Gastroenterological Endoscopy. Группа авторов
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Название: Gastroenterological Endoscopy

Автор: Группа авторов

Издательство: Ingram

Жанр: Медицина

Серия:

isbn: 9783131470133

isbn:

СКАЧАТЬ head nurse should be in charge of the unit for the day, and at least one other handling the recovery area. Lower level staff can be trained to perform cleaning and disinfection effectively, and to assist with recovery duties. However, the procedure-related nurses should maintain their skills in handling those functions and may occasionally rotate through these areas. Since emergency procedures performed outside of regular hours are often the most difficult and dangerous ones, it is essential to have GI nursing staff on 24-hour call. This also ensures a more consistent approach to cleaning and disinfection of endoscopic equipment for patient safety. The extent to which the nurse manager is involved in actual procedures will depend on the size of the unit. In a department with four or five procedure rooms, the nurse manager should allocate at least half of his or her time for office and managerial activities. The amount of secretarial assistance will depend on the methods used for scheduling and reporting. An appropriate technician must be available if radiography equipment is in use—not only to assist with the procedures, but also to help in maintaining and monitoring radiation safety standards.

      References

      [1] Mulder CJJ. The endoscopy unit. In: Tytgat GNJ, Mulder CJJ, eds. Procedures in Hepatogastroenterology. 2nd ed. Dordrecht: Kluwer Academic; 1997:345–53

      [2] Riphaus A, Wehrmann T, Weber B, et al; Sektion Enoskopie im Auftrag der Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen e.V. (DGVS). Bundesverband Niedergelassener Gastroenterologen Deuschlands e. V. (Bng). Chirurgische Arbeitsgemeinschaft für Endoskopie und Sonographie der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung e. V. (DCCV). Deutsche Gesellschaft für Endoskopie-Assistenzpersonal (DEGEA). Deutsche Gesellschaft für Anästhesie und Intensivmedizin (DGAI). Gesellschaft für Recht und Politik im Gesundheitswesen (GPRG). S3-Guidelines–Sedation in endoscopy. Z Gastroenterol. 2008; 46(11):1298–1330

      [3] Working Party of the Clinical Services Committee of the British Society of Gastroenterology. Provision of gastrointestinal endoscopy and related services for a district general hospital. Gut. 1991; 32(1):95–105

      [4] Lennard-Jones JE, Williams CB, Axon A. Provision of Gastrointestinal Endoscopy and Related Services for a District General Hospital: Report of the British Society of Gastroenterology. London: British Society of Gastroenterology; 1990

      [5] Mulder CJJ, Tan AC, Huibregeste K. Guidelines for designing an endoscopy unit: report of the Dutch Society of Gastroenterologists. Endoscopy. 1997; 29(1):I–VI

      [6] Phillip J, Allescher H.D., Hohner R. Endoskopie: Struktur und Ökonomie. Bad Homburg, Eaglewood, NJ: Normed Verlag, International Medical Publishers; 1998

      [7] Waye JD, Rich ME. Planning an Endoscopy Suite for Office and Hospital. Tokyo: Igaku-Shoin Medical; 1990

      [8] Staritz M, Alkier R, Krzoska B. et al Zeitbedarf für endoskopische Diagnostik und Therapie: Ergebnisse einer Multicenterstudie. Z Gastroenterol 1992; 30(8):509–518

      [9] Phillip J, Sahl RJ, Ruus P. Zeitaufwand für endoskopische Untersuchungen. Z Gastroenterol. 1990; 28(1):1–9

      [10] Burton D, Ott BJ, Gostout CJ, DiMagno EP. Approach to designing a gastrointestinal endoscopy unit. Gastrointest Endosc Clin N Am. 1993; 3:525–540

      [11] Sivak MV, Senick JM. The endoscopy unit. In: Sivak MV, ed. Gastroenterologic Endoscopy. Philadelphia, PA: Saunders; 1987:42–66

      [12] Axon ATR. Staffing of endoscopy units. Acta Endosc. 1989; 19:213–216

      [13] Lennard-Jones JE, Slade GE. Report of a working party on the staffing of endoscopy units. Gut. 1987; 28(12):1682–1685

      [14] Marmarinou J. The autonomous endoscopy unit. Designing it for maximum efficiency. AORN J. 1990; 51(3):764–773, 766, 768–769 passim

      [15] Marasco JA, Marasco RF. Designing the ambulatory endoscopy center. Gastrointest Endosc Clin N Am. 2002; 12(2):185–204, v

      [16] Seifert E, Weismüller J. How to run an endoscopy unit? Experience in the Federal Republic of Germany. Results of a survey of 31 centers. Endoscopy. 1986; 18(1):20–24

      [17] Denzer U, Beilenhoff U, Eickhoff A, et al; Deutsche Gesellschaft für Gastroenterologie, Verdauungs-und Stoffwechselkrankheiten. S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021–022 [in German] Z Gastroenterol. 2015; 53(12):1496–1530

      [18] Beilenhoff U, Neumann CS, Rey JF, et al; ESGE Guidelines Committee. European Society of Gastrointestinal Endoscopy. European Society of Gastroenterology and Endoscopy Nurses and Associates. ESGE-ESGENA Guideline: cleaning and disinfection in gastrointestinal endoscopy. Endoscopy. 2008; 40(11):939–957

      [19] Neumann CS, the members of the ESGENA Education. Working Group ESGENA Statement: Staffing in endoscopy. 2008. Available at: www.esgena.org/statements-curricula

      [20] Dumonceau JM, Riphaus A, Aparicio JR, et al. ESGE-ESGEGA-ESA guideline: non-anesthesiologist administration or propofol for GI endoscopy. Endoscopy. 2010; 42:960–974

      6 Cleaning and Disinfection in Endoscopy

       Bret T. Petersen

      6.1 Introduction

      Cleaning and disinfection of endoscopes are critical safety and quality tasks that all gastrointestinal endoscopy departments must be attentive to. The soiled environment in which endoscopes are used yields a significant bioburden for cleaning and eradication before their reuse in subsequent patients. The complexity of endoscope design further challenges the task of producing a microbe-free instrument. Our recognition of reprocessing requirements and adoption of standardized approaches to reprocessing developed slowly over several decades.1 The Spaulding criteria for critical instruments, which are those that contact intact but contaminated mucosal membranes, stipulate that reprocessing should achieve, at a minimum, high-level disinfection (HLD). This level of reprocessing eradicates all living bacteria, viruses, and most spores, unless present in high numbers. Current international guidelines for HLD all espouse stepwise processes, which include precleaning at the bedside, thorough submersion and manual cleaning, standardized disinfection by exposure to approved liquid chemical germicides (LCGs) at specific parameters, and followed by rinsing, drying, and appropriate storage. Recent outbreaks of infections subsequent to endoscopic retrograde cholangiopancreatography (ERCP) have been attributed to persistent contamination at the elevator mechanisms, despite appropriate reprocessing. This has prompted interim advice to ensure optimal training and oversight of cleaning staff while intensifying attention to all standard steps of HLD, plus consideration of local benefit of use of double reprocessing cycles, ethylene oxide sterilization after each procedure, adenosine triphosphate (ATP) testing to assay the adequacy of the cleaning phase of reprocessing, and intermittent or per procedure endoscope cultures after full HLD.

      Recurring clusters of infections, primarily related to lapses in standard reprocessing steps, have repeatedly focused the attention of the medical community and the broader regulatory and patient communities on the issue of reprocessing. This has culminated in the development of multiple national and international standards and guidelines for reprocessing, from many affiliated medical and technical specialty groups. Despite differences in detail and specificity, most existing guidelines are highly uniform in their requirements.2,3,4,5,6,7

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