Safety of technology: infection control standards in endoscopy

WEO position statement on hygiene in digestive endoscopy: Focus on endoscopy units in Asia and the Middle East

The aim of this position statement is to reinforce the key points of hygiene in digestive endoscopy. The present article details the minimum hygiene requirements for reprocessing of endoscopes and endoscopic devices, regardless of the reprocessing method (automated washer-disinfector or manual cleaning) and the endoscopy setting (endoscopy suite, operating room, elective or emergency procedures). These minimum requirements are mandatory for patient safety. Both advanced diagnostic and therapeutic endoscopies should be carried out in an environment that is safe for patients and staff. Particular attention is given to contaminants. Procedural errors in decontamination, defective equipment, and failure to follow disinfection guidelines are major factors contributing to transmission of infection during endoscopy. Other important risk factors include inadequate cleaning, use of older endoscopes with surface and working channel irregularities, and contamination of water bottles or irrigating solutions. Infections by multidrug-resistant organisms have become an increasing problem in health-care systems worldwide. Since 2010, outbreaks of multidrug-resistant bacteria associated with endoscopic retrograde cholangiopancreatography have been reported from the USA, France, Germany, and The Netherlands. In many endoscopy units in Asia and the Middle East, reprocessing procedures have lagged behind those of Western countries for cultural reasons or lack of financial resources. This inconsistency in standards is now being addressed, and the World Endoscopy Organization has prepared this position statement to highlight key points for quality assurance in any endoscopy unit in any country.

[Gastrointestinal endoscopy and infection]

During a gastrointestinal endoscopy, the device crosses natural cavities with always commensal bacterial flora, sometimes pathogenic flora. In all cases, the device is contaminated after the exam. The lack of effective disinfection exposes to the risks of transmission of germs. The infectious risk depends on the patient, the endoscopic procedure as well as on the technique of disinfection. The bacteraemia is usually not clinically significant. The endoscopic transmission of the germs from a patient to another one is very rare and is mostly due to a defect of disinfection. The procedures for disinfecting equipment should be known, established and controlled.

Pre-sterilisation cleaning of re-usable instruments in general dental practice

OBJECTIVE

This study examined the policies, procedures, environment and equipment used for the cleaning of dental instruments in general dental practice.

MATERIALS AND METHODS

A total of 179 surgeries were surveyed. This was an observational based study in which the cleaning processes were viewed directly by a trained surveyor. Information relating to surgery policies and equipment was also collected by interview and viewing of records. Data were recorded onto a standardised data collection form prepared for automated reading.

RESULTS

The BDA advice sheet A12 was available in 79% of surgeries visited. The most common method for cleaning dental instruments was manual washing, with or without the use of an ultrasonic bath. Automated washer disinfectors were not used by any surgery visited. The manual wash process was poorly controlled, with 41% of practices using no cleaning agent other than water. Only 2% of surgeries used a detergent formulated for manual washing of instruments. When using ultrasonic baths, the interval that elapsed between changes of the ultrasonic bath cleaning solution ranged from two to 504 hours (median nine hours). Fifty-eight percent of surgeries claimed to have a dedicated area for instrument cleaning, of which 80% were within the patient treatment area. However, in 69% of surgeries the clean and dirty areas were not clearly defined. Virtually all cleaning of dental instruments was undertaken by dental nurses. Training for this was provided mainly by demonstration and observed practice of a colleague. There was little documentation associated with training. Whilst most staff wore gloves when undertaking manual cleaning, 51% of staff did not use eye protection, 57% did not use a mask and 7% used waterproof overalls.

CONCLUSIONS

In many dental practices, the cleaning of re-usable dental instruments is undertaken using poorly controlled processes and procedures, which increase the risk of cross infection. Clear and unambiguous advice must be provided to the dental team, especially dental nurses, on appropriate equipment, chemicals and environment for cleaning dental instruments. This should be facilitated by appropriate training programmes and the implementation of quality assurance procedures at each stage of the cleaning process.

Epidemiology and Prevention of Infections Related to Endoscopy

Contaminated endoscopes are the most common cause of device-related nosocomial outbreaks in the United States. Because almost all outbreaks are related to breaches in reprocessing techniques, it is crucial that endoscope cleaning and disinfection are performed carefully. Key elements that should be emphasized are availability of and adherence to guidelines, thorough staff training, and ensuring proper equipment is used in the reprocessing. Encouraging endoscopists to notify infection control when they see unexpected postprocedure complications and document which endoscopes are used in each case are key elements in limiting the impact of outbreaks.