Endoscopic GI procedures provide a valuable, life-saving screening tool for the prevention of a wide array of diseases and disorders. However, as simplistic and routine as these may seem on the surface, having comprehensive infection prevention processes in place during GI procedures is a critical and often overlooked step in preventing exposure of your patients, staff, and entire facility to the easily avoidable risks associated with infectious GI pathogens.
In a hospital or ambulatory care setting, there exists no department or patient care area where encountering potentially infectious enteric (GI) bacteria is a more certain and predictable occurrence than during the course of an endoscopic GI procedure. In these procedures, a long flexible endoscope is intended to extensively explore the tissues of the GI tract, which is the ultimate home to many of the most notorious bacterial pathogens, including C. difficile, Enterobacteriaceae (think CRE), Enterococci (including VRE), and a host of other bloodborne pathogens and viruses frequently implicated in hospital infection. Hospital and other healthcare facility infection control processes are often plagued by patients who develop infections from these GI borne pathogens, most of which are known to be extensively transmitted from environmental surfaces. GI endoscopy is often a tool used for the differential diagnosis of many enteric infections, and has long been among the CDC’s top risk factors for the development and transmission of C. difficile. Even so, the critical need to implement common sense strategies to contain these types of pathogens during endoscopic procedures is all too often minimized. Often these are regarded as “dirty, non-sterile procedures,” almost as if this somehow implies that reasonable controls and hygiene measures and are not even necessary to prevent the introduction of bacteria and pathogens into the rest of a facility.
When it comes to infection control and safety during endoscopic GI procedures, discussions have generally focused on scope reprocessing and injection safety. Add in the required reviews of hand hygiene compliance and PPE use to meet OSHA requirements and the bases are all covered, right? Maybe not so fast.
In issuing its “Guidelines for safety in the gastrointestinal endoscopy unit,” the ASGE (American Society for Gastrointestinal Endoscopy, 2014) calls for the elimination of “gaps” along the continuum of care that can negatively impact patient safety. In recognition of these risks, the ASGE guidelines necessitate the development and implementation of a specific infection prevention plan to prevent the transmission of pathogens in GI endoscopy units. This includes a thorough evaluation of the activities that take place from the pre-procedure through discharge in order to protect the health and safety of both patients and care providers.
The CDC has implicated GI bacteria as 2 of its top 3 “Urgent Threats” for the development of multi-drug resistant infection. Furthermore, potentially infectious GI pathogens have been shown to quickly and extensively spread throughout a facility via cross-transmission to a wide variety of environmental surfaces. In accordance with these known risks, current APIC (Association of Professionals in Infection Control and Epidemiology) Guidelines highlight the need for expanded focus on containment strategies for potentially infectious GI pathogens in all procedural areas. After all, is it not both sensible and responsible to contain source pathogens in the very areas of a facility where they are most predictably encountered?
The thorough reprocessing of the flexible endoscopes implemented during these procedures is without question, the single most important (and common sense) component of ensuring the hygiene of equipment used. However, is it not equally important to assure their safe and sanitary handling and storage between uses? In terms of injection safety and sharps handling, these well defined processes must be considered and integrated across the continuum of patient care in endoscopy. This is especially critical due to the predictable nature of the biopsy forceps and snares in repetitively contacting the scope channels as well as the tissue and mucous membranes of a patient. Should these not receive at least a similar level of attention as a needle used for injection or IV line insertion, with standardized handling processes in place to prevent the opportunity for contamination and cross-transmission during an endoscopic GI procedure?
When evaluating infection prevention processes across the endoscopic GI continuum, one of the most commonly overlooked (and preventable) risks of introducing infectious bacteria and pathogens into the hospital or patient care environment is inherent to the traffic patterns and procedure flow within an endoscopy department. In contrast to an aseptic (sterile) surgical environment, during which a patient is transferred to a fixed surgical table and a defined “field” established to differentiate “clean” from potentially contaminated surfaces and equipment, a GI endoscopy patient remains on the same stretcher from admission through discharge. Movement patterns within the “dirty, non-sterile” environment of endoscopy suite are not as standardized, with biopsy snares, for instance, often being moved in and out of the immediate procedure area between uses. The linens, handrail, frame, mattress and exposed patient surfaces are readily contaminated by the bacteria and pathogens through contact with the exterior scope surface, dirty gloved hands, and in the secretions and droplets generated during a GI procedure. Unless adequate containment measures are instituted within the procedure room, these source pathogens are left to move with the stretcher and patient from the endoscopy suite to the PACU or post-procedure areas, and later through the hallways, elevators, and inpatient units during transport.
The routine terminal cleaning of endoscopy stretchers, which takes place after a patient has been transported to their inpatient room or discharged as an outpatient, is often relied upon as a rationale for addressing the contamination present on these surfaces known to occur during use. It has been well established, however, that cross-transmission of infectious pathogens begins as soon as a bacterial source achieves mobility, via high touch surfaces in a hospital environment. In an endoscopic setting, this transmission is set in motion as the stretcher and patient first exit the procedure room headed for recovery. In a PACU or recovery setting, significant contact with a contaminated cart and patient occurs incidentally and repetitively during interactions with staff (who do not typically wear PPE), family members, and anyone else present in the immediate care area, hallways, or entrances. Potentially infectious source pathogens have now found their unwitting “vectors” for extensive and ongoing cross-transmission, with risks increased exponentially given the number of procedures performed on a daily or weekly basis.
In light of the increasing risks and costs associated with HAI’s (healthcare-associated infections), especially those caused by bacteria known to originate from the GI tract, facilities are compelled to objectively assess their current processes and eliminate infection control “gaps” across the endoscopy care continuum. The implementation of comprehensive, common sense strategies designed to adequately meet the predictable exposure risks during these important procedures is a critical step to ensuring the safety of patients and staff members alike.
The need for identification and increased awareness of these risks in endoscopic settings, and the implementation of appropriate containment strategies, is an intrinsic component of effective infection control processes. Basic principles indicate that preventing an initial source of potentially infectious bacteria or pathogens at the first point of encounter is the most effective means of interrupting the cycle of contamination and cross-transmission that leads to hospital infections. Current guidelines, along with a healthy dose of common sense, indicate that this is particularly applicable in endoscopic GI settings as the risks of exposure and spread of potentially infectious GI pathogens is not only predictable and recurring, but also a very preventable event.
Still not convinced? Consider the following question as a litmus test to the effectiveness of current practices and infection control “gaps” at your hospital or surgery center:
A Simple, Cost Effective Solution to Endoscopy Infection Control Gaps
The ENDODRAPE® Endoscopy Containment Systems from Vortek Surgical provide a simple to use, cost effective solution to efficiently and effectively containing pathogens and OPIM, protecting stretcher 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 for cross-transmission as stretchers 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 barrier that is quickly deployed prior to the start of a procedure. This barrier establishes a “Zone of Protection,” shielding the patient, linens, and stretcher 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 stretcher throughout the procedure (and protect expensive endoscopes from unnecessary wear and damage), integrated pockets to facilitate and standardize the safe management of snares and biopsy forceps, and readily accessible gauze sponges.
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.
For additional information regarding the benefits of implementing the ENDODRAPE® Containment Systems, or to view our educational video about enhancing infection control in GI endoscopy, please visit www.endodrape.com or contact Vortek Surgical at (888) VORTEK-1.