Do you think that scope cleaning/decontamination/sterilization methods, products and compliance are improving year to year? Which are improving and which aren’t?
Yes, I believe all three are improving: Methods are becoming simplified by the addition of more sophisticated machines, some of which accomplish elements of the process independently, and many of which document their performance more completely than in the past; products are improving, with both the noted developments in automated reprocessing machines, as well as alternate cleaning solutions with shortened contact times; and compliance is gradually improving with the increasing emphasis and publicity given to lapses in reprocessing and the intensified oversight given during both accreditation and surveys from state health departments.
Compliance is also enhanced by the increasing attention lent to it by the professional societies, including excellent training videos from the Society of Gastroenterology Nurses and Associates (SGNA) and the focused emphasis on infection control in the quality courses and the Endoscopy Unit Recognition Program of the American Society for Gastrointestinal Endoscopy (ASGE).
Do you think mandatory technician certification would improve overall quality of scope and device cleaning?
No, I don't believe that mandatory technician certification would significantly improve overall quality of endoscope and device cleaning. These tasks are straightforward. I believe their performance is primarily dependent upon provision of basic training, consistency, diligence, and appropriate supervision. I don't believe the challenge in accomplishing them relates to difficulty in understanding or complexity. They are done by a variety of personnel.
For all staff involved in these activities, including technicians and varied levels of nursing staff, appropriate training and competency testing is already mandated, and existing accreditation and state licensure processes provide opportunities for review and audit of competency records. I believe mandated certification of a focused class of staff would provide similar training and assurance of competency, with reduced flexibility of staffing and greatly increased expense to individual staff and endoscopy facilities.
Several important messages are present in the newly updated “Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011,” including: 1. High- level disinfection is highly efficacious when appropriately performed; 2. reported infections after gastrointestinal endoscopy frequently relate to inappropriate medication administration and not reprocessing lapses at all; 3. in those few instances when guidelines for performance of HLD differ between specialty groups or between practitioners and manufacturers, there are insufficient data to deem one or another guidance as superior or correct; 4. and when considered as a whole, the pertinent professional societies of nurses, physicians, and infection control experts are in remarkable agreement regarding appropriate disinfection practices for safe delivery of gastrointestinal endoscopic services.
This guideline can be found on ASGE’s website at www.asge.org under Practice Guidelines, or at this direct link http://www.asge.org/PublicationsProductsIndex.aspx?id=352.