Cross-Contamination From Anesthesia Equipment

Gregory K. Applegate, DO; Robert J. Sherertz, MD; Lynne A. Thomas, BSN, RN, CGRN

Q&A

Q Dear Q&A,

Do you have any advice about the most up-to-date guidelines regarding the cleaning and processing of dirty fiberoptic scopes? Specifically, I am curious as to whether there is a national trend for anesthesiology departments to develop a tracking system for each individual fiberoptic scope. This might include the date, medical record number, anesthesia provider, and the anesthesia technician involved with the cleaning.

I have been practicing anesthesiology in Washington, DC, for the past 3 years and have taken a particular interest in difficult airway techniques and equipment. Having evaluated endoscopy inventory and issues involving maintenance, I believe that the implementation of an endoscope tracking log would provide multiple benefits involving issues with infection, maintenance, and accountability.

Thanks for your time.
Sincerely,
Gregory K. Applegate, DO
Washington, DC

A Dear Dr. Applegate,

Thank you very much for your question to the APSF. We have initiated some investigation with experts in this field. Meanwhile, you might also propose your question to the Newsletter editor, in the form of an APSF “Poll Question” to determine whether this type of specific tracking is unique to isolated hospitals or widespread.

The Committee on Technology
Anesthesia Patient Safety Foundation

A Dear Dr. Applegate,

The recommendations are that each time a patient is scoped, that you record on a log the scope that was used. That way, if a problem develops, you can easily determine others that may have been exposed. For example, you might recall the recent large hepatitis B exposure in Las Vegas. The cited reference is a good one. Recommendation number 24 is quoted here for a specific answer to your tracking question:
24. Maintain a log for each procedure and record the following: the patient’s name and medical record number (if available), the procedure, the date, the endoscopist, the system used to reprocess the endoscope (if more than one system could be used in the reprocessing area), and the serial number or other identifier of the endoscope used. Strongly recommended.1

Reference

  1. Rutala WA, Weber DJ. Reprocessing endoscopes: United States perspective. J Hosp Infect 2004;56 (Suppl 2):S27-39.

Sincerely,
Robert J. Sherertz, MD
Section Head, Infectious Diseases
Department of Internal Medicine
Wake Forest University School of Medicine
Winston-Salem, NC

A Dear Dr. Applegate,

The applicable standards and recommended practices are listed below. The Joint Commission establishes standards and not specifics. . . . I believe these areas address the need of effective endoscope leak testing, cleaning, and reprocessing and its documentation.

The Joint Commission’s Comprehensive Accreditation Manual for Hospitals—2009

  • EC.02.01.01 The hospital identifies safety and security risks associated with the environment of care. Risks are identified from internal sources such as ongoing monitoring of the environment, results of root cause analyses, results of annual proactive risk assessments of high-risk processes, and from credible external sources such as Sentinel Event Alerts. The problems identified in the VA system this year are considered sentinel events.
  • EC.04.01.01 The hospital establishes a process for continually monitoring, internally reporting, and investigating medical equipment management problems, failures, and user errors.
  • IC.01.03.01 The hospital prioritizes the identified risks for acquiring and transmitting infections. These prioritized risks are documented.
  • IM.01.01.01.01 The hospital plans for managing information. The hospital identifies the internal and external information needed to provide safe, quality care.
  • PI.01.01.01 The hospital collects data to monitor its performance. EP.1 The leaders set priorities for data collection. EP.2 The hospital identifies the frequency for data collection. The hospital collects data on: EP.3 performance improvement priorities identified by leaders. EP.4 operative or other procedures that place the patients at risk of disability or death. EP.16 Patient perceptionand services.

    Professional societies are the entities that are more specific in issuing standards and recommendations for their membership. In addition to the information listed here, there are several recommended practices that the AORN has in reference to flexible endoscopes that were updated and published in this year’s version of their recommended practices. One can probably put their hands on this book of documents through their Director of Surgery. Here are the referenced links:
    http://www.apic.org/AM/Template.cfm?Section=Topics1&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=6381

    Item 23 discusses logs.

    http://www.sgna.org/Resources/3_stdofinfectionFINAL1208_2.pdf

    The bottom of page 8 and top of page 9 discusses logs. The American Society of Anesthesia Technologists and Technicians do not have a standard for practice at www.asatt.org.
    Finally, a comprehensive response to this question would include reference to a bulletin issued December 3, 2009, from the FDA (http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm194411.htm) for those consumers who currently process their intubation scopes in the STERIS System 1 processors: “The FDA has not determined whether the SS1 is safe or effective for its labeled claims, including claims that it sterilizes medical devices.”

Thanks for your interest in the maintenance of safe patient care outcomes.

Lynne A. Thomas, BSN, RN, CGRN
lynnethomas@imsready.com
Clinical Endoscopy Specialist
Vice President of Education
IMS The InstrumentReady Company


Numerous questions to the Committee on Technology are individually and quickly answered each quarter by knowledgeable committee members. Many of those responses would be of value to the general readership, but are not suitable for the Dear SIRS column. Therefore, we have created this simple column to address the needs of our readership.


The information provided is for safety-related educational purposes only, and does not constitute medical or legal advice. Individual or group responses are only commentary, provided for purposes of education or discussion, and are neither statements of advice nor the opinions of APSF. It is not the intention of APSF to provide specific medical or legal advice or to endorse any specific views or recommendations in response to the inquiries posted. In no event shall APSF be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with the reliance on any such information.