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.
- ASGE. Guidelines for safety in the gastrointestinal endoscopy unit. 2014. Accessible at: www.giejournal.org.
- Szymczak T. Rethinking C. difficile Prevention: Expanding Our Awareness and Necessary Prevention Efforts. Accessed at http://endodrape.com/blog/?p=293. December 2013.
- 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.
- Kramer A, et al. “How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.” BMC Infectious Diseases 2006, 6:130.
- CDC Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007.
- CDC Vital Signs. Making Health Care Safer: Stopping C. difficile infections. March 2012.
- 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
- CDC Guidelines for Environmental Infection Control in Health-Care Facilities, 2003.
- CDC Guidelines for Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006.
- Cohen SH. Et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 SHEA/IDSA Update.
- CDC: Antibiotic Resistance Threats in the United States, 2013. Access: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf.
- Association for Professionals in Infection Control and Epidemiology. Guide to Preventing Clostridium difficile Infections. APIC, 2013.
- APIC. 2013 Clostridium difficile infection (CDI) Pace of Progress Survey. http://cdiff2013.site.apic.org/files/2013/03/APIC-SurveyFinal1.pdf
- The Joint Commission. National Patient Safety Goals 2013. Accessed at www.jointcommission.org/assets. January 2013.
- CDC. Frequently Asked Questions about Clostridium difficile for Healthcare Providers. http://www.cdc.gov/hai/organisms/cdiff/cdiff_faqs_hcp.html. Accessed July 2013.