The Pulse | Tuesday, October 16, 2018

Infection Prevention: Changing Methods and Saving Lives

Infection prevention is such a pivotal part of any gastroenterological professional’s life. It’s hard to believe there was ever a time when it wasn’t a primary concern. Even in the past 10 years, new research and better practices have led to significantly safer facilities and improved patient care. SGNA asked five professionals about the changes they’ve seen, and what those milestones mean to them.

Loralee Kelsey, BSN, RN, CGRN: “In the last five years there has been a greater public awareness of the risks to patients if infection prevention standards are not followed. The CRE infections transmitted by ERCP scopes received international media attention and was instrumental in changing practice in our department. We upgraded our scopes, perform ATP testing after the manual clean and double disinfect prior to the drying phase, and place a tag indicating a seven day expiration date. We also are quick to send the scopes in for evaluation to ensure the integrity of the scopes are maintained.”

Karen Zervopoulos, RN, CGRN, CFER: “A few that stand out are increased efforts to assure proper hand hygiene. Not only are facilities auditing staff periodically for hand hygiene practices, some are installing video cameras, using personalized badges that prove hand hygiene practices were completed, and other methods to assure proper hand hygiene was achieved. Another milestone is the advances in our practices for reprocessing endoscopes. The challenges in duodenoscope reprocessing and resistant CRE bacteria provided changes and safety measures to the GI community.  Manufacturer instructions have been revised and the CDC and FDA have taken steps to assure the safety of our patients. Certification for endoscope reprocessing staff is now strongly recommended by professional organizations.”

Kelly Osborne, MSN, APRN, CNS-BC, CGRN: “Endoscope management over the past five years has completely changed. Health systems are now partnering with their endoscope manufactures to develop collaborative best practices for improved patient care. The management of the endoscope is highly regulated by the FDA and CDC to ensure patient safety. Healthcare systems have better support, educational resources and guidelines to ensure consistent practices. The major milestones I have been a part of have been converting to disposable products like water bottles and endoscope buttons and product review of transport trays, ATP testing and endoscope dryers. Additionally, over the past year I have been involved in a health system wide committee as a strategic priority to develop HLD supportive roles, a HLD structured educational program and improved audit tools that mirror the CDC and FDA guidelines.”

Nancy Denton, SGNA Director: “Infection prevention is probably the single biggest area that has changed in the field of gastroenterology from my prospective in the last three to five years.  With the advent of the superinfections that were transmitted through a contaminated ERCP scope, we all have seen tremendous scrutiny and attention to detail on all aspects of scope cleaning and disinfecting. The use of technology in tracking the time each step that scope cleaning is performed.  Frequent changes to the process as new areas of concern arise causes confusion for the staff. The focus of the Joint Commission on Endoscopy has put us in the spot light, and I would think from my unit’s point of view under a great deal of pressure.  I don’t think we have seen an end to the changes we will see. I think in the next few years we will have a cost effective scope that will be available for general use.”

Beverly Levanti, BSN RN CGRN CASC: “One of the biggest changes in the last three to five years has been the focus on biofilm and how quickly it can develop if proper steps are not followed. It is every patient's right to have a properly reprocessed endoscope, therefore, all endoscopy staff must follow every step in the reprocessing procedure, from pre-cleaning to proper drying and storage of endoscopes."