Techniques in Gastrointestinal Endoscopy最新文献

Other considerations: Perspective and obligations of our societies and governmental organizations 其他考虑因素：我们的社会和政府组织的观点和义务

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-10-01 DOI: 10.1016/j.tgie.2019.04.007

Bret T. Petersen MD

{"title":"Other considerations: Perspective and obligations of our societies and governmental organizations","authors":"Bret T. Petersen MD","doi":"10.1016/j.tgie.2019.04.007","DOIUrl":"10.1016/j.tgie.2019.04.007","url":null,"abstract":"<div><p><span>Recurrent episodes of transmitted infection during gastrointestinal endoscopy have resulted in heightened visibility of the various organizations providing education, guidance, and regulatory oversight for </span>endoscopes<span> and the practice of endoscopy. They include the Food and Drug Administration, the Centers for Disease Control and Prevention, state health departments, accrediting organizations, and national medical societies representing practitioners and nurses. The Food and Drug Administration is responsible for ensuring the safety of manufacturer's products, without constraining the availability of critical medical services, such as gastrointestinal endoscopy. Their ongoing oversight of postmarket surveillance studies, and the results of such studies, will significantly influence the expectations for reprocessing in years to come. As a nonregulatory body, the Centers for Disease Control and Prevention primarily provides investigational expertise pertaining to infectious outbreaks and guidance to the medical industry regarding best practices, with input from the medical experts in their Hospital Infection Control and Professional Advisory Committee. National societies of nurses, reprocessing professionals, and physicians all provide education and guidance to the field, each with viewpoints ostensibly protective of patients and their membership. The Association for the Advancement of Medical Instrumentation, which publishes standards detailing the proper production quality for medical instruments and the procedures in which they are used, is in the midst of rewriting their guidance for reprocessing of gastrointestinal endoscopes. Despite reservations about process, Advancement of Medical Instrumentation deliberations emphasize the original guidance of the Spaulding Criteria for sterilization of semicritical devices, including endoscopes, when feasible and practicable. This is likely the future state for reprocessing in gastrointestinal endoscopy.</span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2019.04.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43435521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Reprocessing of flexible endoscopes: Scientific rationales and patient safety implications 柔性内窥镜的后处理：科学依据和患者安全意义

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-10-01 DOI: 10.1016/j.tgie.2019.150628

J. Hudson Garrett Jr. PhD, MSN, MPH, FNP-BC, PLNC, IP-BC, FACDONA, FAAPM, FNAP , Cindy Winfrey MSN, RN, IP-BC, CIC, FACDONA

{"title":"Reprocessing of flexible endoscopes: Scientific rationales and patient safety implications","authors":"J. Hudson Garrett Jr. PhD, MSN, MPH, FNP-BC, PLNC, IP-BC, FACDONA, FAAPM, FNAP , Cindy Winfrey MSN, RN, IP-BC, CIC, FACDONA","doi":"10.1016/j.tgie.2019.150628","DOIUrl":"10.1016/j.tgie.2019.150628","url":null,"abstract":"<div><p>Proper reprocessing of flexible endoscopes<span> in gastroenterology<span><span> practice is a critical element of a comprehensive patient safety and infection control strategy in both the inpatient and outpatient healthcare setting. This effort requires an interprofessional approach consisting of collaboration between the endoscopist and multiple other facility stakeholders including reprocessing professionals, nursing, infection prevention and control, biomedical engineering, and patient safety professionals. Recent advancements in human factors engineering has demonstrated a high reliability in validated and standardized reprocessing efforts for flexible endoscopes with properly trained reprocessing personnel and appropriate resources to execute the overall reprocessing process. A continued and concerted effort must be paid to maintaining the safety of these devices through focus on personnel, processes, and a continued innovative engineering of the devices themselves. While flexible endoscopes play a pivotal role in delivering diagnostic and therapeutic medical capabilities to endoscopists, their use is not without risk and require a comprehensive approach to </span>medical device hygiene and integrated infection prevention and control.</span></span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2019.150628","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43465695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Medicolegal aspects of ERCP in the era of duodenoscope-related infections 十二指肠镜相关感染时代ERCP的法医学方面

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-10-01 DOI: 10.1016/j.tgie.2019.07.009

Peter J. Hoffman , Albert Bixler , Brooke M. Alston , Andrew J. Bond , Andrew D. Feld

引用次数: 1

Endoscope-associated infections: A microbiologist's perspective on current technologies 内镜相关感染：微生物学家对当前技术的看法

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-10-01 DOI: 10.1016/j.tgie.2019.150625

Grace Thornhill PhD, Maren David MS

{"title":"Endoscope-associated infections: A microbiologist's perspective on current technologies","authors":"Grace Thornhill PhD, Maren David MS","doi":"10.1016/j.tgie.2019.150625","DOIUrl":"10.1016/j.tgie.2019.150625","url":null,"abstract":"<div><p>In the wake of several highly publicized endoscope-associated multidrug-resistant organism (MDRO) outbreaks, healthcare providers have focused on understanding and improving endoscope reprocessing practices. Microbiological culture of endoscopes has emerged as a critical tool in support of these efforts. As healthcare providers increasingly rely on microbiological culture results to make decisions that impact patient safety, it is important to understand the limitations of the methodology as well as the factors that may impact results. The use of traditional cultures in combination with molecular methods has enabled the investigation of disease transmission during outbreaks. With increased prevalence of MDROs, advanced molecular techniques like whole-genome sequencing provide high resolution data and information on the entire bacterial genome that are needed for thorough investigations and management of transmission events. Elucidation of the true burden of postprocedure patient colonization and infection would benefit from improved clinical lab access to molecular biology tools. Molecular biology tools would facilitate detection of emerging MDROs and ever-increasing diversity of antibiotic resistance genes. Implementation of postprocedure surveillance programs aimed at early recognition of colonized and infected patients could improve appropriate management of endoscope infected patients and guide infection prevention measures to prevent the spread of MDROs.</p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2019.150625","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46565586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

Introduction and overview of endoscope-associated infections 内窥镜相关感染的介绍和概述

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-10-01 DOI: 10.1016/j.tgie.2019.150624

Andrew Ross MD, Michael Gluck MD

引用次数: 1

Duodenoscope-related infections: Overview and epidemiology 十二指肠镜相关感染:综述和流行病学

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-10-01 DOI: 10.1016/j.tgie.2019.150623

Jennifer T. Higa MD

引用次数: 4

Getting to zero: Enhanced reprocessing and future directions 归零：强化后处理和未来方向

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-10-01 DOI: 10.1016/j.tgie.2019.150626

M. Phillip Fejleh MD , Jennifer Phan MD , Neil B. Marya MD , Stephen Kim MD , Zachary A. Rubin MD , V. Raman Muthusamy MD

引用次数: 2

Optimizing flexible endoscope reprocessing 优化柔性内窥镜再加工

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-10-01 DOI: 10.1016/j.tgie.2019.150627

Andrew Ross MD, Michael Gluck MD

引用次数: 0

Endoscope-associated infections: A brief summary of the current state and views toward the future 内镜相关感染：现状的简要总结和对未来的看法

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-10-01 DOI: 10.1016/j.tgie.2019.04.006

Arjan W. Rauwers MD, MSc , Judith A. Kwakman MD, MSc , Margreet C. Vos MD, PhD , Marco. J. Bruno MD, PhD

{"title":"Endoscope-associated infections: A brief summary of the current state and views toward the future","authors":"Arjan W. Rauwers MD, MSc , Judith A. Kwakman MD, MSc , Margreet C. Vos MD, PhD , Marco. J. Bruno MD, PhD","doi":"10.1016/j.tgie.2019.04.006","DOIUrl":"10.1016/j.tgie.2019.04.006","url":null,"abstract":"<div><p><span>World-wide reports of duodenoscope-associated outbreaks of multidrug resistant micro-organisms are an indication that transmission of infection via contaminated </span>endoscopes occurs more frequently than previously thought. To reduce the incidence of endoscope contamination, open communication between manufacturers, institutions, and government agencies is urgently needed. Endoscope risk factor studies and thorough investigation of outbreaks by experts are instrumental in lowering and ultimately eliminating infections. These studies should yield improvements in endoscope design, endoscope reprocessing, as well as hospital surveillance and infection control measures. Current reprocessing methods have a very small margin of safety, allowing no room for error. Strictly following the manufacturer's instructions regarding reprocessing does not adequately guarantee complete removal of micro-organisms. New reprocessing measures to reduce contamination show promising results, but they are costly to implement and do not assure zero contamination risk. Redesign of endoscopes to facilitate better cleaning and ultimately sterilization instead of disinfection might provide a solution. Going forward, the focus should extend beyond the forceps elevator to include the entire instrument since every aspect of the duodenoscope can be contaminated by infectious organisms. Single-use duodenoscopes would completely eliminate the risk of transmission of exogenous micro-organisms, but they not the Food and Drug Administration-approved, and are likely to be costly and of unproven efficacy. Indeed, balancing cost-effectiveness of any redesign or use of disposable endoscopes with the actual risk of transmitting exogenous micro-organisms will ultimately determine which solutions are adopted and utilized.</p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2019.04.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43059751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 14

Optimizing ergonomics during endoscopy training 优化内窥镜检查训练中的人体工程学

Techniques in Gastrointestinal Endoscopy Pub Date : 2019-07-01 DOI: 10.1016/j.tgie.2019.07.002

John T. Anderson MD, FRCP

引用次数: 11