Gastroenterological Endoscopy. Группа авторов
mixing of used and unused endoscopes and eliminates possible endoscope contamination. Cleaning of endoscopes should be carried out by fully-automated washing and disinfection machines by skilled personal. The unclean areas should contain stainless-steel work surfaces, with a double sink and an ultrasonic bath for initial cleaning. There should be 1.5 m on either side of the sink to position endoscopes. There should be enough room for brushing, ultrasonic cleaner, tightness control, and a compressed-air system for mechanical cleaning. After cleaning and disinfection of the endoscopes, they should be stored either hanging in a closed storage cabinet or in specially designed venting cabinets. There are various venting cabinets that are commercially available.
The entire cleaning process should be controlled by RFID chip or bar code–mediated control of the endoscopes, processing machines, and the venting cabinet. This allows generation of an endoscope “history” where all relevant data from the endoscope are collected in a central data file. These data include time and use of the endoscopes in the individual patients, time and responsible person who cleaned and processed the endoscope, processing protocol, time and success of the disinfection process, and time during transfer of the endoscope to the venting cabinet. With this log file, continuous monitoring of the endoscope use as well as cleaning and processing can be established. These data can be used to define interval for service and evaluation of endoscopes, hygiene controls, and mandatory service procedures.
The capacity of the disinfection equipment and washing machines needed for a given unit depends on the number of examinations, the time planned per examination, and the time needed to clean, disinfect, and dry (cleaning cycle) the endoscope. As vapors from disinfectants need to be removed from the room, a powerful ventilation system has to be in place for the cleaning and processing area to exclude the possibility of inhalation of toxic or allergenic vapors. There should be separate containers for waste, dirty linen, etc. There should be at least one dirty sink.
5.12 Staffing
Assistance for GI endoscopy is a task for fully-trained professional nurses and technicians.12,13,19 The nursing staff carries a major responsibility for patient safety. In some countries, nursing staff can be trained and specialized for administration of sedation and monitoring of the patient during the endoscopic procedure (NAPS nurses).2 In other countries, for example, France, the sedation and administration of sedatives are required to be performed by anesthetists.20
Per European guidelines, there must be one properly trained nurse assistant in each procedure room, and two for any complex endoscopies such as ERCP and sophisticated therapy. One 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
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6 Cleaning and Disinfection in Endoscopy
Bret T. Petersen