Okay, thank you for the kind introduction and to our course directors, Sonali and Neil, for the invitation to participate in this terrific program. So I do have a couple of disclosures, though there is no conflict either real or perceived with these two companies. So what's being found in our endoscopy unit? So flexible endoscopy is an invaluable diagnostic tool, right? Our GI endoscopy units tend to be busy environments. The prevention of infections is a never-ending challenge. Typically we have a plethora of staff on hand. We have doctors, trainees, we have nurses, nurse anesthetists, medical assistants, technicians and clerics, all with a gambit of tasks to perform from very simple to very complex tasks. So they all need to have proper training on infection prevention principles. There's no threat of an infection, right? Unfortunately, there has been significant interest of regulators into infection prevention practices within healthcare settings. So let's take a peek at what the accreditation agencies are finding, and this is a slide that illustrates from the Joint Commission for 2023 of ambulatory care centers of findings. And in the top ten, infection prevention deficiencies were noted for the top two standards. So instrument processing, high-level disinfection, adherence to MIFU was cited in that first standard. And then the second standard relates to the facility's written IP policies, hand hygiene, and PPE practices. So when we look at hospitals, we find a familiar finding with that first standard and with office-based endoscopy as well. So there's been keen scrutiny into our practice. When we look at the IP practices, the cartoon suggests that endoscope reprocessing is the focus of an IP program, and in all sincerity, it's been since the occurrence of the multidrug-resistant endoscope-associated infections in the recent years, it has been. However, IP in the endoscopy unit is much deeper and broader than endoscope reprocessing, and we're going to explore additional areas of our practice which have found to be problem-prone. So again, with endoscope reprocessing being a component of our IP practice, we have to look beyond it as well. A few areas which have been observed to be noncompliant have been irrigation tubings that were not changed appropriately, such as single-use tubings that were used for multiple patients, 24-hour tubings that were used beyond the time duration, failure to utilize a check valve with tubing, reusable water bottles that have been found to be processed incorrectly, as well as other reusable devices that weren't processed correctly, such as bite blocks, cleaning brushes, and retrieval baskets. And proper handling of syringes, IV tubings, needles, and single- and multidose syringes as well. Poor handwashing continues to plague our IP efforts, environmental concerns to provide a clean environment, and also PPE practices. However, PPE practices have improved since the pandemic, and that's been a good result. So patient-ready endoscopes are the lifeblood of our practice, right? Without them, our units come to a quick gridlock. Ensure there are provisions in your policies and procedures to govern your endoscope reprocessing practices, policies which are inclusive of education, training, and skill verification of all caregivers who are responsible for endoscope reprocessing. Be certain, be certain that this skill verification is documented. Part of the standard for staffing of a unit may include that proper reprocessing staff are available for the duration and the operation hours of your unit. I find that caregivers take their job quite serious and wish to do the best for their patients. However, there may be a backward creep of practice that occurs. This may be so gradual, and it may be overlooked. So as managers, we must be very observant of our practices to detect any backward movement and creeps that may go undetected. Occasionally, these creeps become unintentionally the way things are done within the unit and leads to an unintentional normalization of deviance in our practice that may lead to infection prevention breaches. So this is a grid that shows the nine steps of endoscope reprocessing. Failures can occur in any one of these categories as scope reprocessing is one step built upon the other. Whilst pre-cleaning is performed within the procedure room, be sure that when you're monitoring the reprocessing process to take a look into the room to ensure that endoscope reprocessing, that pre-cleaning or point-of-use testing, which it is known as, is performed correctly. Deficiencies that have well been noted within the endoscope reprocessing realm have contributed to everything from brushing to flushing. This was a study that showed these findings, but I also want to make mention that other failures noted include the wearing of PPE correctly as well as not performing the MEC testing of our disinfectant solution according to the MIFU of the testing strips. So ensure that that testing is done and our documentation of our scope reprocessing is done. Also don't forget there are additional components of scope reprocessing and instrument reprocessing we cannot take for granted. We have to be certain that planned maintenance is performed of our AERs and other equipment that we utilize in reprocessing and make sure that these PMs are well documented. This would include AER preventive maintenances as well as planned maintenance, changing of the AER filters and other water filtration filters as well as storage cabinet filters that many of us have now. Don't forget to document and log any QA that is required for channel flushing pumps and document the cleaning of your endoscope storage cabinets as well. Be certain to date your MEC strips when they are open to ensure that they are not used beyond the expiration date and also inspect any equipment within your reprocessing unit such as cart trolleys that may become contaminated with bio-burden over a period of time. While we look at the steps of reprocessing, we also must be aware of any occupational concerns that may interfere with caregivers performing their duties in the reprocessing room. This may affect their efficacy in performing the task of endoscope reprocessing. Environmental hygiene and maintaining a clean sanitary environment is paramount. As well as our professional relationship with the patient, the physical appearance of our practice will make a great impact on the opinion of your facility. We often don't have a second chance to provide a good first impression. So good environmental hygiene goes way beyond looking for stained ceiling tiles, debris on the floor and walls that require patching and painting. Be observant for torn upholstery as well on stretchers, wheelchairs and other furniture. These tattered surfaces, while unattractive, are not able to be sanitized and disinfected correctly. This includes our stretchers, our carts, our gurneys. Be sure that they're clear of any dust bunnies or any blood that has dripped down from IV starts. Make sure that any patient care equipment that has been cleaned is found in a clean position. These are leads that were found on the floor in a patient ready cubicle. And we love to use storage bins as well. So when we use storage bins, make sure that they are also cleaned and don't have debris left within them. And as Dr. Maid mentioned in our previous presentation, make sure that staff are knowledgeable on the cleaning and sanitation of our glucometers. These little devices have also been found to be a hot item with surveyors and regulators. Due to supply chain issues, many organizations are receiving different sanitizing and disinfection wipes. So make sure you know, and all staff know, the wet time for that wipe because it will be asked. Be certain that the caps are closed tight and there's no dangling participles hanging out of that container, which may dry out and not be effective. Even though I wash stations fall under the environment of care standards, make sure that they are clean of debris. There's no hard water stains on the unit and make sure they are kept in unobstructed access as well. Storage is a perpetual problem with and challenge within all of our units, though we want to make sure that things are easily available to us at our items. But let's don't use adhesive tape to hold them up so they can be found quickly or store them on the floor or under a shelf because those are no-nos. And we want to make sure that we protect any of our items from potential cross-contamination. Any items that are shipped in corrugated cardboard outside packing containers, we want to remove them from those cardboard containers and place them into another receptacle. Medication practices, safe medication practices, injection, and sharp safety is mandatory. Surveyors and other personnel can observe a lot just by watching, so remember to scrub the hub. Deficiencies noted regarding medication administrations are the reuse of syringes and needles and single-use vials as well as the misuse of multi-dose vials. Proper labeling and security of medications is a must as well and always ensure that medications are wasted in the proper fashion. Sharps containers also fall within the realm of the environment of care, but being sure that they're not overfilled, be sure that they are clean so that there's no visible bio-burden on the nozzles to the device, and do not use these sharp containers to house patient care items. They're an easy drop-off for tape, oxygen tubing, nasal cannulas, and what have it. They're considered a contaminated surface and we don't want to put patient-ready devices on them. PPE, ensure that all sizes of PPE is readily available for the staff members. PPE is worn once and discarded. Masks are not meant to be used for crumb catchers, so ensure that they're in the up position when they're worn. If you have the masks that have the ties, the two-tie system, ensure that both ties are properly fashioned. Additional noted deficiencies have been staff that have facial hair or not wearing beard covers as well as in the reprocessing room when they're wearing hair covering that there's dangling earrings outside the hair cover. Additional findings have been gowns that have been used multiple times, hanging on the back of doors, slung over chairs, so PPE should be worn once and discarded, and PPE should not be worn outside your procedural room. Hand hygiene, the basic element of infection prevention, ensure that hand hygiene audits are performed on all caregivers. This is just an example of the cumulative compliance of the unit. This is also a nice area that you can share with any regulatory surveyors that come because you can shoo up some time with talking with them on your unit on what a smart job you're doing with hand hygiene. And we always want to have a culture of safety within our GI unit. Leadership participation is crucial, it's crucial to promote infection prevention practices. Also having an open and safe environment where all staff members can speak up. It needs to be inclusive of the medical and nursing leadership, administrative leadership, and include members of your general staff as well to have infection prevention and control meetings. All staff have and need appropriate education and training on infection prevention principles and access to policies, the MIFUs, and SDS for the chemistries that you have in your department. Annual and ongoing IP education and training for all staff members. When we look at resources for infection prevention, the ASGE has a wonderful paper on infection control during endoscopy that's available. Also mentioned in our previous presentation was the ASGE multi-society paper on endoscope reprocessing, which is quite useful and beneficial, and as noted, the SG&A just updated in May their standards for infection control in the GI settings. So all good resources for you to help build a sound reprocessing practice. So that's the end of this presentation that I have, and I thank you for your attention.

infection prevention

GI endoscopy

sterilization protocols

staff training

environmental hygiene