Download Infection Control

©2013 MFMER | slide-1
INFECTION CONTROL AND
PREVENTION
IN ENDOSCOPY
©2013 MFMER | slide-2
Introduction
CDC estimates that each
year nearly 2 million
patients in the United
States get an infection in
hospitals, and about
90,000 of these patients
die as a result of their
infection.
©2013 MFMER | slide-3
OBJECTIVES:
Discuss the role of healthcare workers and today’s
challenges in infection control.
Discuss preventative measures taken in
Ambulatory and Inpatient settings reduce infection
Demonstrate the role of proper hand hygiene in
infection prevention
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OBJECTIVES CONT.
Explain the types of infections and risk associated
with specific Endoscopic procedures.
Evaluate the increased risk of infection with
possible variations in endoscope cleaning
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Discuss the role of healthcare workers and
today’s challenges in infection control.
Hand Hygiene:
Clean hands are the single most important factor in
preventing the spread of pathogens and antibiotic
resistance in healthcare settings. Hand hygiene
reduces the incidence of healthcare associated
infections.
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 Disinfection of procedure room and all sites
used for endoscopy:
 To prevent cross-contamination in an endoscopic
procedure room, most areas of the room should be
designated as clean areas. Contaminated areas
where accessories and specimens are handled
should be separated from clean counter areas.
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 Cont.
 All contaminated areas must be cleaned
and decontaminated between patients with
an Environmental Protection Agency (EPA)
registered, hospital-grade disinfectant
appropriate for the specific microorganism
(Rey et al., 2005; Rutala et al., 2008).
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 HEALTHCARE WORKERS IN
ENDOSCOPY SHOULD BE EDUCATED IN
ALL OF THE FOLLOWING AREAS:
Reprocessing procedures for endoscopes and
accessory equipment
Standard Precautions
Personal Protective Equipment
OSHA rules on occupational exposure to bloodborne pathogens
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 Cont.
 Mechanisms of disease transmission
Maintenance of safe work environment
Safe handling of high level disinfectants
(SGNA 2010)
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Discuss the role of healthcare workers and
today’s challenges in infection control.
Healthcare workers are the first line of defense
against infection
They have the power to break the cycle or allow it to
continue
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 Cont.
Healthcare workers have an obligation to speak up
if they see something that is not in line with proper
protocol
No one should proceed in the face of uncertainty.
Stop and resolve.
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 Many patient care devices and items are
designed to be used with one patient and
often only one time. These items are
considered disposable and must not be
resterilized or reused. Read the
manufacturer’s directions to be sure how a
device is intended to be used. Healthcare
workers should have extensive knowledge of
such items and their recommendations
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 Challenges
Fiscal restraint
Time
Increase in patient volume
Lack of proper education
Staffing shortages
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Demonstrate the role of proper hand
hygiene in infection prevention
Video: Hand Hygiene
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Explain the types of infections and risk
associated with specific Endoscopic
procedures.
Two endoscopic procedures with an
increased risk of infection are:
MRSA post PEG placement
Post ERCP Infection
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 MRSA POST PEG PLACEMENT
One study evaluated the risk of MRSA infection
post PEG placement. They investigated the impact
of known prior MRSA colonization on the incidence
of symptomatic PEG site wound infection and
mortality.
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 RESULTS
A total of 83 patients underwent PEG placement;
23 (28%) of these patients had known MRSA
colonization before PEG placement. Of these, 13
(57%) developed symptomatic MRSA infection of
the PEG site. The remaining 60 patients (72%) had
no known prior MRSA colonization.
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 Results Cont.
In these patients, 9 (15%) developed symptomatic
MRSA infection of the PEG site. The overall
incidence of wound infection was 37% (31) of the
total undergoing PEG placement, of whom 71% (22)
had developed MRSA infection. The mortality of
those with symptomatic MRSA infection of the PEG
site was 9% (2/22), whereas the mortality from nonMRSA-infected PEGs was 20% (12/61).
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 Results Cont.
The impact of methicillin-resistant
Staphylococcus aureus (MRSA)
colonization of percutaneous endoscopic
gastrostomy (PEG) sites on morbidity and
mortality is uncertain.
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 RESULTS CONT.
Patients with prior MRSA colonization had a
significantly higher risk of developing
symptomatic MRSA infection of the PEG
site. However, there was still a significant
risk (15%) of developing MRSA infection of
the PEG site for patients with no known
prior MRSA infection. MRSA infection of the
PEG site did not affect mortality
(Mainie I, Loughrey A, Watson J, Tham TC 2006).
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 POST ERCP INFECTION
Infection is one of the most morbid
complications of endoscopic retrograde
cholangiopancreatography (ERCP) and
among the most common causes of ERCPrelated death.
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 Cont.
Septic complications of ERCP include
ascending cholangitis, liver abscess, acute
cholecystitis, infected pancreatic
pseudocyst, infection following perforation
of a viscus
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 Post ERCP infection cont.
In the 1980s, cross infection via contaminated
endoscopes and ancillary ERCP equipment, such
as cannulation catheters, was implicated in severe
cases or outbreaks of septicemia from
pseudomonas. (Motte,1991)
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 Cont.
• Improvements have been made in endoscope
reprocessing and handling of ERCP tools and
equipment in the years since. A significant risk,
however, still remains.
(Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F.
Incidence rates of post-ERCP complications: a systematic survey of
prospective studies. Am J Gastroenterol. Aug 2007;102(8):1781-8)
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Evaluate the increased risk of infection with
possible variations in endoscope cleaning
©2013 MFMER | slide-26
 Endoscope Reprocessing
FLEXIBLE ENDOSCOPE REPROCESSING HAS
BEEN SHOWN TO HAVE A NARROW MARGIN OF
SAFETY. ANY SLIGHT DEVIATION FROM THE
RECOMMENDED REPROCESSING PROTOCOL
CAN LEAD TO THE SURVIVAL OF
MICROORGANISMS AND AN INCREASED RISK OF
INFECTION
©2013 MFMER | slide-27
 Cont.
Variations in manual cleaning can increase the risk
of infection due to unacceptable amounts of
bacteria left behind
Manufacturer recommendations are vitally
important in the manual cleaning process
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A recent study conducted in 5 hospitals
nationwide revealed that 3 of the 20
gastroscopes tested were shown to harbor
unacceptable levels of bacteria. These
results were presented at the APIC annual
conference in June 2013. The results were
broken down and categorized
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Instrument
Failure Rate,
Duodenoscope (n = 30)
Gastroscope
(n = 116)
Colonoscope (n = 129)
%
30
24
3
(Bommarito, 2013)
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How can we improve these results?
Patients are essentially waiting for these
endoscopes to be disinfected and made ready for
use. With an increase in patient volumes, a certain
amount of stress has been added.
"It might be a good idea to look at ways to alleviate
that time pressure so that the technicians have
more time to reprocess that scope in a less
stressful way”- Dr. Bommarito
Endoscope cleaning is very labor intensive.
Technicians are sometimes on their feet
consistently for an 8 hour period of time.
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 Cont.
More data should be collected to evaluate the
contamination level prior to manual cleaning.
Shortening the work shift or rotation of work
stations may help alleviate this issue
If you have a scope that has a higher amount of
contamination prior to disinfection, your
disinfection process may be impaired. (Bommarito
2013)
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"The expectation that we would see no
failures was perhaps a high benchmark, but
clearly, we would like no endoscopes to fail a
cleanliness rating," he said (Bommarito) here
at the APIC (Association for Professionals in
Infection Control) 2013 Annual Meeting
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 Conclusion
 Hold each other accountable
Take the time to do the right thing
Treat each patient as if they were your family
member
Address issues as they happen
Be “in the know” when it comes to infection control
practices. Education is the foundation for success..
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Q&A
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