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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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Baker JR, Curtin BF, Moshiree B, Rao SSC. Organizing and Developing a GI Motility Lab in Community Practice: Challenges and Rewards. Curr Gastroenterol Rep 2022; 24:73-87. [PMID: 35674875 DOI: 10.1007/s11894-022-00838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Neurogastroenterology and motility is a rapidly evolving subspecialty that encompasses over 33% of gastroenterological disorders, and up to 50% of referrals to gastroenterology practice. It includes common problems such as dysphagia, gastroesophageal reflux disease, irritable bowel syndrome, chronic constipation, gastroparesis, functional dyspepsia, gas/bloating, small intestinal bacterial overgrowth, food intolerance and fecal incontinence Standard diagnostic tests such as endoscopy or imaging are normal in these conditions. To define the underlying mechanism(s)/etiology of these disorders, diagnostic motility tests are often required. These are best performed by well-trained personnel in a dedicated motility laboratory. Our purpose is to provide an up-to-date overview on how to organize and develop a motility laboratory based on our collective experiences in setting up such facilities in academia and community practice. RECENT FINDINGS A lack of knowledge, training and facilities for providing diagnostic motility tests has led to suboptimal patient care. A motility laboratory is the hub for diagnostic and therapeutic motility procedures. Common procedures include esophageal function tests such as esophageal manometry and pH monitoring, anorectal function tests suchlike anorectal manometry, neurophysiology and balloon expulsion, dysbiosis and food intolerance tests such as hydrogen/methane breath tests, and gastrointestinal transit assessment. These tests provide an accurate diagnosis and guide clinical management including use of medications, biofeedback therapy, neuromodulation, behavioral therapies, evidence-based dietary interventions and endoscopic or surgical procedures. Further, there have been recent developments in billing and coding of motility procedures and training requirements that are not well known. This review provides a stepwise approach on how to set-up a motility laboratory in the community or academic practice and includes the rationale, infrastructure, staffing needs, commonly performed motility tests and their clinical utility, billing and coding strategies, training needs and economic considerations for setting up this service.
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Affiliation(s)
- Jason R Baker
- Atrium Health, Charlotte, NC, USA.,Neurogastroenterology and Motility Laboratory, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28209, USA
| | - Bryan F Curtin
- Division of Neurogastroenterology, The Institute for Digestive and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
| | | | - Satish S C Rao
- Division of Neurogastroenterology/Motility, Augusta University Medical Center, Augusta, GA, USA.
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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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Valeriani F, Agodi A, Casini B, Cristina ML, D'Errico MM, Gianfranceschi G, Liguori G, Liguori R, Mucci N, Mura I, Pasquarella C, Piana A, Sotgiu G, Privitera G, Protano C, Quattrocchi A, Ripabelli G, Rossini A, Spagnolo AM, Tamburro M, Tardivo S, Veronesi L, Vitali M, Romano Spica V. Potential testing of reprocessing procedures by real-time polymerase chain reaction: A multicenter study of colonoscopy devices. Am J Infect Control 2018; 46:159-164. [PMID: 28958445 DOI: 10.1016/j.ajic.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Reprocessing of endoscopes is key to preventing cross-infection after colonoscopy. Culture-based methods are recommended for monitoring, but alternative and rapid approaches are needed to improve surveillance and reduce turnover times. A molecular strategy based on detection of residual traces from gut microbiota was developed and tested using a multicenter survey. METHODS A simplified sampling and DNA extraction protocol using nylon-tipped flocked swabs was optimized. A multiplex real-time polymerase chain reaction (PCR) test was developed that targeted 6 bacteria genes that were amplified in 3 mixes. The method was validated by interlaboratory tests involving 5 reference laboratories. Colonoscopy devices (n = 111) were sampled in 10 Italian hospitals. Culture-based microbiology and metagenomic tests were performed to verify PCR data. RESULTS The sampling method was easily applied in all 10 endoscopy units and the optimized DNA extraction and amplification protocol was successfully performed by all of the involved laboratories. This PCR-based method allowed identification of both contaminated (n = 59) and fully reprocessed endoscopes (n = 52) with high sensibility (98%) and specificity (98%), within 3-4 hours, in contrast to the 24-72 hours needed for a classic microbiology test. Results were confirmed by next-generation sequencing and classic microbiology. CONCLUSIONS A novel approach for monitoring reprocessing of colonoscopy devices was developed and successfully applied in a multicenter survey. The general principle of tracing biological fluids through microflora DNA amplification was successfully applied and may represent a promising approach for hospital hygiene.
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Affiliation(s)
- Federica Valeriani
- Department of Movement, Human and Health Science, University of Rome "Foro Italico", Rome, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy
| | | | - Marcello Mario D'Errico
- Department of Biomedical Sciences and Public Health, Politechnic University of Marche, Ancona, Italy
| | - Gianluca Gianfranceschi
- Department of Movement, Human and Health Science, University of Rome "Foro Italico", Rome, Italy
| | - Giorgio Liguori
- Department of Movement and Health Sciences, University "Parthenope," Napoli, Italy
| | - Renato Liguori
- Department of Movement and Health Sciences, University "Parthenope," Napoli, Italy
| | - Nicolina Mucci
- Department of Technological Innovations and Safety of Plants, Products and Anthropic Settlements, National Institute for Insurance against Accidents at Work, INAIL, Rome, Italy
| | - Ida Mura
- Department of Biomedical Science-Hygiene Section, University of Sassari, Sassari, Italy
| | | | - Andrea Piana
- Department of Biomedical Science-Hygiene Section, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Department of Biomedical Science-Hygiene Section, University of Sassari, Sassari, Italy
| | - Gaetano Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annalisa Quattrocchi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Giancarlo Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Angelo Rossini
- Fondazione Santa Lucia Institute for Research and Health Care, IRCCS, Rome, Italy
| | | | - Manuela Tamburro
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Stefano Tardivo
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Romano Spica
- Department of Movement, Human and Health Science, University of Rome "Foro Italico", Rome, Italy.
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Rutala WA, Weber DJ. Disinfection and Sterilization in Health Care Facilities: An Overview and Current Issues. Infect Dis Clin North Am 2016; 30:609-37. [PMID: 27515140 PMCID: PMC7134755 DOI: 10.1016/j.idc.2016.04.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
When properly used, disinfection and sterilization can ensure the safe use of invasive and noninvasive medical devices. The method of disinfection and sterilization depends on the intended use of the medical device: critical items (contact sterile tissue) must be sterilized before use; semicritical items (contact mucous membranes or nonintact skin) must be high-level disinfected; and noncritical items (contact intact skin) should receive low-level disinfection. Cleaning should always precede high-level disinfection and sterilization. Current disinfection and sterilization guidelines must be strictly followed.
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Affiliation(s)
- William A Rutala
- Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC 27514, USA; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7030, USA.
| | - David J Weber
- Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC 27514, USA; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7030, USA
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