Infection Control in the GI Setting Lisa Maslak BSN, RN, CIC Director of Infection Control Brooks Memorial Hospital

Why is it so important?

Microbial Transmission to Patients Most cases of microbial transmission to patients, via contaminated endoscopes, are a result of nonadherence to reprocessing guidelines Patients can be exposed to multiple organisms, both bacterial and viral. Pseudomonas, Serratia, Proteus, Staph, Clostridium difficile and more.

Guidelines

Reprocessing Errors Not removing patient biomaterial immediately after a procedure *dries and hardens making it difficult for disinfectants and sterilizing agents to penetrate and kill microorganisms Did you know? Patient biomaterial can inactivate disinfectants?

Not cleaning all channels… including unused ones *Fluid and debris can enter the channels at the distal tip

Not soaking in appropriate enzymatic detergent when pre-cleaning is not initiated within one hour *debris dries and hardens Why would this happen?

Using worn or damaged channel brushes *ineffective cleaning or damage to the channels. The brush has to contact the channel wall to cause abrasion and remove debris.

Failure to fully submerge the scope in the disinfectant for the required amount of time. *timing is important-use a timer too little- not clean enough too much-can damage scope not submerged-residual debris

Not rinsing with water *residual detergent can interfere with disinfectant solution which can inhibit or cause staining. Can cause chemical irritation to the patient.

Not storing scopes in clean, dry, and well-ventilated area *minimize the possibility of recontamination. Remove all valves and caps during storage. Do you use distal tip protectors?

Cleaning Verification The scope is free of damage and debris before being high level disinfected.

Visual inspection-can use lighted magnifier Examine inside of scope with borescope

Check for residual blood, protein or organic matter Verification Tests Check for residual blood, protein or organic matter Chemistry ATP swab test Can be done by the tech after manual cleaning either periodically or routinely.

Hang scopes vertically in a clean, well-vented, dust free area Hang scopes vertically in a clean, well-vented, dust free area. They MUST be dried prior to storing. Reprocess after 7 days-label Remove buttons, caps, valves, or any removable parts. Store together for tracking. Consider disposable.

Option B Disposable scopes-FDA approved -pros and cons Sterile sheaths

Environmental Cleaning Surfaces should be cleaned with an EPA disinfectant Contact time Between cases Terminal

PPE Gown, gloves and mask when directly involved in the endoscopy, or any procedure that splashing or contamination is possible Remove prior to leaving procedure area

Device Failures Report any device failure to the manufacturer or FDA Keep logs

Hand Hygiene Soap and water or hand sanitizer No artificial nails Nail polish Remove jewelry

Medication Handling Single patient use vials Multi dose vials Aseptic technique Prep area Syringe use

Staff Staff training Staff competency Staff accountability

Infection Prevention Champions Check the SGNA website for information on the Infection Prevention Champion program. Resources and support for those interested in this area

Quality Assurance Audits logs, refrig, outdates

Thank you Questions?