Improving Quality and Safety in the Endoscopy Unit (Virtual) | August 2023-07_ASGE Quality_Pannala

07_ASGE Quality_Pannala_Infection Control Overview

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This document discusses infection control in endoscopy procedures, with a focus on preventing the transmission of infections during the procedure and the reprocessing of endoscopes. The risks of both endogenous and exogenous infections are explored, as well as the measures that can be taken to prevent these infections.<br /><br />Endogenous infections, which originate from the patient's own flora, can occur during endoscopy procedures. The risk of endogenous infections varies depending on the type of procedure, with some procedures having higher rates of bacteremia than others. Factors that increase the risk of bacteremia include therapeutic interventions, malignancy, and immunosuppressed status. Routine daily activities, such as brushing/flossing and chewing food, also carry a risk of bacteremia.<br /><br />To prevent endogenous infections during endoscopy, measures such as antibiotic prophylaxis and rigorous hand hygiene should be implemented. Exogenous infections, which are transmitted from patient to staff, can occur through various modes such as needlestick injuries, blood splashes, inhalation of microorganisms, and direct handling of patients. Healthcare workers in endoscopy units are at a higher risk of certain infections, including H. pylori. Universal precautions, such as consistent hand hygiene and proper personal protective equipment, should be followed to prevent patient-to-staff transmission of infections.<br /><br />Exogenous infections can also occur from patient to patient, particularly if there are lapses in endoscope reprocessing. Inadequate reprocessing of endoscopes and accessories, as well as improper handling of IV sedation tubing and reuse of needles, can contribute to these infections. Various organisms have been reported to be transmitted between patients during endoscopy procedures.<br /><br />Proper reprocessing of endoscopes is crucial to prevent infections. A framework for endoscope reprocessing is provided, outlining the steps involved in cleaning, disinfection, rinsing, drying, and storage. The challenges of reprocessing specialized endoscopes, such as duodenoscopes, are also discussed. Duodenoscopes have been associated with infectious outbreaks, and factors contributing to contamination include the complex design of the distal end of the scope, internal working channels, and human factors.<br /><br />Several measures can be taken to enhance endoscope reprocessing, including double high-level disinfection, sterilization, culture and quarantine, and single-use or detachable distal caps. The importance of staff training and competency in reprocessing procedures is emphasized.<br /><br />In summary, preventing infections in endoscopy units requires a multidisciplinary team approach and adherence to recognized infection control practices and reprocessing protocols. While some progress has been made in reducing infections associated with standard endoscopes, challenges remain in preventing infections related to specialized endoscopes. Further research and work are needed to address these challenges.

Keywords

infection control

endoscopy procedures

reprocessing of endoscopes

endogenous infections

exogenous infections

bacteremia

hand hygiene

patient-to-staff transmission

duodenoscopes

reprocessing protocols