Feb
12

ASGE Guidelines Call for the Elimination of Gaps in Endoscopy Infection Control to Ensure Safety

The American Society for Gastrointestinal Endoscopy (ASGE) recently issued its “Guidelines for safety in the gastrointestinal endoscopy unit,”1 emphasizing the need for updated processes and procedures to ensure patient and staff safety during the delivery of care in endoscopic GI procedure areas.

 

These newest guidelines, as developed by the ASGE Ensuring Safety in the Endoscopy Unit Task Force, establish the need to evaluate current processes and update practices in place to eliminate the infection control gaps along the continuum of care in endoscopy units, as these gaps can negatively impact both patient and staff safety.  In addition to adherence to meticulous endoscope reprocessing and observation of safe injection practices, the updated ASGE  Guidelines expand the “scope” of necessary infection prevention focus to identify and prevent opportunities for transmission within the endoscopy unit and facility as a whole.  These guidelines compel the careful evaluation of traffic patterns throughout the delivery of care, assessing activities performed, and encompassing transitions spanning preprocedure, intraprocedure, and postprocedure phases of the care provided.  Performing the recommended infection prevention risk assessment is critical to the identification of steps along the continuum of care delivery with the highest risk for exposure to infectious GI bacteria, bloodborne pathogens, and OPIM.  If not adequately addressed in a comprehensive infection prevention plan, these pathogens can present risks for ongoing transmission and cross-transmission and compromise the safety of other patients, staff, and a facility as a whole.  This type of start-to-finish analysis should serve as the foundation for the development of the recommended endoscopy-specific infection prevention plan, and establishment of ongoing educational opportunities and competency evaluations, that are critical to ensuring delivery of care in a hygienic and safe facility environment.

 

Though generally regarded as safe, there is perhaps no other procedure performed in a healthcare facility where the generation of GI bacteria and OPIM is as predictable and repetitive an occurrence as during a GI endoscopy.2  The GI tract has been increasingly recognized in guidelines and research as a source of HAI-causing (Healthcare Associated Infection) bacteria and pathogens.3-7  For more than a decade, GI manipulations and surgeries have been included among the highest risk factors for acquiring infections caused by C. difficile, which can result in life-threatening forms of CDAD (C. difficile-associated diarrhea).8-10   However, outside of monitoring the reprocessing procedures for GI endoscopes, only limited attention has been paid to the risks for ongoing dispersal of GI bacteria and OPIM into the PACU and other environmental surfaces within a facility as patients and gurneys are transported from the procedure room after completion.  Since two of the CDC’s top three “Urgent Threats” for developing dangerous antibiotic resistance (C. difficile and CRE) originate exclusively from the GI tract,11 increased focus on eliminating potential sources and risks of GI bacteria is critical. Unless adequate steps are implemented during GI endoscopy procedures to correct this gap and contain source bacteria at the initial point of contact, this can result in unnecessary and avoidable exposure and cross-transmission risk for other patients, staff, and even visitors in a procedure area and throughout a healthcare facility.12-15

 

Though the generation of GI bacteria and OPIM during endoscopy procedures is predictable, its dissemination and cross-transmission risks are also preventable.  Recognizing its presence is the first important step.  Identifying and eliminating gaps along the infection control continuum, including the proactive management of bacteria, secretions and OPIM generated during endoscopy procedures, can greatly reduce or eliminate risks it can pose outside of the immediate procedure area.

 

Consider for a moment that at the conclusion of an endoscopy procedure, flexible endoscopes are carefully contained and sent for meticulous reprocessing, and gowns and gloves are immediately removed and disposed of, both in recognition of the contamination and cross-transmission risks involved.  Yet, the patient, gurney, and linens are moved out of the procedure room and handed off to recovery staff or transport personnel as if no contact or exposure to contamination had ever occurred.  Once a patient and gurney cross the door threshold of the procedure room, all bets are off as to where any bacteria or other potentially infectious pathogens can end up, especially as recovery staff or transport personnel may not be aware of the imminent risks present.  It looks clean so it must be clean, right?  Where else would this pass the scrutiny of infection control?

 

A Simple, Efficient Solution to Eliminating a Common Endoscopy Infection Control Gap

The ENDODRAPE Endoscopy Containment Systems from Vortek Surgical provide a simple solution to efficiently and effectively containing pathogens and OPIM, protecting gurney surfaces and linens from contact and contamination during GI endoscopy procedures.

 

Similar to the PPE worn by endoscopy personnel, the ENDODRAPE systems efficiently establish the recommended protective barrier to prevent contamination of high touch surfaces during the procedure, consistently providing effective containment within the procedure room.  Preventative containment of bacteria and pathogens at the initial point of contact eliminates risks of these becoming moving vectors from cross transmission as gurneys and patients are transported from the procedure room into PACU/recovery, or moved through other patient care areas through facility hallways and elevators.

 

The ENDODRAPE systems are comprised of a comprehensive, fluid-resistant barrier that is quickly deployed prior to the start of a procedure.  This barrier establishes a “Zone of Protection”, shielding the patient, linens, and gurney surfaces from contamination during an endoscopic GI procedure.  Specifically designed for use in GI endoscopy, the ENDODRAPE systems also incorporate a number of procedure enhancing components, including a modifiable scope guard to effectively assist in maintaining the scope on the gurney throughout the procedure( and protect expensive endoscopes from unnecessary wear and damage), integrated pockets for containing snares and biopsy forceps, and readily accessible gauze sponges in its integrated pocket.

 

Upon completion of the procedure, the ENDODRAPE is quickly removed and disposed of, along with any contamination, disposable supplies and accessories.  The implementation of the ENDODRAPE establishes a functional protective barrier in an integrated self-contained system that promotes procedural process flow and equipment protection.

 

Additional information regarding the benefits of implementing the ENDODRAPE Containment Systems and an educational video about enhancing infection control in GI endoscopy is available at  www.endodrape.com or by contacting Vortek Surgical at (888) VORTEK-1.

 

REFERENCES

  1. ASGE.  Guidelines for safety in the gastrointestinal endoscopy unit.  2014.  Accessible at:  www.giejournal.org.
  2. Szymczak T. Rethinking C. difficile Prevention: Expanding Our Awareness and Necessary Prevention Efforts.  Accessed at http://endodrape.com/blog/?p=293.  December 2013.
  3. Stiefel U and Donskey CJ.  The Role of the Intestinal Tract As a Source for Transmission of Nosocomial Pathogens.  Current Inf Disease Reports. 2004;6:420-25.
  4. Kramer A, et al.  “How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.” BMC Infectious Diseases 2006, 6:130.
  5. CDC Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007.
  6. CDC Vital Signs.  Making Health Care Safer: Stopping C. difficile infections.  March 2012.
  7. Kim KH et al.  Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis.  J Infect Dis 1981:143(1):42-50
  8. CDC Guidelines for Environmental Infection Control in Health-Care Facilities, 2003.
  9. CDC Guidelines for Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006.
  10. Cohen SH. Et al.  Clinical Practice Guidelines for Clostridium difficile Infection in Adults:  2010 SHEA/IDSA Update.
  11. CDC: Antibiotic Resistance Threats in the United States, 2013.  Access:  http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf.
  12. Association for Professionals in Infection Control and Epidemiology.  Guide to Preventing Clostridium difficile Infections.  APIC, 2013.
  13. APIC.  2013 Clostridium difficile infection (CDI) Pace of Progress Survey. http://cdiff2013.site.apic.org/files/2013/03/APIC-SurveyFinal1.pdf
  14. The Joint Commission. National Patient Safety Goals 2013.  Accessed at www.jointcommission.org/assets.  January 2013.
  15. CDC.  Frequently Asked Questions about Clostridium difficile for Healthcare Providers. http://www.cdc.gov/hai/organisms/cdiff/cdiff_faqs_hcp.html.  Accessed July 2013.

Oct
28

Rethinking C. difficile Prevention

Rethinking C. difficile Prevention

Expanding Our Awareness and Necessary Prevention Efforts

Clostridium difficile infection, commonly referred to as CDAD, CDI, or simply C. diff, is one of the greatest infection control challenges facing our healthcare system today.  Within the past decade, we have witnessed patient mortality from this deadly GI bacteria skyrocket more than 400% with the emergence and evolution of even stronger strains1.  The CDC reports that C. diff causes more than 60% of the 23,000 patient deaths it estimates that occur every year from bacteria that has become resistant to the very antibiotics used to treat them1.  Even this may be grossly underestimated, with independent research suggesting a nearly 8 times (8X) higher rate of mortality, exceeding 109,000 patients annually, from C. diff alone2.  This equates to five patients contracting CDI every minute of every day, and one patient death every 5 minutes from this preventable, though deadly infection2.  The economic costs of C. diff are devastating as well, at up to $35k for a single inpatient infection and annual cost estimates ranging from $3 billion to more than $20 billion in the U. S. alone 2-5.  Based on the the critical nature of these risks, the CDC has recently classified C. diff as #1 among Urgent Threats for antibiotic-resistant pathogens, joined only by CRE (Carbapenem-resistant Enterobacteriaceae) and drug-resistant Neisseria gonorrhoeae in this highest risk category.1

Despite the significant amount of research focused on reducing the risks and controlling the threat of C. diff, admittedly only limited progress has been made in the efforts to tackle this problem that continues to threaten our hospitals and healthcare facilities.  In its recent “Pace of Progress” survey, the Association for Professionals in Infection Control (APIC, 2013) stated that even with infections caused by C. diff reaching historic highs, only 42% of facilities have seen any decline in their rates of C. diff -related HAI’s over the past 3 years.6  This same survey reflected an even greater number of facilities (43%) reporting they had been unable to reduce CDI infection rates despite the adoption of additional CDI intervention measures at a vast majority of facilities.

To continue and download the FREE Whitepaper, click here (PDF):

Rethinking C difficile Prevention_2013

 

Mar
15

2013 APIC Guide Expands C. difficile Prevention Efforts to Procedure and Outpatient Care Areas

The newly updated 2013 APIC “Guide to Preventing Clostridium difficile Infections” provides a valuable resource for healthcare professionals and facilities committed to reducing the prevalence of healthcare -associated infections (HAI’s).  Clostridium difficile infections (CDI) affect more than 7,000 inpatients on any given day (5 every minute), costing up to $51.5 million a day, or as high as $18.5 billion annually.  Factor in the mortality rates of up to 300 patients a day (1 every 5 minutes) in one study, and it is no surprise that C. difficile is increasingly referred to as one of the greatest infection control challenges facilities face today. 

The CDC estimates that 94% of C. difficile infections are connected to receiving medical care, including patients seen in hospitals, nursing homes, outpatient centers, and even office settings.  In response to the growing prevalence and risks associated with exposure to C. difficile, the recently updated APIC Guide includes the establishment of containment strategies in both inpatient and outpatient procedure areas (endoscopy, surgery, diagnostic labs, etc).  The implementation of processes to minimize transmission risks as patients are transported to or receive care in these areas include the following: 1) evaluation of patient flow and placement, 2) appropriate use of PPE, 3) enhanced observation of Contact Precautions (to include the use of disposable drapes to protect equipment surfaces from becoming contaminated during procedures), and 4) communication and education efforts regarding the risks of C. difficile.  This expanded focus highlights the critical need for the integration of comprehensive infection prevention protocols throughout the continuum of care as we continue to battle against this highly transmissible and potentially deadly pathogen.

In considering procedure areas and outpatient departments most likely to provide care to patients colonized or infected with C. difficile or other resistant GI pathogens, perhaps none stands out more than an endoscopy/GI lab.  (Table 1 provides an overview of some of the most common GI bacteria and microbiota, though this list is by no means exhaustive.)  Given the nature of the procedures performed in these departments (colonoscopy, sigmoidoscopy), encountering GI bacteria and secretions is not only possible, it is predictable.  Though often regarded as a “dirty, non-sterile procedure,” there (arguably) exists no other department or procedure performed where GI bacteria, secretions, or other potentially infectious materials (OPIM) are as predictably and repetitively encountered.  Colonoscopy or sigmoidoscopy procedures are often performed for the rapid diagnosis or confirmation of C. difficile or pseudomembraneous colitis (PMC) in addition to diagnostic or screening procedures, and can involve a wide demographic of both inpatients and outpatients. 

Endoscopy procedures, by operational definition, are not performed under the more stringent “aseptic” or “sterile field” techniques of a surgical procedure.  However, due to the predictability and nature of potential exposure and origin of pathogens, both Enteric and Contact Precautions should be implemented.    Such precautions should include the use of protective barriers to adequately cover (linens are not barriers) adjacent and high-touch surfaces (gurney, linens, and patient surfaces) that can be removed and disposed of prior to transport from the procedure room.  In the alternative, all exposed surfaces (gurney, frames, hand rails, patient) should be thoroughly cleaned and linens changed prior to moving the patient from the procedure room in order to contain and confine bacterial deposits, secretions, and OPIM.  Given the nature and predictability generating GI secretions and pathogens, containment efforts should be consistently implemented in order to reduce environmental loads and maintain safety for patient staff and a facility.

The ENDODRAPE Endoscopy Containment Systems provide a simple to use, cost effective solution in meeting the Enteric Contact Precautions necessary to contain pathogens, secretions, and OPIM during endoscopic procedures. The ENDODRAPE establishes the barrier protection for high-touch surfaces during the procedure, as recommended by CDC and Joint Commission guidelines. The effective containment of bacteria and secretions generated during these procedures is a critical first step in protecting your patients, staff, and facility from exposure to environmentally mediated GI pathogens.  This can become critically important as patients and gurneys are moved into the recovery area and gurneys used to transport patients to other areas of your facility following an endoscopy procedure.  By containing pathogens at the point of initial contact (or source), the ENDODRAPE provides a valuable tool for reducing risks of infections caused by cross transmission.  The ENDODRAPE promotes cleaner practices during procedures, improves procedural flow and equipment protection, and can substantially reduce procedure room turn-times when compared to the additional interim cleaning processes that would be required.

 For more information on this Best Practice in Infection Prevention and Control, please take just a few minutes to view our educational video at www.endodrape.com/video, or contact us by phone at 888-867-8351 or email at sales@vorteksurgical.com.

 

 

Jan
23

10 Facts Every Healthcare Provider Should Know About C. Difficile

The prevention of healthcare-associated infections (HAI’s) is a key focus of hospitals and health care facilities, and an increasingly prevalent component of Joint Commission and CMS surveys aimed at improving the safety and quality of care. In this era of “smarter,” more resistant pathogens, environmentally mediated bacteria and viruses present ever increasing risks of HAI’s that can negatively impact patient care and devastate a hospitals bottom line. It is well known in current literature that many of the most common, and preventable, HAI’s are caused by bacteria including C. difficile (CDAD), E. coli (UTI, wound infections), and many other bacteria, viruses, and pathogens that originate from the GI tract. Of these, one of the most commonly implicated, and least understood, is C. difficile , which accounts for a significant percentage of the estimated 2 million preventable HAI’s and excess costs up to $45 billion annually.

Recent reports indicate that risks of C. difficile continue to rise, with rates more than doubling in some areas, and CDC reports of C. difficile costs and mortality reaching “Historic Highs.” So how does this happen despite more than 2 decades of enhanced focus on infection prevention, including hand hygiene and emphasis on reducing antibiotic exposure in the fight against C. difficile?

Despite many advances in antibiotic control measures and increased emphasis on hand hygiene compliance initiatives, we still have a long way to go as we continue to gain understanding of this infectious pathogen. Our current experiences show us that to truly contain and prevent HAI’s, including those caused by C. difficile , requires an ongoing commitment to gaining knowledge about these pathogens. Enhancing awareness of the means by which bacteria and pathogens work and spread throughout the care environment is critical to assessing the adequacy of processes and control measures at all levels across the care spectrum. It should be the ongoing goal of any health care facility and organization to identify and eliminate “weak links” in the chain of transmission of this important pathogen.

When considering HAI risks within the continuum of care, facilities should start by identifying and confining potential sources of infectious bacteria and pathogens, and implement processes and protocols to interrupt opportunities for exposure to patients, staff, and surfaces throughout the hospital environment. For example, as commonly implicated bacteria like C. difficile ultimately originate in the GI tract of colonized or infected patients, efforts should be made to contain GI secretions, fluids, or contamination in areas of a facility where predictably or frequently encountered, and prevent inadvertent cross-transmission to patients or surfaces in other areas of the hospital.

It is recommended and accepted practice for a patient admitted for known diarrhea to be proactively placed in contact isolation precautions, with enhanced contact transmission protocols in place. Isolation (enhanced focus on hand hygiene and implementation of enhanced barrier precautions including the use of gowns and gloves for staff and visitors) is intended to reduce the risks of contact and/or cross transmission of any potential GI pathogens (C. difficile , norovirus, E. coli, etc) to other patients or care areas. This not only makes clinical sense, but also common sense right? Of course it does, as we know that diarrhea increases the shedding of GI bacteria and increases the chance of transmission to the surrounding environment where it can quickly be spread to other parts of the facility. After all, such is the purpose of isolation precautions, and the infection prevention case for keeping GI bacteria (which inherently has a high potential for extensive environmental dissemination) contained and confined within a controlled environment before it would have the opportunity to spread.

So what would happen if a patient was wheeled out of an isolation room on their same bed and moved down the hallway to a room with another patient just a few feet away? What if outpatients passed through 2 or 3 care areas on their way to an appointment, even though all of the inpatients had undergone MRSA screening on admission to rule out risks of exposure to other patients or the facility?

Either of these scenarios would make an Infection Preventionist or Risk Manager cringe, as these compromise the effectiveness of any efforts made up to that point in time. Though seemingly unthinkable, occurrences like this take place every day in any procedure or care area where tools and processes are either not available or not implemented to achieve a level of prevention that meets the level of risk.

Consider the under-recognized risks of HAI-causing bacteria that can be introduced to your facility through procedures performed in an ambulatory surgery area. Unlike inpatients, where screening for MRSA is increasingly performed via nasal swab prior to admission, very little is typically known about the potential “carrier” or colonization status of outpatients in ambulatory areas. Factors including procedural or care specific risks of generating or encountering fluids or secretions, proximity or sharing of care areas (i.e.: procedural areas, PACU) and transport equipment, and procedure or care flow should be carefully considered in development of facility wide risk reduction strategies.

Take for instance an endoscopy or GI procedure area, where GI secretions and bacteria are predictably encountered on virtually every procedure performed. Protocols are in place for the reprocessing of flexible endoscopes and the use of PPE based on the perceived level of risk of encountering blood, bacteria and body fluids. However, current risks and infection trends involving uncontrolled and environmentally mediated GI bacteria and pathogens confirm the need for enhancing contact transmission precautions within the immediate procedure area to confine bacteria and secretions within the procedure room. Upon completion of a procedure, the used scope is sealed or contained and taken for reprocessing, and PPE is removed and disposed of, while at the same time the gurney, linens, and even patient surfaces contacted or exposed during the procedure are moved out into PACU to be unwarily placed in close proximity to other patients, staff, or family members.

What if a patient in this scenario was unknowingly colonized with C. difficile ? Or E. Coli? Or some other GI borne bacteria, virus, or other pathogen? Consider the cross-transmission risks in the case of an inpatient transported from PACU to a patient care floor on the same procedure gurney after recovery. Consider the significant reduction in these risks if the clock could be turned back, and bacteria and secretions contained within the procedure room, confined prior to ever moving this patient to recovery.

Though endoscopy areas are by no means the only area within a health care facility where GI bacteria can be encountered, it is arguably one of the most predictable. Eliminating sources of bacteria and pathogens before they have the opportunity to be spread is a critical first step in breaking the chain of infection. When developing a facility-wide “battle plan” for reducing the risks for HAI’s caused by GI mediated bacteria, isn’t looking at procedures where GI-borne bacteria is predictably encountered a good place to start?

Jan
03

Clostridium difficile Rates on the Rise in Illinois

A recent report from Illinois (C. diff Report) indicates that C. difficile rates have more than doubled in the last decade, while MRSA rates have remained steady throughout the last three years.  C. difficile is one of many GI bacteria that account for a significant percentage of the more than 2 million preventable HAI’s, and excess costs of  up to $45 billion in the U.S. annually.

Hand hygiene and antibiotic control have long been the primary components of Infection Control processes aimed at preventing HAI’s, including those caused from GI bacteria like C. difficile , VRE, and E. coli.  Though these are 2 critical components of an overall infection prevention program, growing prevalence of HAI’s over the past 2 decades reinforce the need for a more comprehensive approach that seeks to identify sources of infection risks and implement strategies to interrupt the transmission of bacteria and pathogens throughout a hospital environment.  Identifying potential sources of infectious bacteria like C. difficile , like those implemented for bloodborne pathogens at the onset of the HIV epidemic, is a critical and often overlooked step in establishing comprehensive infection prevention and patient safety protocols.

10 Facts You Should Know About C. Difficile :
1.  The GI tract is the known source (origin) of C. difficile
2. Risk factors for CDAD include advanced age, GI procedures and manipulations, antibiotic exposure, and immunosuppression
3.  C. difficile can be predictably encountered (even in asymptomatic patients) when and where GI secretions are present. (i.e. bathrooms, incontinent patients, rectal lab test materials, GI/endoscopy procedures)
4.  C. difficile can survive on environmental surfaces for 5 months or longer
5.  C. difficile is transmitted via the fecal-oral route from environmental or source surfaces to people (patients, staff, visitors)
6.  Alcohol-based hand sanitizers are not effective against C. difficile spores
7.  Most hospital disinfectants are not active against C. difficile unless they contain bleach
8.  CDAD results when beneficial bacteria in the GI tract is altered by antibiotics and PPI’s, but it takes both exposure to these drugs and the presence of C. difficile to cause infection
9.  CDAD risks and prevalence continue to rise despite more than 2 decades of focus on hand hygiene and antibiotic control, evidencing that more needs to be done to interrupt sources and transmission in healthcare facilities
10.  Mortality rates for patients developing CDAD can be greater than 40%, with recurrence in up to one third of patients following an initial CDAD infection.

Current infection trends and the rising prevalence of highly resistant strains of C. difficile reinforce the need to enhance focus on preventing and controlling opportunities for cross transmission of infectious pathogens in health care environments.  While adequate hand hygiene and judicious use of antibiotics are important components of an overall infection prevention strategy, facilities who rely on these exclusively will remain “behind the curve” in proactively reducing risks of exposure and infection.  Experiences and process changes implemented during the HIV epidemic in the 1980′s resulted in a high level of effectiveness in identification and risk reduction for activities during which blood or blood products were encountered during the delivery of patient care.  As a result, occurrences of transmission of bloodborne pathogens like  HIV/HBV in the healthcare has been drastically reduced, and are almost always associated with a breach in protocols and common sense practices.  The same is equally attainable with infectious pathogens like C. difficile  and similar bacteria by identifying  learning opportunities and correcting weak links in a facility wide exposure control plan.

Aug
15

Welcome To The New Vortek Surgical News Channel

Welcome to Vortek Surgical, your source for cutting edge products and information for infection prevention and improving patient and staff safety during the delivery of healthcare services.

Vortek Surgical is pleased to offer the patented ENDODRAPE Endoscopy Containment Systems.  The ENDODRAPE quickly and efficiently establishes the recommended precautions for effectively

Containing and Confining the bacteria, bloodborne, and other pathogens predictably generated during endoscopic procedures, including colonoscopy, EUS, EGD, ERCP, and many others.  Containing bacteria and pathogens at its origin is the first and most effective opportunity for infection prevention and reduction for the risks of spreading the bacteria that causes Healthcare-Associated Infections (HAI’s).

For anyone interested in identifying and addressing origin and source reservoirs of bacteria in your facility (or if you think you already have all potential bases covered), please take a minute to view the following educational video atwww.endodrape.com/video.

Vortek Surgical also offers the patented EPS-30 Endoscopy Positioning Systems.  These positioning systems are specially designed to provide optimal patient positioning during endoscopic procedures performed in the lateral, supine, prone, or combination of these positions.  The EPS-30 Endoscopy Positioning Systems are available in Standard and Low-Profile versions to meet the unique needs of patients and their facilities.  For more information, please contact us at (888) VORTEK-1 or visit or website at www.vorteksurgical.com.