Question

Part A: Mrs. Jones enters the hospital for a routine endoscopy for esophageal erosion which is not responsive to prescription drugs. The procedure goes well, however, Mrs. Jones becomes quite ill with an infection and has to be readmitted to the hospital for sepsis and nearly dies. During a meeting to conduct a root cause analysis, the gastroenterologist blames the endoscopy room nurse and the nurse blames the vendor. You are the VP of GI services and your bottom line is turning red. What would be the appropriate steps to take at this point in time? Part B: In a subsequent investigation, the infectious disease team discovers the solution sold to clean the endoscopes was not removing all the contaminants. The FDA announces a halt to all endoscopic procedures with this equipment and the cleaning solution. What are your next steps?

Answer 1

As a VP of GI services, i will ensure the compliance of staff working in endoscopy room to infection control protocol which will include following aspects:

• hand washing hould be made mandatory with alcohol based rub or soap and water . use of gloves in case patient has chlostridium deficile infection
• respiratory precautions should be taken in the patient undergoing endoscopy is having respiratory infection like tubercuosis.
• endoscopic procedures should be performed in negative pressure room such that the direction of the air flow is from the outside adjacent space into the procedure room.
• After the endoscopic procedure, exposed surfaces should be thoroughly cleaned of visible contaminants and then disinfected with an Environmental Protection Agency–registered hospital disinfectant.
• rigorous cleaning of endoscopic unit with bleach containing disinfectant is needed when  patient with or suspected of having, C difficile or norovirus undergo an endoscopic procedure. Also, isolation precautions that are otherwise indicated in patients who are potentially infected should be maintained when patients are transported to endoscopy units. For some patients, convenience or isolation requirements may require performance of an endoscopy at the bedside, rather than in the endoscopy unit.
• safe use of needles should be practised in endoscopy room. Proper disposal of sharps in puncture proof containers should be ensured.
• single-dose vials should be used, all medications should be labeled, reuse of syringes to enter a medication vial or solution should be prohibited, and the same syringe should not be used to administer medications to multiple patients.
• Gown gloves, mask and eyewear should be worn in which contact with blood- borne pathogens or other potentially infectious materials might be anticipated. Of note, personal protective equip ment should never be reused and must be removed when the wearer leaves a procedure room.
• Written plan should be prepared addressing the terminal cleaning of all procedure rooms, including methods and chemical agents for cleaning and disinfecting the procedure space at the end of the scheduled procedure day. The terminal cleaning process should include cleaning of all surfaces in the procedure room sufficient to remove all soil and biofilm, followed by proper disinfection. This requires use of 2 distinct agents because chemical disinfec- tants are not effective at cleaning, and cleaning agents are not effective at disinfecting surfaces. Agents for terminal cleaning should have efficacy in spore removal, which may differ from requirements for agents used in sterile operating rooms.
• A training and competency assessment program should be in place for staff who are involved in terminal cleaning to ensure proper and safe handling and use of the chemicals.