1
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Rutala WA, Weber DJ. Reprocessing semicritical items: An overview and an update on the shift from HLD to sterilization for endoscopes. Am J Infect Control 2023; 51:A96-A106. [PMID: 37890958 DOI: 10.1016/j.ajic.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (e.g., gastrointestinal endoscopes, endocavitary probes). Such medical devices require minimally high-level disinfection. METHODS Analyze the methods used to reprocess semicritical medical devices and identify methods and new technologies to reduce the risk of infection. RESULTS The reprocessing methods for semicritical medical devices is described as well as a shift from high-level disinfection to sterilization for lumened endoscopes. CONCLUSIONS Strict adherence to current guidelines and transition to sterilization for endoscopes is required as more outbreaks have been linked to inadequately disinfected endoscopes and other semicritical items than any other reusable medical devices.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Department of Infection Prevention, Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC
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2
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Biadsee A, Crosby L, Chow W, Sowerby LJ. Cost minimization analysis of nasopharyngoscope reprocessing in community practice. J Otolaryngol Head Neck Surg 2023; 52:8. [PMID: 36750881 PMCID: PMC9906939 DOI: 10.1186/s40463-022-00610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/16/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Reprocessing of nasopharyngoscopes represents a large financial burden to community physicians. The aim of this study was to perform a cost analysis of nasopharyngoscope reprocessing methods at the community level. METHODS Electronic surveys were distributed by email to community otolaryngologists. Surveys were comprised of 14 questions assessing clinic size, nasopharyngoscope volume, scope reprocessing method and maintenance. Four manual techniques were evaluated: (1) soak with ortho-phthalaldehyde solution (Cidex-OPA; Advanced Sterilization Products, Johnson and Johnson Inc., Markham, Canada), (2) soak with accelerated hydrogen peroxide solution (Revital-Ox; Steris Canada Inc., Mississauga, Canada), (3) disinfection with chlorine dioxide wipe (Tristel Trio Wipes System; Tristel plc., Cambridgeshire, UK), (4) UV-C light system (UV Smart, Delft, The Netherlands). All costs are reported in CAD, and consumable and capital costs for reprocessing methods were obtained from reported vendor prices. Time costs were derived from manufacturer recommendations, the Ontario Medical Association Physician's Guide to Uninsured Services, and the Ontario Nurses Association Collective Agreement. Cost analyses determined the most cost-effective reprocessing method in the community setting. Sensitivity analyses assessed the impact of reprocessing volume and labour costs. RESULTS Thirty-six (86%) otolaryngologists responded and answered the survey. The cost per reprocessing event for Cidex-OPA, Revital-Ox, Tristel and UV system were $38.59, $26.47, $30.53, and $22.74 respectively when physicians reprocessed their endoscopes themselves. Sensitivity analyses demonstrated that Revital-Ox was the least costly option in a low volume, however, the UV system remained the most cost effective in higher volumes. The cost per reprocessing event when done by clinic staff was $5.51, $4.42, $11.23 and $6.21 for Cidex-OPA, Revital-Ox, Tristel and the UV system. CONCLUSIONS The UV light system appears to be the most cost-effective method in high volumes of reprocessing, and Revital-Ox is cheaper in lower volumes and when performed by clinic staff rather than physicians. It is important to consider the anticipated work volume, shared clinic space and number of co-workers prior to choosing a reprocessing method.
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Affiliation(s)
- Ameen Biadsee
- grid.39381.300000 0004 1936 8884Department of Otolaryngology- Head and Neck Surgery, Western University, 268 Grosvenor Street, London, ON N6A 4V2 Canada ,grid.415250.70000 0001 0325 0791Department of Otolaryngology- Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lauren Crosby
- grid.22072.350000 0004 1936 7697Department of Anesthesiology, Perioperative and Pain Medicine, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Winsion Chow
- grid.28046.380000 0001 2182 2255Deptartment of Otolaryngology- Head and Neck Surgery, University of Ottawa, Ottawa, ON Canada
| | - Leigh J Sowerby
- Department of Otolaryngology- Head and Neck Surgery, Western University, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
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3
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Nagata Cavalheiro M, Fonseca VR, Zeigelboim BS, Costa DF, de Lima LV, Bozzo MK, Tonochi RDC, Hartmann BC. Evaluating the Quality of Rigid Optic Videolaryngoscopy Image Taken Through Dental Protection Cap and Its Feasibility as Additional Barrier Method Against COVID-19. J Voice 2023; 37:141.e13-141.e21. [PMID: 33168360 PMCID: PMC7605857 DOI: 10.1016/j.jvoice.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 01/17/2023]
Abstract
Videolaryngoscopy screening is essential to help assessing human larynx. The use of 70° optical fiber in association with image recording by analog or digital cameras is one of the methods adopted to perform this examination. Endoscopic exams can contaminate the equipment with several microorganisms. The pandemic caused by the new coronavirus reinforces the importance of developing efficient barrier methods to be adopted in videolaryngoscopy procedures. Although dental intraoral camera covers are a barrier method authorized by Brazilian health organs, it has not yet been used in videolaryngoscopy examinations. The aim of the current longitudinal, individualized, single-blind, prospective, self-controlled, and accurate study is to evaluate the quality of images generated through, and confidence level of, diagnosis based on videolaryngoscopy performed with intraoral dental camera equipped with disposable protection cap and connected to 70° rigid laryngoscope in vocally healthy individuals. Videolaryngoscopy examinations based on 70° rigid optics were performed in 13 euphonic and asymptomatic volunteers at an otorhinolaryngology specialist clinic; only 1 patient was excluded from the study. Images were taken with, and without, disposable intraoral dental camera protection cap; high-grade disinfection protocol was applied between examinations. Recorded videos were randomly distributed in a single-blind manner in order to be evaluated by four otorhinolaryngologists, who answered a questionnaire comprising three questions. Statistical analysis was used to compare groups - which were defined by the use, or not, of protection cap - based on Wilcoxon nonparametric test. Statistical significance was set at 5% with 95% confidence interval. There was no statistically significant difference in image quality between examinations performed with, and without, protection cap (P= 0.646) or in the diagnosis confidence level of examinations performed with, or without, the barrier method. The use of disposable protection cap on intraoral dental camera did not significantly change the quality of images taken through videolaryngoscopy performed with 70° rigid optics in vocally healthy patients.
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Affiliation(s)
| | - Vinicius Ribas Fonseca
- Lauro Grein Filho Center for Otorhinolaryngological Studies,Positivo University,Postgraduate Program in Communication Disorders, Tuiuti do Paraná University,Brazilian Red Cross Hospital, Paraná, Brazil
| | | | - Diego F. Costa
- Lauro Grein Filho Center for Otorhinolaryngological Studies
| | | | | | | | - Bruno Ceron Hartmann
- Lauro Grein Filho Center for Otorhinolaryngological Studies,Address correspondence and reprint requests to Bruno Ceron Hartmann, Rua Marquês do Paraná, 1275, Apartamento 43, Bloco A, bairro Água Verde, Curitiba, Paraná CEP: 80620-210, Brazil
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4
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Santos MCJ, Pauna HF, Graziano KU, Voegels RL. Efficacy of Disinfection of Rigid Endoscope by Ethyl Alcohol 70%. Int Arch Otorhinolaryngol 2022; 26:e460-e466. [PMID: 35846816 PMCID: PMC9282946 DOI: 10.1055/s-0042-1742330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/02/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction
Currently, there is no safe, affordable, and ecologically-sustainable guideline that helps prevent contamination through endoscopy. We evaluated the safety of intermediate-level disinfection with 70% ethyl alcohol (w/v) based on biological-load recovery from rigid endoscopes after nasal endoscopy.
Objective
To demonstrate the efficacy of 70% ethanol in disinfecting rigid endoscopes (REs) to reduce microbial growth in microbiological cultures.
Methods
After a nasal endoscopy examination, the endoscope was swabbed with gauze; this served as the positive-control sample. The standard operating procedure for intermediate-level disinfection with 70% ethyl alcohol (w/v) following prior cleaning was applied. The endoscope was again swabbed; this served as the experimental sample. The collected material from the endoscope was extracted from gauze pieces, filtered through a 0.22-μm cellulose membrane, and cultivated in different means of culture.
Results
The results revealed a significant difference between the positive-control and experimental groups regarding the presence of
Streptococcus
coagulase (-) (
p
< 0.001),
Bacillus
spp. (
p
< 0.001), and
Staphylococcus aureus
(
p
= 0.001). These microorganisms were detected in the control group, but not in the experimental group.
Conclusions
Microorganisms were not recovered from the samples of the experimental group, demonstrating the efficacy and the germicidal action of 70% ethyl alcohol (w/v) as a means of achieving intermediate-level disinfection.
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Affiliation(s)
- Marco Cesar J. Santos
- Department of Ophthalmology and Otorhinolaryngology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital IPO, Curitiba, PR, Brazil
- Department of Otorhinolaryngology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
| | - Henrique F. Pauna
- Hospital IPO, Curitiba, PR, Brazil
- Department of Otorhinolaryngology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
| | | | - Richard L. Voegels
- Department of Ophthalmology and Otorhinolaryngology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Jiang R, Kasle DA, Alzahrani F, Kohli N, Lerner MZ. A Manufacturer and User Facility Device Experience Analysis of Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different? Laryngoscope 2020; 131:598-605. [PMID: 32558941 DOI: 10.1002/lary.28826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Several recent studies have observed a high incidence of duodenoscope microbial contamination and an association of contamination with healthcare-acquired infections. This study sought to quantify nasopharyngoscope microbial contamination relative to that of other endoscope categories and characterize the manufacturers, outcomes, and microbial profiles associated with these cases. STUDY DESIGN Retrospective, cross-sectional study. METHODS A total of 3,865 adverse events were collected from 2013 to 2019 using the US Food and Drug Administration Manufacturer and User Facility Device Experience database. The fraction of total device failures associated with contamination was quantified for nasopharyngoscopes, bronchoscopes, duodenoscopes, and gastroscopes. Odds ratios of nasopharyngoscope contamination compared to that of bronchoscopes, duodenoscopes, or gastroscopes were calculated, and significance was assessed by χ2 analysis. The Kruskal-Wallis test was used for nonparametric testing of significance. RESULTS Nasopharyngoscope device failures were reported at an incidence of 0.646 per month; 34.1% involved contamination, comparable to the frequency observed for bronchoscopes (23.4%, P = .118), duodenoscopes (29.2%, P = .493), and gastroscopes (45.3%, P = .178). The frequency of device contamination was observed to be significantly higher for a particular endoscope manufacturer regardless of endoscope category (Kruskal-Wallis P = .021). In instances of contamination, nasopharyngoscopes were significantly less associated with patient harm or death than bronchoscope (odds ratio [OR] = 10.2) and duodenoscope (OR = 4.81) cases. CONCLUSIONS Although the rates of contamination were comparable across all endoscope categories, nasopharyngoscope contamination was less commonly associated with patient harm or death. In an era of rising healthcare costs, determining adequate disinfection standards for nasopharyngoscopes and their impact on patient safety is crucial. LEVEL OF EVIDENCE NA Laryngoscope, 131:598-605, 2021.
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Affiliation(s)
- Roy Jiang
- Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - David A Kasle
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Faisal Alzahrani
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Nikita Kohli
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael Z Lerner
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A
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6
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Fonseca VR, Bozo MKW, da Silva APPM, Oliveira PAM, Costa DF. Videolaryngoscopy Quality with Protective Cover of Intraoral Odontologic Camera Evaluation in Vocal Fold Coverage Lesions. J Voice 2020; 35:665.e7-665.e12. [PMID: 32216976 DOI: 10.1016/j.jvoice.2019.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/19/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The examination of the larynx with indirect visualization is one of a series of steps in otorhinolaryngological evaluation. In the past this exam was performed more commonly with mirrors and headlights, but for at least the last four decades physicians have resorted to assessing the laryngopharynx with both rigid and fiberoptic instruments. The rigid 70° laryngoscope is the most used in our practice, its main drawback being the time-consuming resterilization process needed between scope usages in different patients. Recently we have been using a disposable protective cover over the rigid scope to obviate instrument contamination and thus the office time delays. OBJECTIVE To investigate the maintenance of image quality in videolaryngoscopy (VDL), with and without a protective cover of intraoral odontologic camera (PCIOC), in patients with benign lesions of the vocal fold. METHODS Quantitative and accurate cross-sectional study of VDL images with and without PCIOC. The images were captured by videolaringoscope of digital camera chip-on-the-tip type in an otorhinolaryngological care center. We studied patients presenting with vocal fold nodules, intracordal cysts, polyps, and Reinke's edema. All judges evaluating the images were otorhinolaryngologists. The exams with and without PCIOC were presented in a randomized form. The data of professionals' answers were analyzed by means of descriptive statistics and application of variables association tests. RESULTS Thirty professionals participated in the study. There was no statistically significant difference between the probability of success in exams performed with or without PCIOC, nor between the perception of image quality and the number of correct answers in the diagnosis. In the polyp lesion without PCIOC there was a statistically significant difference between the confidence level of the diagnosis (and the number of correct answers (P = 0.037). CONCLUSION There is no difference between VDL diagnoses of vocal fold coverage lesions with and without PCIOC, maintaining image quality in both VDL exams.
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Affiliation(s)
- Vinicius Ribas Fonseca
- Positivo University, Otorrinos - Brazilian Red Cross Hospital, Branch of Paraná; Otorrinos Curitiba, Tuiuti University of Paraná, Curitiba, Paraná, Brazil
| | | | | | | | - Diego Fernando Costa
- Brazilian Red Cross Hospital, Branch of Paraná, Lauro Grein Study Center, Curitiba, Paraná, Brazil
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7
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Pynnonen MA, Whelan J. Reprocessing Flexible Endoscopes in the Otolaryngology Clinic. Otolaryngol Clin North Am 2019; 52:391-402. [DOI: 10.1016/j.otc.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Abstract
Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (eg, gastrointestinal endoscopes, endocavitary probes). Such medical devices require minimally high-level disinfection. As many of these items are temperature sensitive, low-temperature chemical methods must be used rather than steam sterilization. Strict adherence to current guidelines is required as more outbreaks have been linked to inadequately cleaned or disinfected endoscopes and other semicritical items than any other reusable medical devices.
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9
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Ofstead CL, Hopkins KM, Quick MR, Brooks KB, Eiland JE, Wetzler HP. A Systematic Review of Disposable Sheath Use During Flexible Endoscopy. AORN J 2019; 109:757-771. [PMID: 31135992 DOI: 10.1002/aorn.12699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Flexible endoscopes are exposed to blood, mucus, and other secretions during procedures. Single-use sheaths are designed to prevent contact between contaminants and reusable endoscope components. This systematic review examined findings from 22 studies that assessed endoscopic sheath use during urologic, gastrointestinal, or respiratory procedures. The evidence showed that sheaths were durable and yielded faster endoscope turnover times because their reusable components did not require high-level disinfection or sterilization. After a brief learning period, health care providers successfully assembled and maneuvered sheathed endoscopes. Patients generally did not experience greater discomfort during procedures in which sheaths were used. Microbial cultures of sheathed endoscopes were negative or similar to unsheathed endoscopes. More research is needed to evaluate the potential effect of disposable sheaths on infection risks. The evidence suggests that sheaths are a viable option for reliably providing a barrier between endoscopes and patients without affecting the quality of endoscopic procedures.
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10
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Ditommaso S, Giacomuzzi M, Ricciardi E, Zotti C. Experimental Study to Develop a Method for Improving Sample Collection to Monitor Laryngoscopes after Reprocessing. Clin Endosc 2018; 51:463-469. [PMID: 30130841 PMCID: PMC6182295 DOI: 10.5946/ce.2018.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/10/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/AIMS The microbiological surveillance of endoscopes and automated flexible endoscope reprocessing have been proven to be two of the most difficult and controversial areas of infection control in endoscopy. The purpose of this study was to standardize a sampling method for assessing the effectiveness of standard reprocessing operating procedures for flexible fiberoptic laryngoscopes (FFLs). METHODS First, the sampling devices were directly inoculated with Bacillus atrophaeus spores; second, tissue non tissue (TNT) wipes were tested on artificially contaminated surfaces and on FFLs. RESULTS Comparison of the sponges, cellulose, and TNT wipes indicated that the TNT wipes were more effective in releasing spores (93%) than the sponges (49%) and cellulose wipes (52%). The developed protocol provides a high efficiency for both collection and extraction from the stainless steel surface (87% of the spores were removed and released) and from the FFL (85% of the spores were removed and released), with relatively low standard deviations for recovery efficiency, particularly for the analysis of the FFL. CONCLUSION TNT wipes are more efficient for sampling surface areas, thereby aiding in the accuracy and reproducibility of environmental surveillance.
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Affiliation(s)
- Savina Ditommaso
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Monica Giacomuzzi
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Elisa Ricciardi
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Carla Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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11
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A randomised, single-blind comparison of high-level disinfectants for flexible nasendoscopes. The Journal of Laryngology & Otology 2016; 130:983-989. [PMID: 27669971 DOI: 10.1017/s0022215116008860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To compare the microbiological efficacy, turnaround time, cost, convenience, and patient and user tolerance of Tristel Trio Wipes, PeraSafe solution and Cidex OPA solution for the high-level disinfection of flexible nasendoscopes. METHODS Flexible nasendoscopes were used in routine clinical encounters. They were then disinfected with one of the three disinfectant methods. Surveillance cultures were taken before and after each disinfection process. Data relating to each of the study parameters were recorded. RESULTS Positive bacterial cultures were discovered on nasendoscopes disinfected with PeraSafe and Cidex OPA. Tristel Trio Wipes have no capital outlay cost, the lowest running cost, the greatest convenience and the fastest turnaround time. PeraSafe had a faster turnaround time than Cidex OPA, and lower running costs. CONCLUSION Tristel Trio Wipes are equal to PeraSafe and Cidex OPA in terms of microbiological efficacy. Turnaround time and cost are dramatically reduced when using Tristel Trio Wipes compared to the other disinfectant methods.
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12
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Danino J, Muzaffar J, Metcalfe C, Coulson C. Patient safety in otolaryngology: a descriptive review. Eur Arch Otorhinolaryngol 2016; 274:1317-1326. [PMID: 27623822 DOI: 10.1007/s00405-016-4291-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022]
Abstract
Human evaluation and judgement may include errors that can have disastrous results. Within medicine and healthcare there has been slow progress towards major changes in safety. Healthcare lags behind other specialised industries, such as aviation and nuclear power, where there have been significant improvements in overall safety, especially in reducing risk of errors. Following several high profile cases in the USA during the 1990s, a report titled "To Err Is Human: Building a Safer Health System" was published. The report extrapolated that in the USA approximately 50,000 to 100,000 patients may die each year as a result of medical errors. Traditionally otolaryngology has always been regarded as a "safe specialty". A study in the USA in 2004 inferred that there may be 2600 cases of major morbidity and 165 deaths within the specialty. MEDLINE via PubMed interface was searched for English language articles published between 2000 and 2012. Each combined two or three of the keywords noted earlier. Limitations are related to several generic topics within patient safety in otolaryngology. Other areas covered have been current relevant topics due to recent interest or new advances in technology. There has been a heightened awareness within the healthcare community of patient safety; it has become a major priority. Focus has shifted from apportioning blame to prevention of the errors and implementation of patient safety mechanisms in healthcare delivery. Type of Errors can be divided into errors due to action and errors due to knowledge or planning. In healthcare there are several factors that may influence adverse events and patient safety. Although technology may improve patient safety, it also introduces new sources of error. The ability to work with people allows for the increase in safety netting. Team working has been shown to have a beneficial effect on patient safety. Any field of work involving human decision-making will always have a risk of error. Within Otolaryngology, although patient safety has evolved along similar themes as other surgical specialties; there are several specific high-risk areas. Medical error is a common problem and its human cost is of immense importance. Steps to reduce such errors require the identification of high-risk practice within a complex healthcare system. The commitment to patient safety and quality improvement in medicine depend on personal responsibility and professional accountability.
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Affiliation(s)
- Julian Danino
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, England, UK.
| | - Jameel Muzaffar
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, England, UK
| | - Chris Metcalfe
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, England, UK
| | - Chris Coulson
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, England, UK
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13
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Reprocessing semicritical items: Current issues and new technologies. Am J Infect Control 2016; 44:e53-62. [PMID: 27131136 DOI: 10.1016/j.ajic.2015.12.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/23/2022]
Abstract
Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (eg, gastrointestinal endoscopes, endocavitary probes). Such medical devices minimally require high-level disinfection. Because many of these items are temperature sensitive, low-temperature chemical methods are usually used rather than steam sterilization. Strict adherence to current guidelines is required because more outbreaks have been linked to inadequately cleaned or disinfected endoscopes and other semicritical items undergoing high-level disinfection than any other reusable medical device.
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14
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The effect of endoscopic sheaths on visualization in distal chip and fiberoptic laryngoscopy. Eur Arch Otorhinolaryngol 2014; 271:2757-60. [PMID: 24756617 DOI: 10.1007/s00405-014-3058-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
Endoscopic sheaths covering the laryngoscope are advised to prevent cross contamination, but might hamper visualization as the most important tool in the diagnostic approach of laryngeal disease. We evaluated whether endoscopic sheaths change image quality and diagnostic accuracy of flexible distal chip laryngoscopy (DCL) and flexible fiberoptic laryngoscopy (FOL). Twelve healthy volunteers underwent a flexible laryngoscopy using a distal chip and a fiberoptic laryngoscope with and without endoscopic sheaths, and in this way 48 images were collected. To determine diagnostic accuracy, the 48 images were mixed with images of 40 patients. All images were randomly shown to four experts in the field of laryngology and head and neck oncology. Observers were asked to validate image quality, choose a diagnosis, and express their confidence level of that diagnosis. Image quality was validated better in DCL as compared to FOL (p < 0.05) both with or without endoscopic sheaths. Endoscopic sheaths worsened image quality in DCL (p < 0.05) but not in FOL. No differences were observed between DCL and FOL with or without endoscopic sheaths in diagnostic accuracy (79-89%). Confidence levels (7.7-8.1) were comparable in DCL and FOL and not influenced by endoscopic sheaths. Image quality in DCL is superior to FOL, but significantly hampered by the use of endoscopic sheaths. In FOL the image quality is already low and not further diminished by endoscopic sheaths.
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15
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Plaat BEC, van der Laan BFAM, Wedman J, Halmos GB, Dikkers FG. Distal chip versus fiberoptic laryngoscopy using endoscopic sheaths: diagnostic accuracy and image quality. Eur Arch Otorhinolaryngol 2014; 271:2227-32. [PMID: 24515919 DOI: 10.1007/s00405-014-2916-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/23/2014] [Indexed: 11/28/2022]
Abstract
Laryngeal visualization is the hallmark in the diagnostic approach of laryngeal disease. In addition to fiberoptic techniques, digital distal chip technology has been developed to improve visualization. Endoscopic sheaths are used in daily clinical practice to prevent cross-contamination. The objective of the study was to evaluate diagnostic accuracy, image quality and interrater reliability of both flexible distal chip laryngoscopy (DCL) and flexible fiberoptic laryngoscopy (FOL) using contamination preventing endoscopic sheaths. In 53 cases both DCL and FOL images were collected during routine examination using endoscopic sheaths. All images were randomly shown to four experts in the field of laryngology and head and neck oncology. Observers were asked to choose a diagnosis, express their confidence level of that diagnosis and validate image quality: in this way 420 observations (four observers using two techniques) were analyzed. Accuracy in detecting laryngeal disease was 78 % (both DCL and FOL). Confidence level of diagnosis tended to be higher in DCL (p = 0.05). Image quality was validated better in DCL as compared to FOL (p < 0.05). Interrater agreement in identifying laryngeal disease was 1.5 times higher in DCL (κ = 0.44) as compared to FOL (κ = 0.29). In this study, reflecting daily clinical setting using sheathed endoscopes, DCL is identical to FOL regarding diagnostic accuracy, but DCL is superior to FOL in image quality and interrater reliability.
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Affiliation(s)
- Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands,
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16
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Bhatt JM, Peterson EM, Verma SP. Microbiological sampling of the forgotten components of a flexible fiberoptic laryngoscope: what lessons can we learn? Otolaryngol Head Neck Surg 2013; 150:235-6. [PMID: 24334960 DOI: 10.1177/0194599813513424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effectiveness of a Cidex-based decontamination protocol was analyzed for its effectiveness in cleaning various components of a flexible fiberoptic laryngoscope (FFL), including the handle, eyepiece, and detachable light cable. A random microbiological sampling and aerobic bacterial culture analysis of 6 FFL eyepieces, 6 FFL driver handles, and 5 light cables prior to patient use was performed. Of 17 samples collected, 7 (41%) were contaminated with bacterial organisms. Organisms recovered represented both environmental organisms from skin and oral flora origin. This study demonstrates that potential contaminants may be present on FFL eyepieces and light cables, which are commonly overlooked in the cleaning protocols of a standard otolaryngology clinic.
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Affiliation(s)
- Jay M Bhatt
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California at Irvine Medical Center, Irvine, California, USA
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17
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Johnston AM, Batchelor NK, Wilson D. Evaluation of a disposable sheath bronchoscope system for use in the deployed field hospital. J ROY ARMY MED CORPS 2013; 160:217-9. [PMID: 24109112 DOI: 10.1136/jramc-2013-000125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
At present, UK field hospitals use standard flexible bronchoscopes which require specialised disinfection services that are not integral to the hospital. This leads to prolonged turnover of used bronchoscopes as they have to be sent away to external facilities, which takes 1-3 days and is dependent on air transport to other facilities. In contingency operations, off site sterilisation facilities may not be available. There is a need for a bronchoscope system which can be rapidly cleaned and reused. We evaluated the Vision Sciences EndoSheath Bronchoscopy system, which uses a disposable outer sheath to remove the need for specialised disinfection. We report our experience of using this system in a deployed field hospital in Afghanistan.
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Affiliation(s)
- Andrew McD Johnston
- Department of Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - N K Batchelor
- Pulmonary-Critical Care Medicine, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - D Wilson
- Department of Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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18
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Rutala WA, Weber DJ. New developments in reprocessing semicritical items. Am J Infect Control 2013; 41:S60-6. [PMID: 23622752 DOI: 10.1016/j.ajic.2012.09.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/07/2012] [Accepted: 09/10/2012] [Indexed: 10/26/2022]
Abstract
Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (eg, gastrointestinal endoscopes). Such medical devices require minimally high-level disinfection. Because many of these items are temperature sensitive, low-temperature chemical methods must be used rather than steam sterilization. Strict adherence to current guidelines is required because more outbreaks have been linked to inadequately cleaned or disinfected endoscopes undergoing high-level disinfection than any other medical device.
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