . Reprocessing ERCP endoscopes before each use may be advisable 8 If using an AER, ensure that it is performing properly; has been validated for the effective reprocessing of each GI endoscope in inventory; has been serviced and maintained as required; and that its internal surfaces and components are being routinely self-disinfected as instructed by its manufacturer 9 Manufacturers may consider enhanced design controls and validation measures to ensure the adequate reprocessing of ERCP endoscopes and other complex reusable instrumentation, to further minimize the risk of disease transmission during GI endoscopy CRE: Carbapenem-resistant Enterobacteriaceae; GI: Gastrointestinal.…”

“…For example: (1) practice proper hand-hygiene etiquette consistent with the CDC's guidelines [59] ; (2) don personal protective equipment (PPE), wearing gloves, gowns, and a face mask, as needed [15] ; and (3) in addition to high-level disinfecting (or sterilizing) GI endoscopes (and other semi-critical devices), sterilize reusable critical items, such as reusable biopsy forceps, and regularly clean and disinfect (using a low-or intermediate-level disinfectant) both non-critical devices, such as stethoscopes, and environment surfaces, such as countertops, as prescribed by the CDC's guidelines (i.e., ideally, using an EPA-registered, hospital-grade disinfectant labeled to rapidly kill CRE for those surfaces potentially contaminated with these superbugs) [60] . Moreover, the prevention of CRE transmissions will also likely require the implementation of Contact Precautions for patients infected or colonized with CRE, cohorting these patients and the healthcare staff treating them as deemed necessary [25] .…”

“…An outbreak of CRE at "Hospital X" near Chicago (IL) in 2013 following GI endoscopy Despite GI endoscopy's low reported infection rate, endoscope reprocessing lapses confirmed in recent years have resulted in an heightened focus on patient safety in the GI endoscopic setting [15] . And, with the recent emergence of the "superbug" known as carbapenem-resistant Enterobacteriaceae, or "CRE", infection control in this setting has taken on even more urgency and closer examination [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] .…”

The application of workflow control in colonoscopy department

“…The painless (general anesthesia) endoscopy examination service room should be established according to the medical center operating room standards. The standards should include pre-, during, and post-examination patient requirements and expectations; environmental infection control such as clean and contaminated areas; strict inspection, cleaning, and high-level disinfection of instruments and endoscope; professional education and training, and allocation of all operation personnel (examination physician and anesthesiologist, endoscopy room and nurse anesthetist, and endoscopy technicians); unit personnel resource and material management (patient, staff, facility, and material process flow); the respect and safeguard of patient privacy; procedure scheduling management, and the establishment of all related standard operating procedures (5).…”

Needs assessment survey for simulation‐based training for gastrointestinal endoscopy nurses

“…Endoscopic procedures are at risk for adverse events due to failure to monitor or respond during procedures (Matharoo et al, ). Early recognition and prompt management of adverse endoscopy events or complications, including infection, cardiopulmonary events, bowel perforations, and bleeding, are essential to ensure patient safety and successful outcomes (Deas Jr & Sinsel, ; Rolanda et al, ). Optimal nursing care in the endoscopy unit demands competence‐based training for GI endoscopy nurses to master knowledge and skills for patient care (Vuorinen, Heino, & Meretoja, ).…”