infection risk," says Dr. Rutala, a professor in the division of infectious
diseases at the University of North Carolina's School of Medicine.
"Although the incidence of post-procedure infection remains very low,
endoscopes represent a significant risk of disease transmission."
Sterilizable scopes by 2018?
Dr. Rutala will recommend to the U.S. Food and Drug Administration
that it mandate that all GI scopes be sterilizable by 2018. A scope you
could steam sterilize would be a "game-changer," says Donna Nucci,
RN, BSN, CIC, an infection preventionist at Yale New Haven (Conn.)
Hospital. "Nobody is going to get to zero microbial contamination all
the time. Even if you're following the new CDC guidelines, that might
not be enough."
The good news, says Dr. Rutala, is that there are steps you can take
today to help prevent GI scope cross-transmission, including the use
of disposable sterile GI endoscopes, and such non-endoscope meth-
ods to diagnosis or treat disease as capsule endoscopy. Based on out-
break data, Dr. Rutala estimates that you can eliminate about 85% of
outbreaks if you curb deficiencies associated with what takes place in
the soiled utility room: cleaning, disinfection, automated endoscope
reprocessors (AERs), contaminated water and drying.
Nosocomial infections via GI endoscopes are linked to several defi-
cient practices, says Dr. Rutala.
• Failing to bedside clean. The pre-clean involves removing debris by
wiping the scope's exterior and aspiration of detergent through biopsy
channels. Are your techs consistent in their bedside pre-cleaning of
scopes, or does this all-important step sometimes fall by the wayside in
the rush to turn over a room? "That initial manual clean is every bit as
important as what the AER is going to do in terms of high-level disin-
fection," says Erica Natal, BSN, MHA, MBA, director of clinical servic-
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