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Yang AF, Sherman A, Nazarian E, Haas W, Mehr J, Pedrani M, Kirn T, Brant S, Boruchoff SE, Kaye KS, Mills JP. Evidence of transmission of New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae through a gastrointestinal endoscope without an elevator channel. Infect Control Hosp Epidemiol 2024:1-6. [PMID: 38563218 DOI: 10.1017/ice.2024.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To investigate the source and transmission dynamics of an endoscope-associated New Delhi metallo-β-lactamase-producing Klebsiella pneumonia (NDM-KP) outbreak. DESIGN Epidemiological and genomic investigation. SETTING Academic acute care hospital in New Jersey. PATIENTS Five patients with active NDM-KP infection identified on clinical isolates, and four NDM-KP colonized patients identified via rectal swab screening. RESULTS Over a twelve-month period, nine patients were identified with NDM-KP infection or colonization. Whole-genome sequencing (WGS) revealed that all of the identified cases were related by 25 mutational events or less. Seven of the cases were linked to gastrointestinal endoscopic procedures (four clinical cases and three positive screens among patients exposed to endoscopes suspected of transmission). Two cases demonstrated delayed transmission that occurred five months after the initial outbreak, likely through shared usage of a non-therapeutic gastroscope without an elevator channel. CONCLUSIONS Although all endoscope cultures in our investigation were negative, the epidemiological link to gastrointestinal endoscopes, the high degree of relatedness via WGS, and the identification of asymptomatic NDM-KP colonization among patients exposed to shared endoscopes make the endoscopic mode of transmission most likely. This investigation highlights the probable transmission of NDM-KP via a gastroscope without an elevator channel, observed several months after an initial outbreak. We hypothesize that persistent mechanical defects may have contributed to the delayed device-related transmission of NDM-KP.
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Affiliation(s)
- Ann Fan Yang
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Adrienne Sherman
- Communicable Disease Service, New Jersey Department of Health, Trenton, NJ, USA
| | | | - Wolfgang Haas
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Jason Mehr
- Communicable Disease Service, New Jersey Department of Health, Trenton, NJ, USA
| | - Michele Pedrani
- Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Thomas Kirn
- Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Steven Brant
- Department of Medicine, Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Susan E Boruchoff
- Department of Medicine, Division of Allergy, Immunology, and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Keith S Kaye
- Department of Medicine, Division of Allergy, Immunology, and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John P Mills
- Department of Medicine, Division of Allergy, Immunology, and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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2
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Cimen C, Bathoorn E, Loeve AJ, Fliss M, Berends MS, Nagengast WB, Hamprecht A, Voss A, Lokate M. Uncovering the spread of drug-resistant bacteria through next-generation sequencing based surveillance: transmission of extended-spectrum β-lactamase-producing Enterobacterales by a contaminated duodenoscope. Antimicrob Resist Infect Control 2024; 13:31. [PMID: 38459544 PMCID: PMC10924313 DOI: 10.1186/s13756-024-01386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/03/2024] [Indexed: 03/10/2024] Open
Abstract
Contamination of duodenoscopes is a significant concern due to the transmission of multidrug-resistant organisms (MDROs) among patients who undergo endoscopic retrograde cholangiopancreatography (ERCP), resulting in outbreaks worldwide. In July 2020, it was determined that three different patients, all had undergone ERCP with the same duodenoscope, were infected. Two patients were infected with blaCTX-M-15 encoding Citrobacter freundii, one experiencing a bloodstream infection and the other a urinary tract infection, while another patient had a bloodstream infection caused by blaSHV-12 encoding Klebsiella pneumoniae. Molecular characterization of isolates was available as every ESBL-producing isolate undergoes Next-Generation Sequencing (NGS) for comprehensive genomic analysis in our center. After withdrawing the suspected duodenoscope, we initiated comprehensive epidemiological research, encompassing case investigations, along with a thorough duodenoscope investigation. Screening of patients who had undergone ERCP with the implicated duodenoscope, as well as a selection of hospitalized patients who had ERCP with a different duodenoscope during the outbreak period, led to the discovery of three additional cases of colonization in addition to the three infections initially detected. No microorganisms were detected in eight routine culture samples retrieved from the suspected duodenoscope. Only after destructive dismantling of the duodenoscope, the forceps elevator was found to be positive for blaSHV-12 encoding K. pneumoniae which was identical to the isolates detected in three patients. This study highlights the importance of using NGS to monitor the transmission of MDROs and demonstrates that standard cultures may fail to detect contaminated medical equipment such as duodenoscopes.
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Affiliation(s)
- Cansu Cimen
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands
- Institute for Medical Microbiology and Virology, University of Oldenburg, Oldenburg, Germany
| | - Erik Bathoorn
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands
| | - Arjo J Loeve
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Monika Fliss
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands
| | - Matthijs S Berends
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands
- Certe Medical Diagnostics and Advice Foundation, Department of Medical Epidemiology, Groningen, The Netherlands
| | - Wouter B Nagengast
- Department of Gastroenterology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Axel Hamprecht
- Institute for Medical Microbiology and Virology, University of Oldenburg, Oldenburg, Germany
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands
| | - Mariëtte Lokate
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands.
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3
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Filley GI, Kayastha D, Hayes W, Mehra S, Sherman JD, Eckelman MJ. Environmental Impact of a Direct Laryngoscopy: Opportunities for Pollution Mitigation. Laryngoscope 2024. [PMID: 38379176 DOI: 10.1002/lary.31341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To quantify the environmental impact of standard direct laryngoscopy surgery and model the environmental benefit of three feasible alternative scenarios that meet safe decontamination reprocessing requirements. STUDY DESIGN This is a life cycle assessment (LCA) modeling study. SETTING Yale-New Haven Hospital (YNHH), a 1541-bed tertiary medical center in New Haven, Connecticut, USA. METHODS We performed cradle-to-grave LCA of DLS at Yale New Haven Hospital in 2022, including global warming potential (GWP), water consumption, and fine particulate matter formation. Three alternative scenarios were modeled: disinfecting surgical tools using high-level disinfection rather than steam sterilization, substituting non-sterile for sterile gloves and gowns; and reducing surgical towel and drape sizes by 30%. RESULTS Changes in disinfection practices would decrease procedure GWP by 11% in each environmental impact category. Substituting non-sterile gowns and gloves reduced GWP by 15%, with nominal changes to water consumption. Linen size reduction resulted in 28% less procedure-related water consumption. Together, a nearly 30% reduction across all environmental impact categories could be achieved. CONCLUSIONS Not exceeding minimum Center for Disease Control (CDC) decontamination standards for reusable devices and optimizing non-sterile consumable materials could dramatically reduce healthcare-associated emissions without compromising safety, thereby minimizing the negative consequences of hospital operations to environmental and human health. Findings extend to other non-sterile surgical procedures. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
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Affiliation(s)
- Grace I Filley
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, U.S.A
| | - Darpan Kayastha
- Department of Surgery (Division of Otolaryngology), Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Wesley Hayes
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, U.S.A
| | - Saral Mehra
- Department of Surgery (Division of Otolaryngology), Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, U.S.A
| | - Matthew J Eckelman
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, U.S.A
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4
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Toy G, Colletier K, Hale G, Valentine J, Gawron AJ, Sossenheimer M, Peterson K, Aparicio R, Fang JC. Incidence of retained biopsy specimens after esophagogastroduodenoscopy and colonoscopy. Endosc Int Open 2023; 11:E653-E659. [PMID: 37614326 PMCID: PMC10442972 DOI: 10.1055/a-2098-2470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/03/2023] [Indexed: 08/25/2023] Open
Abstract
Background and study aims In gastrointestinal endoscopy, biopsies must transit through the accessory channel and cap, presenting an opportunity for loss of tissue. We sought to determine the incidence of specimen retention in the accessory channel or cap and identify procedure characteristics associated with specimen retention. Patients and methods After completion of standard endoscopic procedures in which biopsies were obtained, the biopsy cap and accessory channel were inspected, brushed, and irrigated for any retained biopsy specimens according to a standard protocol. For controls, the same protocol was applied to procedures in which biopsies were not obtained. Specimen bottles from the recovery protocol were sent for pathological examination regardless of whether any visible tissue was present. Results A total of 216 outpatient procedures were included: 55 esophagogastroduodenoscopies (EGDs) and 50 colonoscopies in which biopsies were obtained and 56 EGDs and 55 colonoscopies in the control group. Retained specimens were found in either the cap or channel in 50 of 105 (48%). In 20 of 105 (19%), retained specimens were found just in the cap, in six of 105 (5.7%), retained specimens were found just in the channel, while in 24 of 105 (23%), retained specimens were found in both the cap and channel. Retained specimens were more likely to be found in EGDs compared to colonoscopies (58% vs. 36%, P = 0.031). No retained specimens were found in the control group. Conclusions Retained specimens are startingly common in standard gastrointestinal endoscopic procedures and could potentially change diagnoses and management. Quality improvement measures should be instituted to monitor prevalence of retained biopsies and methods to prevent them should be developed.
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Affiliation(s)
- Gregory Toy
- Gastroenterology, University of Utah, Salt Lake City, United States
| | - Keegan Colletier
- Gastroenterology, University of Utah, Salt Lake City, United States
| | - Gillian Hale
- Gastroenterology, University of Utah, Salt Lake City, United States
| | - John Valentine
- Gastroenterology, University of Utah, Salt Lake City, United States
| | | | | | - Kathryn Peterson
- Gastroenterology, University of Utah, Salt Lake City, United States
| | - Rodrigo Aparicio
- Gastroenterology, University of Utah, Salt Lake City, United States
| | - John C Fang
- Gastroenterology, University of Utah, Salt Lake City, United States
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5
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Scholz PM, Kirstein MM, Solbach PC, Vonberg RP. [A systematic analysis of nosocomial outbreaks of nosocomial infections after gastrointestinal endoscopy]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:536-543. [PMID: 37146632 PMCID: PMC10162863 DOI: 10.1055/a-1983-4100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Esophagogastroduodenoscopy (EGD), endoscopic retrograde cholangiopancreatography (ERCP) and colonoscopy (CLN) come with a potential risk of pathogen transmission. Unfortunately, up to now data on the causes and the distribution of pathogens is rather sparse.We performed a systematic review of the medical literature using the Worldwide Outbreak Database, the PubMed, and Embase. We then checked so-retrieved articles for potential sources of the outbreak, the spectrum of pathogens, the attack rates, mortality and infection control measures.In total 73 outbreaks (EGD: 24, ERCP: 42; CLN: 7) got included. The corresponding attack rates were 3.5%, 7.1% and 12.8% and mortality rates were 6.3%, 12.7% and 10.0% respectively. EGD was highly associated with transmission of enterobacteria including a large proportion of multi-drug resistant strains. ERCP led primarily to transmission of non-fermenting gram-negative rods. The most frequent cause was human failure during reprocessing regardless of the type of endoscope.Staff working in the field of endoscopy should always be aware of the possibility of pathogen transmission in order to detect and terminate those events at the early most time point. Furthermore, proper ongoing education of staff involved in the reprocessing and maintenance of endoscopes is crucial. Single-use devices may be an alternative option and lower the risk of pathogen transmission, but on the downside may also increase costs and waste.
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Affiliation(s)
- Paulina Marie Scholz
- Insitute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Martha Maria Kirstein
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Philipp Christoph Solbach
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ralf-Peter Vonberg
- Insitute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
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6
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Sultan S. Gastrointestinal Endoscopy in Patients with Coronavirus Disease 2019: Indications, Findings, and Safety. Gastroenterol Clin North Am 2023; 52:157-172. [PMID: 36813423 PMCID: PMC9678816 DOI: 10.1016/j.gtc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed the practice of gastroenterology and how we perform endoscopy. As with any new or emerging pathogen, early in the pandemic, there was limited evidence and understanding of disease transmission, limited testing capability, and resource constraints, especially availability of personal protective equipment (PPE). As the COVID-19 pandemic progressed, enhanced protocols with particular emphasis on assessing the risk status of patients and proper use of PPE have been incorporated into routine patient care. The COVID-19 pandemic has taught us important lessons for the future of gastroenterology and endoscopy.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 420 Delaware Street Southeast, MMC 36, Minneapolis, MN 55455, USA.
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7
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Perisetti A, Desai M, Bourke MJ, Penman I, Repici A, Reddy DN, Tajiri H, Rex DK, Hassan C, Sharma P. Production and possible reduction of greenhouse gases produced during GI endoscopy activity: a systematic review of available literature. Gut 2023; 72:493-500. [PMID: 36522150 DOI: 10.1136/gutjnl-2022-328369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Greenhouse gases (GHGs) that trap heat in the atmosphere are composed of carbon dioxide (CO2), methane, nitrous oxide and fluorinated gases (synthetic hydrofluorocarbons, perfluorocarbons and nitrogen trifluoride). In the USA, the health sector accounts for 8.5% of total GHG emissions. The primary objective of this systematic review was to critically analyse the carbon emissions data from GI endoscopic activity. DESIGN The GI endoscopy carbon cycle was evaluated at preprocedural, intraprocedural and postprocedural levels. We performed a systematic literature search of articles published on these issues until 30 June 2022 and discussed these available data on endoscopy unit GHG carbon cycle, barriers to reduce GHG emissions and potential solutions. The inclusion criteria were any full-text articles (observational, clinical trials, brief communications, case series and editorials) reporting waste generation from GI endoscopy. Abstracts, news articles and conference proceedings were excluded. RESULTS Our search yielded 393 records in PubMed, 1708 in Embase and 24 in Google Scholar. After application of inclusion and exclusion factors, we focused on 9 fulllength articles in detail, only 3 of them were cross-sectional studies (all from the USA), the others reviews or position statements. Therefore, the quality of the studies could not be assessed due to heterogeneity in definitions and amount of emissions. CONCLUSIONS Recognition of carbon emissions generated by GI endoscopy activity is critical. Although multiple limitations exists for quantification of these emission, there is an urgent need for collecting proper data as well as examining novel methods for reduction of these emissions for a sustainable endoscopic practices in the future.
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Affiliation(s)
- Abhilash Perisetti
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Madhav Desai
- Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Michael J Bourke
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ian Penman
- Gastroenterology and Hepatology, Centre for Liver & Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Alessandro Repici
- Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
| | - Duvvur Nageshwar Reddy
- Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
| | - Hisao Tajiri
- Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Douglas K Rex
- Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA
| | - Cesare Hassan
- Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
| | - Prateek Sharma
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Missouri, USA
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8
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Hoshi K, Kikuchi H, Narita K, Fukutoku Y, Asari T, Miyazawa K, Murai Y, Sawada Y, Tatsuta T, Hasui K, Hiraga H, Chinda D, Mikami T, Subsomwong P, Asano K, Nakane A, Fukuda S, Sakuraba H. Bacterial exposure risk to the endoscopist's face while performing endoscopy. DEN OPEN 2023; 3:e209. [PMID: 36714062 PMCID: PMC9873584 DOI: 10.1002/deo2.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
Objectives Gastrointestinal endoscopy increases the risk of bacterial exposure to endoscopists. However, before 2019, most endoscopists did not pay attention to microorganism transmission from patients. This study aimed to investigate the incidence of bacterial exposure to endoscopists' faces during gastrointestinal endoscopic procedures using the bacterial culture method. Methods This was a single-centered, retrospective study including endoscopists who performed various gastrointestinal endoscopy procedures at the Division of Endoscopy, Hirosaki University Hospital between August 31 and October 6, 2020. Endoscopists wore surgical masks and affixed pre-sterilized films over them. Following the gastrointestinal endoscopic procedures, attached microbes were collected from the endoscopists' surface films using sterilized swabs. Collected microorganisms were cultured on tryptic soy agar and 5% sheep blood agar, and the incidence of bacterial exposure was determined by bacterial culture positivity. Cultured bacteria were identified by gram staining and 16S rRNA gene sequencing. Results Bacterial culture positivity was 12.6%, and it was significantly higher in therapeutic than in diagnostic endoscopy. Notably, therapeutic endoscopy increased bacterial culture positivity in colonoscopy, but not in esophagogastroduodenoscopy. Staphylococci, including Staphylococcus epidermidis and Staphylococcus capitis, were the most commonly found bacteria in samples identified through 16S rRNA gene sequencing. Conclusions The risk of bacterial exposure to the endoscopist's face was increased in colonoscopy treatment procedures. Therefore, endoscopists should be aware of the significant risk of microbial infection from scattering fluid that comes from the endoscopy's working channel.
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Affiliation(s)
- Kentaro Hoshi
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Hidezumi Kikuchi
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan,Department of Community MedicineHirosaki University Graduate School of MedicineAomoriJapan
| | - Koji Narita
- Department of Microbiology and ImmunologyHirosaki University Graduate School of MedicineAomoriJapan,Institute for Animal ExperimentationHirosaki University Graduate School of MedicineAomoriJapan
| | - Yukari Fukutoku
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Taka Asari
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Kuniaki Miyazawa
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Yasuhisa Murai
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Yohei Sawada
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Tetsuya Tatsuta
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Keisuke Hasui
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Hiroto Hiraga
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Daisuke Chinda
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Tatsuya Mikami
- Department of Preemptive MedicineHirosaki University Graduate School of MedicineAomoriJapan
| | - Phawinee Subsomwong
- Department of Microbiology and ImmunologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Krisana Asano
- Department of Microbiology and ImmunologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Akio Nakane
- Department of Biopolymer and Health ScienceHirosaki University Graduate School of MedicineAomoriJapan
| | - Shinsaku Fukuda
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Hirotake Sakuraba
- Department of Gastroenterology and HematologyHirosaki University Graduate School of MedicineAomoriJapan
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9
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Waddingham W, Kamran U, Kumar B, Trudgill NJ, Tsiamoulos ZP, Banks M. Complications of diagnostic upper Gastrointestinal endoscopy: common and rare - recognition, assessment and management. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000688. [PMID: 36572454 PMCID: PMC9806027 DOI: 10.1136/bmjgast-2021-000688] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/26/2022] [Indexed: 12/27/2022] Open
Abstract
A clear understanding of the potential complications or adverse events (AEs) of diagnostic endoscopy is an essential component of being an endoscopist. Creating a culture of safety and prevention of AEs should be part of routine endoscopy practice. Appropriate patient selection for procedures, informed consent, periprocedure risk assessments and a team approach, all contribute to reducing AEs. Early recognition, prompt management and transparent communication with patients are essential for the holistic and optimal management of AEs. In this review, we discuss the complications of diagnostic upper gastrointestinal endoscopy, including their recognition, treatment and prevention.
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Affiliation(s)
- William Waddingham
- Gastro-intestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Umair Kamran
- Department of gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Bhaskar Kumar
- Department of Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Nigel J Trudgill
- Department of gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Matthew Banks
- Gastro-intestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
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10
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Bortoluzzi F, Sorge A, Vassallo R, Montalbano LM, Monica F, La Mura S, Canova D, Checchin D, Fedeli P, Marmo R, Elli L. Sustainability in gastroenterology and digestive endoscopy: Position Paper from the Italian Association of Hospital Gastroenterologists and Digestive Endoscopists (AIGO). Dig Liver Dis 2022; 54:1623-1629. [PMID: 36100516 DOI: 10.1016/j.dld.2022.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
Climate crisis is dramatically changing life on earth. Environmental sustainability and waste management are rapidly gaining centrality in quality improvement strategies of healthcare, especially in procedure-dominant fields such as gastroenterology and digestive endoscopy. Therefore, healthcare interventions and endoscopic procedures must be evaluated through the 'triple bottom line' of financial, social, and environmental impact. The purpose of the paper is to provide information on the carbon footprint of gastroenterology and digestive endoscopy and outline a set of measures that the sector can take to reduce the emission of greenhouse gases while improving patient outcomes. Scientific societies, hospital executives, single endoscopic units can structure health policies and investment to build a "green endoscopy". The AIGO study group reinforces the role of gastrointestinal endoscopy professionals as advocates of sustainability in digestive endoscopy. The "green endoscopy" can shape a more sustainable health service and lead to an equitable, climate-smart, and healthier future.
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Affiliation(s)
- Francesco Bortoluzzi
- Gastrointestinal Unit, Ospedale dell'Angelo, Venice, Italy; Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy
| | - Andrea Sorge
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Roberto Vassallo
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, Buccheri la Ferla Hospital, Palermo, Italy
| | - Luigi Maria Montalbano
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Fabio Monica
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Academic Hospital Cattinara, Trieste, Italy
| | | | - Daniele Canova
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, San Bortolo Hospital, Vicenza, Italy
| | - Davide Checchin
- Gastrointestinal Unit, Ospedale dell'Angelo, Venice, Italy; Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy
| | - Paolo Fedeli
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, Santo Spirito Hospital, Rome, Italy
| | - Riccardo Marmo
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, PO Polla, ASL Salerno, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy.
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11
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de Paula Vargas R, Naves KSC, Paranhos LR, Vidigal MTC, Dos Reis GR, de Sousa Menezes M. Knowledge and practice of dentists in processing polishing points: A cross-sectional study. J ESTHET RESTOR DENT 2022; 34:1230-1237. [PMID: 35924696 DOI: 10.1111/jerd.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adequately processing polishing points used to polish composite resin restorations is necessary for microbiological control in dentistry, but there is no specific protocol to guide professionals. Therefore, this study aimed to assess the knowledge and practice of dentists in processing these instruments. METHODS This cross-sectional observational study included the application of an online questionnaire via Google Forms and social media promotion. The study evaluated the association of field of activity, time since graduation, age, and sex of professionals with processing practice. The statistical analysis was performed with absolute and relative frequencies and logistic and Poisson regressions at a 5% significance level. RESULTS Overall, 473 questionnaires were analyzed. A rate of 51% of professionals reported using inadequate processing methods, and almost 68% claimed to have good knowledge of the topic. Both regression analyses were significantly associated, showing a direct effect of age and time since graduation on adequate processing practices. CONCLUSIONS Although most professionals reported understanding the processing of polishing points, they do not perform it most adequately. CLINICAL SIGNIFICANCE An expressive number of dentists process polishing points improperly. The topic is significant for representing a semi-critical instrument extensively used in esthetic restorations.
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Affiliation(s)
- Renata de Paula Vargas
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Luiz Renato Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Maria Tereza Campos Vidigal
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Giselle Rodrigues Dos Reis
- Department of Operative Dentistry, School of Dentistry, University of Rio Verde, Rio Verde, Goiás, Brazil
| | - Murilo de Sousa Menezes
- Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
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12
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Giri S, Sundaram S. Disposable endoscopes: need for clarity on environmental impact and absolute indications. Gastrointest Endosc 2022; 96:690. [PMID: 36116848 DOI: 10.1016/j.gie.2022.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/21/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
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13
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Rodríguez de Santiago E, Dinis-Ribeiro M, Pohl H, Agrawal D, Arvanitakis M, Baddeley R, Bak E, Bhandari P, Bretthauer M, Burga P, Donnelly L, Eickhoff A, Hayee B, Kaminski MF, Karlović K, Lorenzo-Zúñiga V, Pellisé M, Pioche M, Siau K, Siersema PD, Stableforth W, Tham TC, Triantafyllou K, Tringali A, Veitch A, Voiosu AM, Webster GJ, Vienne A, Beilenhoff U, Bisschops R, Hassan C, Gralnek IM, Messmann H. Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2022; 54:797-826. [PMID: 35803275 DOI: 10.1055/a-1859-3726] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Climate change and the destruction of ecosystems by human activities are among the greatest challenges of the 21st century and require urgent action. Health care activities significantly contribute to the emission of greenhouse gases and waste production, with gastrointestinal (GI) endoscopy being one of the largest contributors. This Position Statement aims to raise awareness of the ecological footprint of GI endoscopy and provides guidance to reduce its environmental impact. The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) outline suggestions and recommendations for health care providers, patients, governments, and industry. MAIN STATEMENTS 1: GI endoscopy is a resource-intensive activity with a significant yet poorly assessed environmental impact. 2: ESGE-ESGENA recommend adopting immediate actions to reduce the environmental impact of GI endoscopy. 3: ESGE-ESGENA recommend adherence to guidelines and implementation of audit strategies on the appropriateness of GI endoscopy to avoid the environmental impact of unnecessary procedures. 4: ESGE-ESGENA recommend the embedding of reduce, reuse, and recycle programs in the GI endoscopy unit. 5: ESGE-ESGENA suggest that there is an urgent need to reassess and reduce the environmental and economic impact of single-use GI endoscopic devices. 6: ESGE-ESGENA suggest against routine use of single-use GI endoscopes. However, their use could be considered in highly selected patients on a case-by-case basis. 7: ESGE-ESGENA recommend inclusion of sustainability in the training curricula of GI endoscopy and as a quality domain. 8: ESGE-ESGENA recommend conducting high quality research to quantify and minimize the environmental impact of GI endoscopy. 9: ESGE-ESGENA recommend that GI endoscopy companies assess, disclose, and audit the environmental impact of their value chain. 10: ESGE-ESGENA recommend that GI endoscopy should become a net-zero greenhouse gas emissions practice by 2050.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Mario Dinis-Ribeiro
- Porto Comprehensive Cancer Center (Porto.CCC), and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Heiko Pohl
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, and Section of Gastroenterology and Hepatology, VA White River Junction, Vermont, USA
| | - Deepak Agrawal
- Division of Gastroenterology and Hepatology, Dell Medical School, University of Texas Austin, Texas, USA
| | - Marianna Arvanitakis
- Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Robin Baddeley
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital, and Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Elzbieta Bak
- Department of Gastroenterology and Internal Medicine, Clinical Hospital of Medical University of Warsaw, Warsaw, Poland
| | | | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Patricia Burga
- Endoscopy Department, University Hospital of Padua, Italy
| | - Leigh Donnelly
- Endoscopy Department, Northumbria Healthcare NHS Trust, Northumberland, United Kingdom
| | - Axel Eickhoff
- Klinik für Gastroenterologie, Diabetologie, Infektiologie, Klinikum Hanau, Hanau, Germany
| | - Bu'Hussain Hayee
- Department of Gastroenterology, University College London Hospitals, London, United Kingdom
| | - Michal F Kaminski
- Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarina Karlović
- Clinical Hospital Center Rijeka , Department of Gastroenterology, Endoscopy Unit, Rijeka, Croatia
| | - Vicente Lorenzo-Zúñiga
- Department of Gastroenterology, University and Polytechnic La Fe Hospital/IIS La Fe, Valencia, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Mathieu Pioche
- Endoscopy Unit, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Keith Siau
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - William Stableforth
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom
| | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Alberto Tringali
- Digestive Endoscopy Unit, ULSS 2 Marca Trevigiana, Conegliano Hospital, Conegliano, Italy
| | - Andrew Veitch
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Andrei M Voiosu
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, Bucharest, Romania
| | - George J Webster
- Department of Gastroenterology, University College London Hospitals, London, United Kingdom
| | | | | | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospitals Leuven, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, and Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, and Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Helmut Messmann
- III Medizinische Klinik Universitätsklinikum Augsburg, Augsburg, Germany
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14
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Urdaneta F, Wardhan R, Wells G, White JD. Prevention of pulmonary complications in sedated patients undergoing interventional procedures in the nonoperating room anesthesia setting. Curr Opin Anaesthesiol 2022; 35:493-501. [PMID: 35787534 DOI: 10.1097/aco.0000000000001158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Nonoperating room anesthesia (NORA) procedures have expanded in number, variety, and complexity. NORA involves all age groups, including frail older adults and patients often considered too sick to tolerate traditional surgical interventions. Postoperative pulmonary complications are a significant source of adverse events in the perioperative setting. We present a review focused on preventing pulmonary complications in the interventional NORA setting. RECENT FINDINGS NORA locations should function as independent, autonomous ambulatory units. We discuss a strategic plan involving a thorough preoperative evaluation of patients, including recognizing high-risk patients and their anesthetic management. Finally, we offer guidance on the challenges of conducting sedation and anesthesia in patients with coronavirus disease 2019 (COVID-19) or a history of COVID-19. SUMMARY The demands on the interventional NORA anesthesia team are increasing. Strategic planning, checklists, consistent staffing assignments, and scheduled safety drills are valuable tools to improve patient safety. In addition, through quality improvement initiatives and reporting, NORA anesthetists can achieve reductions in periprocedural pulmonary complications.
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Affiliation(s)
- Felipe Urdaneta
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
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15
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Weissman S, Aziz M, Baniqued MR, Taneja V, El-Dallal M, Lee-Smith W, Elias S, Feuerstein JD. Quality measures in endoscopy: A systematic analysis of the overall scientific level of evidence and conflicts of interest. Endosc Int Open 2022; 10:E776-E786. [PMID: 35692919 PMCID: PMC9187391 DOI: 10.1055/a-1809-4219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background and study aims Quality measures were established to develop standards to help assess quality of care, yet variation in endoscopy exists. We performed a systematic review to assess the overall quality of evidence cited in formulating quality measures in endoscopy. Methods A systematic search was performed on multiple databases from inception until November 15, 2020, to examine the quality measures proposed by all major societies. Quality measures were assessed for their level of quality evidence and categorized as category A (guideline-based), category B (observational studies) or category C (expert opinion). They were also examined for the type of measure (process, structure, outcome), the quality, measurability, review, existing conflicts of interest (COI), and patient participation of the quality measure. Results An aggregate total of 214 quality measures from nine societies (15 manuscripts) were included and analyzed. Of quality measures in endoscopy, 71.5 %, 23.8 %, and 4.7 % were based on low, moderate, and high quality of evidence, respectively. The proportion of high-quality evidence across societies was significantly different ( P = 0.028). Of quality measures, 76 % were quantifiable, 18 % contained patient-centric outcomes, and 7 % reported outcome measures. None of the organizations reported on patient involvement or external review, six disclosed existing COI, and 40 % were published more than 5 years ago. Conclusions Quality measures are important to standardize clinical practice. Because over 70 % of quality measures in endoscopy are based on low-quality evidence, further studies are needed to improve the overall quality to effectively set a standard, reduce variation, and improve care in endoscopic practice.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Matthew R. Baniqued
- Hackensack Meridian Health School of Medicine, Hackensack, New Jersey, United States
| | - Vikas Taneja
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Mohammed El-Dallal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Wade Lee-Smith
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, United States
| | - Joseph D. Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
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16
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Taunk P, Shimpi R, Singh R, Collins J, Muthusamy VR, Day LW. GI endoscope reprocessing: a comparative review of organizational guidelines and guide for endoscopy units and regulatory agencies. Gastrointest Endosc 2022; 95:1048-1059.e2. [PMID: 35303991 DOI: 10.1016/j.gie.2021.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Pushpak Taunk
- Division of Gastroenterology, University of South Florida, Tampa, Florida, USA
| | - Rahul Shimpi
- Department of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ravi Singh
- Department of Gastroenterology, Great South Bay Endoscopy Center, LLC, East Patchogue, New York, USA
| | - James Collins
- Department of Digestive Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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17
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Segura A, Dalal RS, Golla M, Gerson JN, Mahmud N, Lewis JD, Vajravelu RK. Endoscopy Is Not Associated with Infectious Adverse Events After Hematopoietic Cell Transplantation: A Retrospective Cohort Study. Dig Dis Sci 2022; 67:2310-2319. [PMID: 34050445 PMCID: PMC8820278 DOI: 10.1007/s10620-021-07062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/13/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Patients with recent hematopoietic cell transplantation (HCT) are considered high risk for gastrointestinal endoscopy due to the potential for procedural bacterial translocation. Prior studies investigating these risks do not account for the higher baseline rate of infectious complications among those who are immunocompromised. We performed a retrospective cohort study of patients with recent HCT who underwent endoscopy and their matched controls who did not undergo endoscopy. METHODS We identified patients who underwent HCT followed by upper and/or lower endoscopy at the University of Pennsylvania from 2000 to 2018. Individuals were matched 1:1 by age, sex, and type of HCT to controls who underwent HCT without subsequent endoscopy. Infectious adverse events were assessed by Sepsis-3 and Sepsis-2 criteria. Factors associated with infectious adverse events after endoscopy/index date were assessed using multivariable conditional logistic regression. RESULTS We identified 149 patients who underwent HCT and endoscopy and 149 matched controls who underwent HCT without endoscopy. Sepsis-3 infectious adverse events occurred in 3.4% of patients in each group. Sepsis-2 infectious adverse events occurred in 20.1% of patients who underwent endoscopy compared to 19.5% of controls. There was no association between endoscopy and Sepsis-2 infectious adverse events in the multivariable regression analysis (adjusted odds ratio 1.65, 95% CI 0.51-5.26). CONCLUSIONS When compared to controls with similar immune statuses, patients who underwent endoscopy after HCT did not have a higher risk of infectious adverse events. These results may inform clinical decision making regarding the risks and benefits of endoscopic management after HCT.
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Affiliation(s)
- Abraham Segura
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Rahul S. Dalal
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Meghana Golla
- Department of Medicine, Vanderbilt University, 719 Thompson Lane, Suite 20400, Nashville, TN 37204, USA
| | - James N. Gerson
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Perelman Center 12th Floor, Philadelphia, PA 19104, USA
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Perelman Center 7th Floor, Philadelphia, PA 19104, USA
| | - James D. Lewis
- Division of Gastroenterology and Hepatology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Perelman Center 7th Floor, Philadelphia, PA 19104, USA
| | - Ravy K. Vajravelu
- Division of Gastroenterology and Hepatology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Perelman Center 7th Floor, Philadelphia, PA 19104, USA
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18
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Deb A, Perisetti A, Goyal H, Aloysius MM, Sachdeva S, Dahiya D, Sharma N, Thosani N. Gastrointestinal Endoscopy-Associated Infections: Update on an Emerging Issue. Dig Dis Sci 2022; 67:1718-1732. [PMID: 35262904 DOI: 10.1007/s10620-022-07441-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/07/2022] [Indexed: 02/06/2023]
Abstract
Over 17.7 million gastrointestinal (GI) endoscopic procedures are performed annually, contributing to 68% of all endoscopic procedures in the United States. Usually, endoscopic procedures are low risk, but adverse events may occur, including cardiopulmonary complications, bleeding, perforation, pancreatitis, cholangitis, and infection. Infections after the GI endoscopies most commonly result from the patient's endogenous gut flora. Although many studies have reported infection after GI endoscopic procedures, a true estimate of the incidence rate of post-endoscopy infection is lacking. In addition, the infection profile and causative organisms have evolved over time. In recent times, multi-drug-resistant microorganisms have emerged as a cause of outbreaks of endoscope-associated infections (EAI). In addition, lapses in endoscope reprocessing have been reported, with some but not all outbreaks in recent times. This systematic review summarizes the demographical, clinical, and management data of EAI events reported in the literature. A total of 117 articles were included in the systematic review, with the majority reported from North America and Western Europe. The composite infection rate was calculated to be 0.2% following GI endoscopic procedures, 0.8% following ERCP, 0.123% following non-ERCP upper GI endoscopic procedures, and 0.073% following lower GI endoscopic procedures. Pseudomonas aeruginosa was the most common culprit organism, followed by other Enterobacteriaceae groups of organisms and Gram-positive cocci. We have also elaborated different prevention methods such as antimicrobial prophylaxis, adequate sterilization methods for reprocessing endoscopes, periodic surveillance, and current evidence supporting their utilization. Finally, we discuss disposable endoscopes, which could be an alternative to reprocessing to minimize the chances of EAIs with their effects on the environmental and financial situation.
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Affiliation(s)
- Anasua Deb
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Abhilash Perisetti
- Advance Endoscopy, Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, 11050 Parkview Circle, Fort Wayne, IN, 46845, USA
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, 501 S. Washington Avenue, Scranton, PA, 18503, USA.
| | - Mark M Aloysius
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, 501 S. Washington Avenue, Scranton, PA, 18505, USA
- Geisinger Commonwealth School of Medicine, 525, Pine Street, Scranton, PA, 18510, USA
| | - Sonali Sachdeva
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Dushyant Dahiya
- Central Michigan University College of Medicine, 1000 Houghton Ave, Saginaw, MI, 48603, USA
| | - Neil Sharma
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, 11050 Parkview Circle, Fort Wayne, IN, 46845, USA
- Indiana University School of Medicine, Fort Wayne, IN, USA
| | - Nirav Thosani
- Division of Gastroenterology, Hepatology & Nutrition, Center for Interventional Gastroenterology at UTHealth (iGUT), Atilla Ertan MD Chair in Gastroenterology, Hepatology & Nutrition, McGovern Medical School, UTHealth, Houston, USA
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19
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Impact of Infection Control Education on Gastrointestinal Endoscopy Procedural Staff. Gastroenterol Nurs 2022; 45:91-100. [PMID: 35220373 DOI: 10.1097/sga.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022] Open
Abstract
To date, minimal research has been conducted on proper use of personal protective equipment and hand hygiene within endoscopy. The American Society for Gastrointestinal Endoscopy has developed guidelines for infection control within the endoscopy suite. A practice change based upon these guidelines was implemented. Education was provided to endoscopy procedural staff within a Midwestern hospital based upon the World Health Organization 5 Moments for Hand Hygiene initiative and included personal protective equipment. Knowledge, skills, and attitudes of the participant group were compared from paired pre- to posteducation surveys pertaining to hand hygiene and personal protective equipment. Observation of personal protective equipment use and hand hygiene implementation during procedures was also documented pre- to posteducation. The project results revealed both willingness to implement proper donning and doffing of personal protective equipment and improved technique as evidenced by improved observed technique with the endoscopy suite and moderately improved hand hygiene questionnaire results. Although conducted as a quality improvement project, clinical significance was found via observation following education. These practices can aid in reduction of organism transmission from patients to staff.
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20
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Sivek AD, Davis J, Tremoulet P, Smith M, Lavanchy C, Sparnon E, Kommala D. Healthcare worker feedback on duodenoscope reprocessing workflow and ergonomics. Am J Infect Control 2022; 50:1038-1048. [PMID: 35108583 DOI: 10.1016/j.ajic.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objectives of this survey study were to assess duodenoscope precleaning and manual cleaning times, identify human factors issues in duodenoscope reprocessing workflow or ergonomics, and ascertain any best practices in duodenoscope reprocessing. METHODS Researchers developed the confidential, qualitative, online Duodenoscope Reprocessing Workflow and Ergonomic Design Human Factors Survey with an intended audience of healthcare workers (HCWs) who routinely perform duodenoscope precleaning or manual cleaning. The unrestricted survey link was distributed to target HCW email addresses in December 2020; the survey closed in January 2021. RESULTS Three hundred and forty-one individuals completed the survey. Most respondents complete duodenoscope precleaning in 10 minutes or less and manual cleaning in 16-to-30 minutes. Most respondents' facilities use fixed distal endcap duodenoscopes. Most respondents experience pressure to work faster when cleaning duodenoscopes and reported that cleaning duodenoscopes caused fatigue or discomfort in at least one body part. Mentoring HCWs and retaining experienced staff were 2 primary duodenoscope reprocessing best practices identified by respondents. DISCUSSION AND CONCLUSIONS To enhance duodenoscope cleaning, facilities should provide ample reprocessing work spaces with incorporated height-adjustable work surfaces, train HCWs on validated duodenoscope reprocessing instructions, provide step-by-step instructions for HCWs when duodenoscope cleaning is performed, mentor reprocessing HCWs, and retain experienced staff.
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Affiliation(s)
| | | | - Patrice Tremoulet
- ECRI, Plymouth Meeting, PA; Department of Psychology, Rowan University, Glassboro, NJ
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21
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Underwater endoscope cleaning method for use during COVID-19. Arab J Gastroenterol 2021; 23:61-63. [PMID: 35151590 PMCID: PMC8668382 DOI: 10.1016/j.ajg.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 01/15/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
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22
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Slivka A, Ross AS, Sejpal DV, Petersen BT, Bruno MJ, Pleskow DK, Muthusamy VR, Chennat JS, Krishnamoorthi R, Lee C, Martin JA, Poley JW, Cohen JM, Thaker AM, Peetermans JA, Rousseau MJ, Tirrell GP, Kozarek RA. Single-use duodenoscope for ERCP performed by endoscopists with a range of experience in procedures of variable complexity. Gastrointest Endosc 2021; 94:1046-1055. [PMID: 34186052 DOI: 10.1016/j.gie.2021.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Expert endoscopists previously reported ERCP outcomes for the first commercialized single-use duodenoscope. We aimed to document usability of this device by endoscopists with different levels of ERCP experience. METHODS Fourteen "expert" (>2000 lifetime ERCPs) and 5 "less-expert" endoscopists performed consecutive ERCPs in patients without altered pancreaticobiliary anatomy. Outcomes included ERCP completion for the intended indication, rate of crossover to another endoscope, device performance ratings, and serious adverse events. RESULTS Two hundred ERCPs including 81 (40.5%) with high complexity (American Society for Gastrointestinal Endoscopy grades 3-4) were performed. Crossover rate (11.3% vs 2.5%, P = .131), ERCP completion rate (regardless of crossovers) (96.3% vs 97.5%, P = .999), median ERCP completion time (25.0 vs 28.5 minutes, P = .130), mean cannulation attempts (2.8 vs 2.8, P = .954), and median overall satisfaction with the single-use duodenoscope (8.0 vs 8.0 [range, 1.0-10.0], P = .840) were similar for expert versus less-expert endoscopists, respectively. The same metrics were similar by procedural complexity except for shorter median completion time for grades 1 to 2 versus grades 3 to 4 (P < .001). Serious adverse events were reported in 13 patients (6.5%). CONCLUSIONS In consecutive ERCPs including high complexity procedures, endoscopists with varying ERCP experience had good procedural success and reported high device performance ratings. (Clinical trial registration number: NCT04223830.).
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Affiliation(s)
- Adam Slivka
- Department of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew S Ross
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Divyesh V Sejpal
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Douglas K Pleskow
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, USA
| | - V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer S Chennat
- Department of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rajesh Krishnamoorthi
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Calvin Lee
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Jonah M Cohen
- Division of Gastroenterology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Adarsh M Thaker
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joyce A Peetermans
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Matthew J Rousseau
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Gregory P Tirrell
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Richard A Kozarek
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
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Dilaghi E, Marcolongo A, Anibaldi P, Simmaco M, Prestigiacomo C, Angeletti S, Corleto VD, D'Ambra G, Ruggeri M, Di Giulio E, Annibale B, Lahner E. Gastrointestinal endoscopy can be safely performed during pandemic SARS-CoV-2 infection in Central Italy. Eur J Gastroenterol Hepatol 2021; 33:e505-e512. [PMID: 33795580 DOI: 10.1097/meg.0000000000002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly contagious; gastrointestinal endoscopies are considered risky procedures for the endoscopy staff. Data on the SARS-CoV-2-exposure/infection rate of gastrointestinal endoscopy staff is scarce. This study aimed to assess the SARS-CoV-2-exposure/infection rate among gastrointestinal endoscopists/nurses performing gastrointestinal endoscopies before and after the adoption of specific prevention measures. PATIENTS AND METHODS Cross-sectional study in a teaching hospital (Rome, Central Italy) on retrospective data (9 March-15 April 2020) of consecutive gastrointestinal endoscopies, characteristics of procedures, patients and endoscopy staff, SARS-CoV-2-exposure/positivity of patients and staff before and after adoption of prevention measures. Exposed staff tested for SARS-CoV-2 by nasopharyngeal swabs(RNA-PCR) and serology. RESULTS A total of 130 gastrointestinal endoscopies were performed in 130 patients (age 66 ± 14 years, 51% women, 51% inpatients, 56.9% lower). A total of 12 (9.2%) patients were SARS-CoV-2-positive and 14(10.8%) had a high risk of potential infection. Of the endoscopy staff (n = 16, 5 endoscopists, 8 nurses and 3 residents), 14 (87.5%) were exposed to SARS-CoV-2-infected and 16 (100%) to potentially infected patients. 3/5 and 5/5 endoscopists were exposed to actual and potential, 1/3 and 3/3 residents to actual and potential and 8/8 nurses to actual and potential infection, respectively. None of the staff was found to be infected with SARS-CoV-2. None experienced fever or any other suspicious symptoms of coronavirus disease 2019. Before the adoption of prevention measures, more endoscopists/nurses were in the endoscopy room than after (3.5 ± 0.6 vs. 2.1 ± 0.3, P < 0.0001). CONCLUSIONS Despite supposed high infection risk, gastrointestinal endoscopies may be safe for the endoscopy staff during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Emanuele Dilaghi
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome
| | | | | | - Maurizio Simmaco
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, via di Grottarossa 1035
| | | | - Stefano Angeletti
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Vito D Corleto
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giancarlo D'Ambra
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Ruggeri
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Emilio Di Giulio
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Bruno Annibale
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome
| | - Edith Lahner
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome
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Voiosu TA, Puscasu CI, Voiosu A. SARS-CoV-2 transmission via endoscopy in the COVID-19 era. Gut 2021; 70:2218-2219. [PMID: 33674340 DOI: 10.1136/gutjnl-2021-324276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/08/2022]
Affiliation(s)
- Theodor Alexandru Voiosu
- Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania.,Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Andrei Voiosu
- Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania.,Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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25
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SAFETY IN THE GASTROENTEROLOGY SETTING. Gastroenterol Nurs 2021; 44:467-479. [PMID: 34519675 DOI: 10.1097/sga.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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26
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Jin B, Hu Y, Huang L, Cheng X, Zhao J, Yang X, Sun X, Gan T, Lu B. Effectiveness Between Daily and After-Each-Case Room Disinfection of the Endoscopy Unit. Front Public Health 2021; 9:700041. [PMID: 34676191 PMCID: PMC8523938 DOI: 10.3389/fpubh.2021.700041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To evaluate the effectiveness between daily and after-each-case room disinfection in the endoscopy unit. Methods: This study was conducted in an endoscopy unit of the First Affiliation of Zhejiang Chinese Medical University. We cultured samples from the surface of endoscopy unit items, including operation unit air, isolation gown of an endoscopist, control panel buttons, workstation mouse, and the bed head of the patient. All the samples were divided into daily and after-each-case room disinfection groups. In addition, each group was subdivided into sedation and nonsedation gastroscopy with and without ventilation room groups. Results: The qualified rate of bed head samples of the patient were lower in the daily room disinfection group (76.67%) compared with the after-each-case group (100%). The isolation gown, mouse at the workstation, and the bed head of the patient demonstrated the lowest bacterial and fungal load in the after-each-case room disinfection group compared with the daily room disinfection group (p < 0.05). In the subgroup analysis, a higher microbial load was observed for the isolation gown of the endoscopist used during nonsedation gastroscopy in an unventilated room under the after-each-case room disinfection pattern (p < 0.05); a higher microbial load was observed for the control panel buttons used during nonsedation gastroscopy under the after-each-case room disinfection pattern (p < 0.05). Conclusions: For risk-free or low-risk patients, daily room disinfection provides the basic health requirements of the endoscopy procedure. However, it is better to adopt the after-each-case room disinfection for the isolation gown of the endoscopist and bed head of the patient. For the patients with high risk, the after-each-case room disinfection is more suitable for every endoscopy unit (www.ClinicalTrials.gov, NCT04399005).
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Affiliation(s)
- Bo Jin
- Department of Endoscopy Center, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yue Hu
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Key Laboratory of Digestive Pathophysiology of Zhejiang Province, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Liang Huang
- Department of Endoscopy Center, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoyun Cheng
- Department of Endoscopy Center, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jin Zhao
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Key Laboratory of Digestive Pathophysiology of Zhejiang Province, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuejing Yang
- Department of Clinical Laboratory, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiling Sun
- Department of Clinical Laboratory, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Tieer Gan
- Department of Hospital-Acquired Infection Control, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Lu
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Key Laboratory of Digestive Pathophysiology of Zhejiang Province, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Abstract
Gastrointestinal (GI) endoscopy units tend to be busy environments in which numerous categories of staff provide moderately complex procedural care to high volumes of patients. The prevention of infections of both patients and staff is a never-ending endeavor for both inpatient and outpatient environments. Necessary considerations must address patient-to-staff, staff-to-patient, environmental, and device-related transmission of infection. In addition to the typical environmental and interpersonal infection risks present in all medical environments, the major concern within the endoscopy suite relates to contamination and potential transmission via reusable devices and endoscopes. Our understanding of this ever-present issue has evolved over time and has become a major focus of scrutiny in the past 5 years. This significant problem has stimulated guidance and ingenuity by regulators, investigators, and industry. Most recently, the COVID-19 pandemic of 2020 to 21 has also added significant burdens to our infection control efforts in gastrointestinal endoscopy.
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Affiliation(s)
- Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, 201 1st Street Southwest, Rochester, MN 55905, USA.
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28
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Abstract
PURPOSE OF REVIEW Given the growing concerns about infection transmission from use of contaminated reusable duodenoscopes, technological advancements have been made that vary from modifications of existing designs to development of single-use devices. RECENT FINDINGS To circumvent mechanical limitations that preclude access to critical areas of a duodenoscope to perform thorough cleaning and disinfection, single-use disposable duodenoscopes have been developed. A thorough assessment of this technology is limited by the minimal published data that is currently available. This opinion assesses the current technical functionality of these devices, potential for further improvements, implications for healthcare economics and the future of gastrointestinal endoscopy. SUMMARY Currently available data suggest that majority of endoscopic retrograde cholangiopancreatography procedures can be safely performed using single-use duodenoscopes. The ability to improve technical functionality, incorporate futuristic technology and secure financial reimbursement from insurance carriers will largely define the future prospects of this recent innovation.
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Affiliation(s)
- Shajan Peter
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ji Young Bang
- Digestive Health Institute, Orlando Health, Orlando, Florida, USA
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29
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Kwakman JA, Rauwers AW, Klaassen CHW, Bruno MJ, Vos MC. Investigation of possible transmission of a susceptible microorganism through a contaminated duodenoscope; a case report. Antimicrob Resist Infect Control 2021; 10:127. [PMID: 34454611 PMCID: PMC8403455 DOI: 10.1186/s13756-021-00996-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/20/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite compliance to extensive reprocessing protocols, duodenoscopes have been linked to outbreaks of susceptible and multi-drug resistant organisms (MDRO) due to persistent duodenoscope contamination. Duodenoscope-associated infections (DAIs) based on transmission of susceptible microorganisms are likely to be underreported due to detection bias. CASE PRESENTATION We describe the retrospective detection of a DAI case caused by a susceptible microorganism which at the time of clinical infection was not recognized as such. During 2017 and 2018, duodenoscopes were cultured on a daily basis due to research activities. While analyzing this data, it was found that a duodenoscope had been contaminated with Enterobacter cloacae complex over a period of 3 months. We checked whether patients treated with this duodenoscope had developed infections and found one patient with an E. cloacae cholangitis 3 months after the ERCP (Endoscopic retrograde cholangiopancreaticography) procedure. The isolates on the duodenoscope and in the patients' blood culture were indistinguishable by amplified fragment length polymorphism (AFLP). By classical multi-locus sequence typing (MLST), both strains were of the same (but novel) sequence type. Application of whole genome MLST showed 93 (out of 3757) allelic differences. CONCLUSION This case report describes a plausible link between a contaminated duodenoscope and a patient infection with E. cloacae. Transmission of susceptible E. cloacae was highly suspected from AFLP and MLST results; by WGS, 93 allelic differences were found which proves closely related strains. This report shows that DAIs by susceptible microorganisms can be easily missed and therefore its true prevalence remains underscored.
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Affiliation(s)
- Judith A Kwakman
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, Mailbox 2040, Rotterdam, The Netherlands. .,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Arjan W Rauwers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, Mailbox 2040, Rotterdam, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corné H W Klaassen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, Mailbox 2040, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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30
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Infection prevention measures in acute care settings based on severe acute respiratory syndrome coronavirus 2 transmission patterns and risk: a review. Curr Opin Infect Dis 2021; 34:346-356. [PMID: 34127582 DOI: 10.1097/qco.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW During the coronavirus disease 2019 pandemic, when facing extraordinary infection prevention challenges, acute care settings have balanced routine patient safety needs while minimizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission risk to patients and healthcare personnel (HCP). Mitigation strategies in acute care settings are based on a combination of basic science, environmental, and epidemiologic evidence. Here, we review the literature on SARS-CoV-2 transmission, how it has shaped infection prevention interventions in acute care settings, and the results of such measures to reduce transmission. RECENT FINDINGS HCP adherence to transmission-based precautions in acute care settings, such as the use of personal protective equipment (PPE), is essential to mitigating SARS-CoV-2 spread. Although the SARS-CoV-2 virus has been isolated in nonrespiratory body sites, such exposure has not been shown to definitively cause transmission in humans. Epidemiologic evidence has demonstrated that implementation and adherence to infection prevention strategies reduces acute setting transmission. SUMMARY Given SARS-CoV-2 infection occurs primarily through respiratory transmission, preventing HCP acquisition requires fidelity to consistent PPE usage. Infection prevention strategies and implementation of transmission-based precautions have reduced spread and outbreaks. Epidemiologic studies of acute care outbreaks often include reports of PPE nonadherence and community exposure contributing to SARS-CoV-2 transmission within this setting.
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Tarik A, Soukaina R, Samir M, Asmae S, Ahlame B, Rida B, Yasser A, Ilham E, Noureddine E, Hassan S, Ahmed B. Gastrointestinal manifestations during COVID-19 virus infection: A Moroccan prospective study. Arab J Gastroenterol 2021; 22:305-309. [PMID: 34509387 PMCID: PMC8321706 DOI: 10.1016/j.ajg.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Gastrointestinal manifestations are common during coronavirus disease (COVID-19) infection. They can occur before respiratory symptoms, resulting in a diagnostic delay and an increased risk of disease transmission. The current study reports major gastrointestinal manifestations as initial symptoms of COVID-19. PATIENTS AND METHODS This prospective, descriptive, cross-sectional, and single-center study of 713 cases was conducted in a field hospital in Morocco over a 5-week period from June 21 to July 25, 2020. RESULTS The average age of our patients was 31.95 years. Clinically, on admission, anorexia was the main symptom, present in 32.3% of patients. Gastrointestinal manifestations were present in 14.9% of patients, including watery diarrhea in 8.6% of cases, nausea and/or vomiting in 4.6% of cases, and abdominal pain in 1.6% of cases. Six hundred thirty-two patients were treated in accordance with one of the two therapeutic protocols recommended by the National Ministry of Health. The treatment-related effects that occurred in 61.4% of patients were primarily digestive in 55.3% of cases. In multivariate analysis, following adjustment of the studied parameters, only the presence of gastrointestinal manifestations (odds ratio [OR]: 1.478 confidence interval [CI]: 1.286-1.698; p < 0.001) and treatment side effects (OR = 1.069, CI: 1.020-1.119, p = 0.005) altered the rate of negative polymerase chain reaction (PCR) tests on day 10. CONCLUSION Gastrointestinal manifestations are common during COVID-19 and seem to be linked to a longer duration of disease. SARS-CoV-2 (the causative virus of COVID-19) can persist in the digestive tract, with the possibility of fecal-oral transmission. Therefore, hygiene is extremely important, especially handwashing and strict precautions when performing gastrointestinal endoscopy and handling stools from infected patients.
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Affiliation(s)
- Addajou Tarik
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco.
| | - Rokhsi Soukaina
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
| | - Mrabti Samir
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
| | - Sair Asmae
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
| | - Benhamdane Ahlame
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
| | - Berraida Rida
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
| | - Azali Yasser
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
| | - Elkoti Ilham
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
| | - Errami Noureddine
- Department of Otorhinolaryngology, Military Hospital Mohammed V, Rabat, Morocco
| | - Seddik Hassan
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
| | - Benkirane Ahmed
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
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Grassi G, Lenci I, Signorello A, Milana M, Baiocchi L. Gastrointestinal endoscopy in cirrhotic patient: Issues on the table. World J Gastrointest Endosc 2021; 13:210-220. [PMID: 34326942 PMCID: PMC8311468 DOI: 10.4253/wjge.v13.i7.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with liver cirrhosis are fragile and present specific clinical hallmarks. When undergoing to gastrointestinal (GI) endoscopy, these subjects require an individual pre evaluation, taking into account: Level of haemostasis impairment, the individual risk of infection, the impact of sedation on hepatic encephalopathy and other factors. The overall assessment of liver function, employing common scoring systems, should be also assessed in the preprocedural phase. Beside some common general problems, regarding GI endoscopy in cirrhotic subjects, also specific issues are present for some frequent indications or procedures. For instance, despite an increased incidence of adenomas in cirrhosis, colon cancer screening remains suboptimal in subjects with this disease. Several studies in fact demonstrated liver cirrhosis as a negative factor for an adequate colon cleansing before colonoscopy. On the other hand, also the routine assessment of gastroesophageal varices during upper GI endoscopy presents some concern, since important inter-observer variability or incomplete description of endoscopic findings has been reported in some studies. In this review we discussed in details the most relevant issues that may be considered while performing general GI endoscopic practice, in patient with cirrhosis. For most of these issues there are no guidelines or clear indications. Moreover until now, few studies focused on these aspects. We believe that targeting these issues with corrective measures may be helpful to develop a tailored endoscopic approach for cirrhosis, in the future.
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Affiliation(s)
- Giuseppe Grassi
- Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
| | - Ilaria Lenci
- Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
| | | | - Martina Milana
- Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
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34
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Kim JS, Jung E, Kang SH, Ji JS, Cho YK, Lee BI, Cho YS, Kim BW, Choi H, Jeong HY, Choi MG, Park JM. Safety of Endoscopy in Peritoneal Dialysis Patients. Clin Transl Gastroenterol 2021; 12:e00379. [PMID: 34193802 PMCID: PMC8345910 DOI: 10.14309/ctg.0000000000000379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endoscopic procedures can provoke peritonitis in patients receiving peritoneal dialysis (PD). The aim of this study was to assess the development of peritonitis after endoscopic procedures in PD patients. METHODS We retrospectively reviewed the data from PD patients who underwent endoscopies in 3 tertiary hospitals between 2008 and 2018. The patients were grouped into nonprophylactic, prophylactic, and prior antibiotic therapy groups. The incidence of peritonitis within 7 days of endoscopy was assessed. We also examined the factors associated with peritonitis. RESULTS There were 1,316 endoscopies performed in 570 PD patients. The peritonitis rate after endoscopy was 3.0%. Specifically, the peritonitis rate was 1.8% for esophagogastroduodenoscopies, 4.2% for the colonoscopy group, and 5.3% for the sigmoidoscopy group. The prior antibiotic therapy group showed a significantly higher risk of peritonitis (odds ratio = 4.6; 95% confidence interval: 2.2-9.6; P < 0.01). Prophylactic antibiotics were not associated with reducing peritonitis. Therapeutic colonoscopies such as polypectomy were associated with an increased risk of developing peritonitis (odds ratio = 6.5; 95% confidence interval: 1.6-25.9). However, biopsies were not associated with an increased risk of peritonitis. DISCUSSION Prophylactic antibiotics did not reduce the risk of peritonitis after endoscopy in PD patients. Therapeutic colonoscopies such as polypectomy and prior antibiotic therapy before endoscopy were associated with an increased risk of peritonitis.
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Affiliation(s)
- Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eunha Jung
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeong-Seon Ji
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Kyung Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Seok Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwang Choi
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Yong Jeong
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Khalid A, Romutis S, Ibinson J, Thomas C, Myint A, Dueker J, Johnston E, Kreiss C, Kingsley M, Skef W, Vipperla K, McGrath K, Phillips AE, Das R, Fasanella K, Ibinson J. Acute physiologic effects of N95 respirator use on gastroenterologists performing simulated colonoscopy. Gastrointest Endosc 2021; 94:160-168.e3. [PMID: 33497642 DOI: 10.1016/j.gie.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS During the severe acute respiratory syndrome coronavirus 2 pandemic, N95 filtering facepiece respirator (FFR) use was required while performing aerosol-generating procedures. We studied the physiologic effects of N95 FFR use in a cohort of gastroenterologists performing simulated colonoscopies. METHODS Data collection and comparisons included (1) symptoms and change in vital signs in 12 gastroenterologists performing simulated colonoscopy for 60 minutes while wearing a surgical mask (SM) and faceshield (FS); N95 FFR, SM, and FS; and powered air-purifying respirator (PAPR) and (2) respiratory belt plethysmography and continuous electrocardiographic frequency-based heart rate (HR) variability indices including very low frequency power (measures intracardiac sympathetic tone) and low frequency to high frequency ratios (intracardiac sympathetic to vagal ratio) in 11 gastroenterologists performing simulated colonoscopy while wearing an SM (15 minutes), N95 FFR and SM (60 minutes), and SM (15 minutes) in rapid sequence. RESULTS Ten of 12 gastroenterologists (83%) reported symptoms with N95 FFR use, most commonly breathing difficulty, frustration, fatigue, and headache. Nine of these gastroenterologists (75%) had associated significant HR elevation. Respiratory peak to trough measurement showed a significant increase (F(2) = 7.543, P = .004) during the N95 FFR stage, which resolved after removal of the N95 FFR. Although not statistically different, all gastroenterologists showed a decrease in sympathetic to vagal ratios and an increase in intracardiac sympathetic effects in the N95 FFR stage. PAPR use was better tolerated but was associated with headache and elevated HR in 4 gastroenterologists (33%). CONCLUSIONS N95 FFR use by gastroenterologists is associated with development of acute physiologic changes and symptoms.
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Affiliation(s)
- Asif Khalid
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Stephanie Romutis
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | | | | | - Alex Myint
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Dueker
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Elyse Johnston
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | | | - Michael Kingsley
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Wasseem Skef
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Kishore Vipperla
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Kevin McGrath
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | | | - Rohit Das
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - Kenneth Fasanella
- University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
| | - James Ibinson
- VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania, USA; University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA
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Gruszecka J, Filip R, Gutkowska D. The State of Microbiological Cleanliness of Surfaces and Equipment of an Endoscopic Examination Laboratory-Data from a Reference Tertiary Clinical Endoscopy Center in Southern Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126346. [PMID: 34208169 PMCID: PMC8296163 DOI: 10.3390/ijerph18126346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
The increasing number of endoscopic procedures performed and their increasing invasiveness mean that endoscopy of the gastrointestinal tract is associated with the risk of transmitting pathogenic microorganisms through infected equipment or contact with other patients and medical staff. In order to ensure protection of the health of both patients and medical staff, endoscopy laboratories should meet high hygiene standards. The results of tests of the microbiological cleanliness of surfaces and equipment of an endoscopic examination laboratory performed in the period from January to December 2019 at the Provincial Clinical Hospital No. 2 in Rzeszow were assessed retrospectively. Samples for testing were collected by swabbing from places where microbiological contamination was the most likely and cleaning was the most difficult. In the analyzed period, a total of 86 samples were collected for microbiological tests, of which positive results accounted for 6.9%. Positive results were obtained mainly from swabs collected from wet surfaces (66.7%). Most of the isolated microorganisms were Gram-negative bacteria (66.7% of all positive tests) and they were: Acinetobacter junii, Ralstonia pickettii, and Achromobacter denitrificans. The condition of the microbiological cleanliness of the surfaces and equipment of the endoscopic examination laboratory was satisfactory. A very low level of microbiological contamination of the tested items indicates occasional shortcomings in the decontamination processes. Since microorganisms isolated from the collected samples may be the cause of infection in patients and medical personnel, it is necessary to verify the decontamination procedures applied and to continue periodic microbiological monitoring of their effectiveness.
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Affiliation(s)
- Jolanta Gruszecka
- Institute of Health Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
- Department of Clinical Microbiology, Clinical Hospital No. 2 im. Św. Jadwigi Królowej, 35-301 Rzeszow, Poland
- Correspondence:
| | - Rafał Filip
- Faculty of Medicine, Medical College of Rzeszow University, 35-959 Rzeszow, Poland;
- Department of Gastroenterology with IBD Unit of Clinical Hospital 2 im. Św. Jadwigi Królowej, 35-301 Rzeszow, Poland
| | - Dorota Gutkowska
- Institute of Health Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
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Kim KH, Kim SB, Kim TN. Changes in endoscopic patterns before and during COVID-19 outbreak: Experience at a single tertiary center in Korean. World J Clin Cases 2021; 9:3576-3585. [PMID: 34046457 PMCID: PMC8130062 DOI: 10.12998/wjcc.v9.i15.3576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/28/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The surge of coronavirus disease 2019 (COVID-19) patients has markedly influenced the treatment policies of tertiary hospitals because of the need to protect medical staff and contain viral transmission, but the impact COVID-19 had on emergency gastrointestinal endoscopies has not been determined.
AIM To compare endoscopic activities and analyze the clinical outcomes of emergency endoscopies performed before and during the COVID-19 outbreak in Daegu, the worst-hit region in South Korea.
METHODS This retrospective cohort study was conducted on patients aged ≥ 18 years that underwent endoscopy from February 18 to March 28, 2020, at a tertiary hospital in Daegu. Demographics, laboratory findings, types and causes of emergency endoscopies, and endoscopic reports were reviewed and compared with those obtained for the same period in 2018 and 2019.
RESULTS From February 18 to March 28, a total of 366 emergent endoscopic procedures were performed: Upper endoscopy (170, 50.6%), endoscopic retrograde cholangiopancreatography (113, 33.6%), and colonoscopy with sigmoidoscopy (53, 15.8%). The numbers of procedures performed in 2018 and 2019 dropped by 48.8% and 54.8%, respectively, compared with those in 2020. During the COVID-19 outbreak, the main indications for endoscopy were melena (36.7%), hematemesis (30.6%), and hematochezia (10.2%). Of the endoscopic abnormalities detected, gastrointestinal bleeding was the most common: 39 cases in 2018, 51 in 2019, and 35 in 2020.
CONCLUSION The impact of COVID-19 is substantial and caused dramatic reductions in endoscopic procedures and changes in patient behaviors. Long-term follow-up studies are required to determine the effects of COVID-19 induced changes in the endoscopy field.
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Affiliation(s)
- Kook Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea
| | - Sung Bum Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea
| | - Tae Nyeun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea
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Cordie A, Gaber Y, AbdAllah M, Vergori A, Kharono B, Omran S, Afify S, Karkouri M, Chakroun M, Musa S, Moorhouse M, Esmat G. Gastrointestinal manifestations of human immunodeficiency virus and coronavirus disease 2019: Understanding the intersecting regions between the two epidemics. Arab J Gastroenterol 2021; 22:75-87. [PMID: 34120849 PMCID: PMC8149211 DOI: 10.1016/j.ajg.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/07/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023]
Abstract
In March 2020, the World Health Organization declared coronavirus disease (COVID-19) a pandemic. As of February 2021, there were 107 million COVID-19 cases worldwide. As a comparison, there are approximately 38 million people living with human immunodeficiency virus (PLHIV) worldwide. The coexistence of both epidemics, and the syndemic effect of both viruses could lead to a delirious impact both at individual and community levels. Many intersecting points were found between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19, and HIV; among which, gastrointestinal (GI) manifestations are the most notable. GI manifestations represent a common clinical presentation in both HIV and SARS-CoV-2. The emergence of GI symptoms as a result of SARS-CoV-2 infection provides a new dynamic to COVID-19 diagnosis, management, and infection control measures, and adds an additional diagnostic challenge in case of coinfection with HIV. The presence of GI manifestations in PLHIV during the COVID-19 pandemic could be referred to HIV enteropathy, presence of opportunistic infection, adverse effect of antiretrovirals, or coinfection with COVID-19. Thus, it is important to exclude SARS-CoV-2 in patients who present with new-onset GI manifestations, especially in PLHIV, to avoid the risk of disease transmission during endoscopic interventions. Structural similarities between both viruses adds a valuable intersecting point, which has mutual benefits in the management of both viruses. These similarities led to the hypothesis that antiretrovirals such as lopinavir/Rironavir have a role in the management of COVID-19, which was the target of our search strategy using the available evidence. These similarities may also facilitate the development of an efficient HIV vaccine in the future using the advances in COVID-19 vaccine development.
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Affiliation(s)
- Ahmed Cordie
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasmine Gaber
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mohamed AbdAllah
- Medical Research Division, National Research Center, Giza, Egypt
| | - Alessandra Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy.
| | | | - Salma Omran
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shimaa Afify
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mehdi Karkouri
- Association de Lutte Contre le Sida/Coalition Plus, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Morocco
| | - Mohamed Chakroun
- Infectious Diseases Department, University Hospital of Monastir, Tunisia
| | - Sherief Musa
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | - Gamal Esmat
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Zhang S, Wu X, Pan H, Wu D, Xu T, Shen N, Zhang Y, Feng Y, Wang Q, Jiang Q, Guo T, Wu D, Tang S, Yang A. Gastrointestinal endoscopy infection control strategy during COVID-19 pandemic: Experience from a tertiary medical center in China. Dig Endosc 2021; 33:577-586. [PMID: 32594570 PMCID: PMC7361359 DOI: 10.1111/den.13783] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) has spread globally and become a pandemic. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) not only infects the gastrointestinal (GI) tract and causes GI symptoms, but also increases nosocomial transmission risk during endoscopic procedures for aerosol generation. We hereby share our infection control strategies aiming to minimize COVID-19 transmission in the endoscopy center. METHODS We established our infection control strategies based on the guidance of Chinese Society of Digestive Endoscopy and inputs from hospital infection control experts: admission control through the procedure and patient triage, environmental control to reduce possible virus exposure, proper usage of personal protective equipment (PPE), and scope disinfection and room decontamination. All endoscopic procedures accomplished during COVID-19 outbreak and progress of stepwise resumption of elective endoscopy procedures were retrospectively reviewed. RESULTS Only urgent or semi-urgent procedures were performed during COVID-19 outbreak. After no local new-onset COVID-19 case in Beijing for four weeks, we reopened the endoscopy center for elective procedures and monitored the outbreak continuously while maintaining a sustainable endoscopy service. CONCLUSIONS It is imperative that all endoscopy centers should establish standard infection control strategies in order to fight COVID-19 pandemic based on national guidance and academic society guidelines and tailor them to individual resources. These measures and setup can also be reserved for future pandemics.
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Affiliation(s)
- Shengyu Zhang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Xi Wu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Hui Pan
- Medical Affairs DepartmentPeking Union Medical College HospitalBeijingChina
| | - Dong Wu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Tao Xu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Ning Shen
- Medical Affairs DepartmentPeking Union Medical College HospitalBeijingChina
| | - Yizhen Zhang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Yunlu Feng
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Qiang Wang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Qingwei Jiang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Tao Guo
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Dongsheng Wu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Shou‐jiang Tang
- Division of Digestive DiseasesDepartment of MedicineUniversity of Mississippi Medical CenterJacksonUSA
| | - Aiming Yang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
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Ehrlich D, Muthusamy VR. Device profile of the EXALT Model D single-use duodenoscope for endoscopic retrograde cholangiopancreatography: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:421-427. [PMID: 33855920 DOI: 10.1080/17434440.2021.1917990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: The management of pancreaticobiliary disorders relies heavily on endoscopic retrograde cholangiopancreatography, which is performed with a duodenoscope. Bacterial colonization of reusable duodenoscopes leading to subsequent infectious outbreaks is well recognized and remains an issue despite efforts to optimize best practices in high-level disinfection. The EXALT Model D duodenoscope (EXALT) (Boston Scientific Corporation, Marlborough, MA) is a single-use device, designed to achieve technical equivalency with reusable devices while eliminating the potential for device-related outbreaks.Areas covered: This review covers the challenges associated with reprocessing duodenoscopes and the development of duodenoscope-related infections, with an emphasis on the use of single-use duodenoscopes as a potential solution to this issue.Expert Opinion: Duodenoscope-related infections are an increasingly recognized problem. Infectious outbreaks harm patients, significantly affect providers and medical centers, and can erode patient trust in the health-care system. Single-use duodenoscopes eliminate both the risk of device-related infection transmission and the need for burdensome duodenoscope reprocessing. In clinical evaluations, the EXALT device has demonstrated an equivalent technical performance and provider satisfaction compared to reusable duodenoscopes. Increasing use of this device will clarify how it compares to reusable duodenoscopes in a variety of clinical settings among endoscopists of varying skills levels.
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Affiliation(s)
- Dean Ehrlich
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - V Raman Muthusamy
- Medical Director of Endoscopy, UCLA Health System, Professor of Clinical Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Donato G, Forti E, Mutignani M, Laterra MA, Arese D, Coppola F, Zaccari P, Mariani A, Arcidiacono PG, Pigò F, Conigliaro R, Costa D, Tringali A, Lavagna A, Rocca R, Gabbiadini R, Fugazza A, Repici A, Fava G, Marini F, Mosca P, Urban F, Monica F, Crinò SF, Gabbrielli A, Blois M, Binda C, Sbrancia M, Fabbri C, Frego R, Dinelli M, Imbesi V, Gambitta P, Balzarini M, Segato S, Grazioli LM, Spada C, Amato A, Venezia G, Aragona G, Rosa C, Alvisi C, Devani M, Manes G, Dell’Amico I, Gemme C, Reati R, Auriemma F, Mangiavillano B, Rodi M, Bertani H, Mazzucco D, Armellini E, Cantù P, Penagini R, Occhipinti P. A multicenter survey on endoscopic retrograde cholangiopancreatography during the COVID-19 pandemic in northern and central Italy. Endosc Int Open 2021; 9:E629-E634. [PMID: 33880397 PMCID: PMC8050562 DOI: 10.1055/a-1380-3419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background and study aims COVID-19 has dramatically impacted endoscopy practice because upper endoscopy procedures can be aerosol-generating. Most elective procedures have been rescheduled. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed in emergency or urgent settings in which rescheduling is not possible. We evaluated the impact of the COVID-19 pandemic on ERCP in Italy during the SARS-CoV-2 lockdown, in areas with high incidence of COVID-19. Patients and methods We performed a retrospective survey of centers performing ERCP in high COVID-19 prevalence areas in Italy to collect information regarding clinical data from patients undergoing ERCP, staff, case-volume and organization of endoscopy units from March 8, 2020 to April 30, 2020. Results We collected data from 31 centers and 804 patients. All centers adopted a triage and/or screening protocol for SARS-CoV-2 and performed follow-up of patients 2 weeks after the procedure. ERCP case-volume was reduced by 44.1 % compared to the respective 2019 timeframe. Of the 804 patients undergoing ERCP, 22 (2.7 %) were positive for COVID-19. Adverse events occurred at a similar rate to previously published data. Of the patients, endoscopists, and nurses, 1.6 %, 11.7 %, and 4.9 %, respectively, tested positive for SARS-CoV-2 at follow up. Only 38.7 % of centers had access to a negative-pressure room for ERCP. Conclusion The case-volume reduction for ERCP during lockdown was lower than for other gastrointestinal endoscopy procedures. No definitive conclusions can be drawn about the percentage of SARS-CoV-2-positive patients and healthcare workers observed after ERCP. Appropriate triage and screening of patients and adherence to society recommendations are paramount.
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Affiliation(s)
- Giulio Donato
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Edoardo Forti
- Digestive and Operative Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Operative Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Daniele Arese
- Gastroenterology Unit, Ospedale San Giovanni Bosco, Torino, Italy
| | - Franco Coppola
- Gastroenterology Unit, Ospedale San Giovanni Bosco, Torino, Italy
| | - Piera Zaccari
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Alberto Mariani
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy – Azienda Ospedaliero-Universitaria Modena, Ospedale di Baggiovara, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy – Azienda Ospedaliero-Universitaria Modena, Ospedale di Baggiovara, Italy,Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria Modena, Policlinico di Modena, Italy
| | - Deborah Costa
- Gastroenterology Unit, ULSS 2 Marca Trevigiana, Ospedale Conegliano-Vittorio Veneto, Italy
| | - Alberto Tringali
- Gastroenterology Unit, ULSS 2 Marca Trevigiana, Ospedale Conegliano-Vittorio Veneto, Italy
| | | | - Rodolfo Rocca
- Gastroenterology Unit, AO Ordine Mauriziano, Torino, Italy
| | - Roberto Gabbiadini
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
| | - Giammarco Fava
- SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, Ancona, Italy
| | - Francesco Marini
- SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, Ancona, Italy
| | - Piergiorgio Mosca
- SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, Ancona, Italy
| | - Flavia Urban
- Gastroenterology Unit, ASU GI Ospedale di Cattinara Trieste, Italy
| | - Fabio Monica
- Gastroenterology Unit, ASU GI Ospedale di Cattinara Trieste, Italy
| | | | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Verona, Italy
| | - Matteo Blois
- Operative Endoscopy Unit, Azienda Usl Toscana Nord-Ovest, Livorno, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | | | | | - Venerina Imbesi
- Gastroenterology and Digestive Endoscopy Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | - Pietro Gambitta
- Gastroenterology and Digestive Endoscopy Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | | | - Sergio Segato
- Gastroenterology Unit, ASST Sette-Laghi, Varese, Italy
| | | | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Arnaldo Amato
- Gastroenterology Unit, Ospedale Valduce, Como, Italy
| | - Giovanna Venezia
- Gastroenterology Unit, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy
| | - Giovanni Aragona
- Gastroenterology and Hepatology Unit, Ospedale Civile, AUSL Piacenza, Italy
| | - Cesare Rosa
- Digestive Endoscopy Unit, ASST Pavia, Ospedali Voghera-Vigevano, Pavia, Italy
| | - Costanza Alvisi
- Digestive Endoscopy Unit, ASST Pavia, Ospedali Voghera-Vigevano, Pavia, Italy
| | | | | | - Iginio Dell’Amico
- Endoscopy Unit, Azienda Usl Toscana Nord-Ovest, Massa Carrara, Italy
| | - Carlo Gemme
- Gastroenterology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Raffaella Reati
- ASST Rhodense, Presidio di Garbagnate Milanese, Milan, Italy
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas – Mater Domini, Castellanza, Varese, Italy
| | | | - Marcello Rodi
- Gastroenterology and Digestive Endoscopy Unit, Ospedale S. Andrea, ASL VC, Vercelli, Italy
| | - Helga Bertani
- Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria Modena, Policlinico di Modena, Italy
| | | | - Elia Armellini
- Gastroenterology and Digestive Endoscopy Unit, ASST Bergamo Est, Bergamo, Italy
| | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pietro Occhipinti
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
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Microbiological Surveillance of Endoscopes in a Southern Italian Transplantation Hospital: A Retrospective Study from 2016 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063057. [PMID: 33809670 PMCID: PMC8002344 DOI: 10.3390/ijerph18063057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/13/2021] [Indexed: 11/24/2022]
Abstract
Endoscopes are medical instruments that are used routinely in health structures. Due to their invasive nature and contact with many patients, they may cause hospital-acquired infections if not disinfected correctly. To ensure a high-level disinfection procedure or reprocessing, since the methods currently adopted in our institute are adequate, we evaluated retrospectively the presence of microorganisms in our endoscopes after reprocessing. Microbiological surveillance was performed from January 2016 to December 2019 in the instruments in use in our endoscopic room after reprocessing. In total, 35 endoscopes (3 duodenoscopes, 3 echoendoscopes, 12 bronchoscopes, 5 colonoscopes, and 12 gastroscopes) were evaluated for the presence of microorganisms, including multidrug-resistant pathogens and indicator microorganisms (IMOs). Our procedures were in agreement with an internal protocol based on Italian, international, and the Center for Disease Control and Prevention (CDC) recommendations. Of a total of 811 samples, 799 (98.5%) complied with the regulatory guidelines, while 9 (1.1%) were positive for IMOs, and 3 (0.4%) displayed more than 10 colony-forming units (CFU) of environmental and commensal pathogens. Our results show that the internal reprocessing protocol is very efficient, leading to a very low number of observed contaminations, and it could be easily implemented by other health facilities that face a huge number of hospital-acquired infections due to incorrectly disinfected endoscopes.
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Casini B, Tuvo B, Marciano E, Del Magro G, Gemignani G, Luchini G, Cristina ML, Costa AL, Arzilli G, Totaro M, Baggiani A, Privitera G. Improving the Reprocessing Quality of Flexible Thermolabile Endoscopes: How to Learn from Mistakes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052482. [PMID: 33802350 PMCID: PMC7967619 DOI: 10.3390/ijerph18052482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
Background: Failure in the reprocessing of thermolabile flexible endoscopes has been reported as one of the most important threats to patient health. Method: A case report and observational study was conducted, from August 2014 to December 2019, in the Digestive Endoscopy Unit of a University Hospital in Italy, where two cases of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae infections in patients undergoing endoscopic retrograde cholangio-pancreatography were observed. Following the risk/safety management practices, an epidemiological investigation was started, duodenoscopes were removed from use and the reprocessing practices reviewed. Moreover, microbiological surveillance of endoscopes was carried out according to the CDC guidelines. Results: In the first phase of sampling, 10/10 (100%) endoscopes were found to be non-compliant, of which 7 showed results for high-concern organisms (HCOs), such as KPC-K. pneumoniae, P. aeruginosa and E. coli. After implementing corrective actions, 12 out of 17 endoscopes were found to be non-compliant (70.5%), of which 8 showed results for HCOs, such as KPC-K. oxytoca and P. aeruginosa. During the last year of regular microbiological surveillance, only 23% of endoscopes (35/152) were found to be non-compliant, of which 7 showed results for HCOs, such as NDM-K. pneumoniae, P. aeruginosa and A. baumannii. The crucial issues were related to samples collected from the internal channels of duodenoscopes. Conclusion: Managing the risk associated with the reprocessing of digestive endoscopes, through risk assessment at every stage of the process, is important for the prevention of infections associated with the use of these device.
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Affiliation(s)
- Beatrice Casini
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
- Correspondence: ; Tel.: +39-050-2213590; Fax: +39-050-2213588
| | - Benedetta Tuvo
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Emanuele Marciano
- Endoscopy Service Division, University Hospital of Pisa, 56126 Pisa, Italy; (E.M.); (G.D.M.)
| | - Giuliana Del Magro
- Endoscopy Service Division, University Hospital of Pisa, 56126 Pisa, Italy; (E.M.); (G.D.M.)
| | - Giulia Gemignani
- Medical Direction, University Hospital of Pisa, 56126 Pisa, Italy; (G.G.); (G.L.)
| | - Grazia Luchini
- Medical Direction, University Hospital of Pisa, 56126 Pisa, Italy; (G.G.); (G.L.)
| | | | - Anna Laura Costa
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Guglielmo Arzilli
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Michele Totaro
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Angelo Baggiani
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
| | - Gaetano Privitera
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (B.T.); (A.L.C.); (G.A.); (M.T.); (A.B.); (G.P.)
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Liao Z, He S, Sha W, Feng Z, Sun X, Wan J, Pan J, Wang S, Linghu E, Li Z. Capsule endoscopy practice during the COVID-19 pandemic: Recommendations from the Capsule Endoscopy Group of the Chinese Society of Digestive Endoscopy. Endosc Int Open 2021; 9:E280-E283. [PMID: 33655021 PMCID: PMC7892273 DOI: 10.1055/a-1333-6635] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/11/2020] [Indexed: 02/08/2023] Open
Abstract
The Capsule Endoscopy Group of the Chinese Society of Digestive Endoscopy has issued recommendations for capsule endoscopy (CE) practice during the COVID-19 pandemic to standardize workflow, preventive strategies, and management of a CE unit and in so doing, ensure the safety of both medical staff and patients.
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Affiliation(s)
- Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, Shanghai, China
| | - Shuixiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Weihong Sha
- Department of Gastroenterology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Zhijie Feng
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xiaomei Sun
- Digestive Disease Hospital of Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
| | - Jun Wan
- Department of Gastroenterology, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jun Pan
- Department of Gastroenterology, Changhai Hospital, Shanghai, China
| | - Shasha Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Enqiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Shanghai, China
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Ferreira-Silva J, Peixoto A, Rodrigues-Pinto E, Macedo G. Implications of COVID-19 for the busy gastroenterologist. Eur J Gastroenterol Hepatol 2021; 33:319-324. [PMID: 32501876 PMCID: PMC7846254 DOI: 10.1097/meg.0000000000001811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/10/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an infection caused by a novel coronavirus (SARS-CoV-2) originated in China in December 2020 and declared pandemic by WHO. This coronavirus mainly spreads through the respiratory tract and enters cells through angiotensin-converting enzyme 2 (ACE2). The clinical symptoms of COVID-19 patients include fever, cough, and fatigue. Gastrointestinal symptoms (diarrhea, anorexia, and vomiting) may be present in 50% of patients and may be associated with worst prognosis. Other risk factors are older age, male gender, and underlying chronic diseases. Mitigation measures are essential to reduce the number of people infected. Hospitals are a place of increased SARS-CoV-2 exposure. This has implications in the organization of healthcare services and specifically endoscopy departments. Patients and healthcare workers safety must be optimized in this new reality. Comprehension of COVID-19 gastrointestinal manifestations and implications of SARS-CoV-2 in the management of patients with gastrointestinal diseases, under or not immunosuppressant therapies, is essential. In this review, we summarized the latest research progress and major societies recommendations regarding the implications of COVID-19 in gastroenterology, namely the adaptations that gastroenterology/endoscopy departments and professionals must do in order to optimize the provided assistance, as well as the implications that this infection will have, in particularly vulnerable patients such as those with chronic liver disease and inflammatory bowel disease under or not immunosuppressant therapies.
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Affiliation(s)
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar de São João
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar de São João
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João
- Faculty of Medicine, University of Porto, Porto, Portugal
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Zhao Y, Chen Q, Guo Q, Chen N, Hou W, Wang Y, Qu W, Tang SJ, Sun S, Cheng B. Performing EUS during COVID-19 postendemic period: A report from endoscopy center in Wuhan. Endosc Ultrasound 2021; 10:93-97. [PMID: 32675462 PMCID: PMC8098845 DOI: 10.4103/eus.eus_37_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023] Open
Abstract
In early April 2020, the 3-month-long city-wide lockdown was lifted in Wuhan, the epicenter of China during Coronavirus Disease 2019 (COVID-19) global pandemic. However, continuing precautions are still practiced considering the risk of transmission from asymptomatic carriers. Given that COVID-19 is spread via airborne droplets, including aspiration of oral and fecal material through endoscopes, our endoscopy center has strategically assigned health-care providers to ensure triage workflow and to minimize concomitant exposure from potential asymptomatic carriers. Here, we share the experience of performing EUS-FNA during the COVID-19 pandemic and postendemic periods. We illustrate our workflow using a patient with a left adrenal mass as an example and followed a biosafety level-2 standard. We believe all endoscopy centers need to focus on these three directions: (1) pre-EUS patients risk assessment and triage, (2) Personal protective equipment (PPE), and (3) dressing code modalities. We fully adopted them in our hospital to reduce COVID-19 resurgence risk.
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Affiliation(s)
- Yuchong Zhao
- Department of Internal Medicine, The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- The Second Clinical School Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qian Chen
- Department of Internal Medicine, The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qiaozhen Guo
- Department of Internal Medicine, The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Nianjun Chen
- Department of Internal Medicine, The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wei Hou
- Department of Internal Medicine, The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yun Wang
- Department of Internal Medicine, The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Weinuo Qu
- Department of Internal Medicine, The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- The Second Clinical School Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Shou Jiang Tang
- Department of Medicine, Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Bin Cheng
- Department of Internal Medicine, The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Shin R, Lee S, Han KS, Sohn DK, Moon SH, Choi DH, Kye BH, Son HJ, Lee SI, Si S, Kang WK. Guidelines for accreditation of endoscopy units: quality measures from the Korean Society of Coloproctology. Ann Surg Treat Res 2021; 100:154-165. [PMID: 33748029 PMCID: PMC7943281 DOI: 10.4174/astr.2021.100.3.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/29/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can prevent CRC by detection and removal of precancerous lesions. The most important considerations when performing colonoscopy screening are the safety and satisfaction of the patient and the diagnostic accuracy. Accordingly, the Korean Society of Coloproctology (KSCP) herein proposes an optimal level of standard performance to be used in endoscopy units and by individual colonoscopists for screening colonoscopy. These guidelines establish specific criteria for assessment of safety and quality in screening colonoscopy. Methods The Colonoscopy Committee of the KSCP commissioned this Position Statement. Expert gastrointestinal surgeons representing the KSCP reviewed the published evidence to identify acceptable quality indicators and indicators that lacked sufficient evidence. Results The KSCP recommends an optimal standard list for quality control of screening colonoscopy in the following 6 categories: training and competency of the colonoscopist, procedural quality, facilities and equipment, performance indicators and auditable outcomes, disinfection of equipment, and sedation and recovery of the patient. Conclusion The KSCP recommends that endoscopy units performing CRC screening evaluate 6 key performance measures during daily practice.
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Affiliation(s)
- Rumi Shin
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea.,Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Seongdae Lee
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Kyung-Su Han
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Dae Kyung Sohn
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Sang Hui Moon
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Dong Hyun Choi
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Bong-Hyeon Kye
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Hae-Jung Son
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Sun Il Lee
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Sumin Si
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Won-Kyung Kang
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea.,Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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48
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Fujimura H, Nishikawa J, Okamoto T, Goto A, Hamabe K, Sakaida I. Use of portable partitions with high-efficiency particulate air filters in the endoscopy unit. Endosc Int Open 2021; 9:E278-E279. [PMID: 33553593 PMCID: PMC7857964 DOI: 10.1055/a-1322-2761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Hiroyuki Fujimura
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Jun Nishikawa
- Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takeshi Okamoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Atsushi Goto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Koichi Hamabe
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Isao Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Safety in Endoscopy for Patients and Healthcare Workers During the COVID-19 Pandemic. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2021; 23:170-178. [PMID: 33103130 PMCID: PMC7568769 DOI: 10.1016/j.tige.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is still wreaking havoc in many parts of the world and poses a great burden to healthcare systems worldwide. Mitigation and suppression strategies have been implemented globally but the disease has proven to be difficult to contain. Initially many elective gastrointestinal endoscopies were cancelled to reduce the risk of infection and conserve personal protective equipment, but many endoscopy units are now faced with the dilemma of resuming endoscopy service during the pandemic as indefinitely postponing diagnostic procedures may lead to a delay in the diagnosis and treatment of malignancies. Further concerns are surfacing as COVID-19 is now known to affect the gastrointestinal tract and may potentially be spread via the fecal-oral route. Until more effective drugs and vaccines are available, it is unlikely that the pandemic will wind down in the near future. Maintaining a balance between protecting healthcare workers and patients from being infected on the one hand and providing timely and effective clinical care on the other will become increasingly important as the pandemic persists. In this narrative review, the risk of COVID-19 infection for healthcare workers and patients undergoing endoscopy, and recommendations on maintaining safe, high-quality endoscopy practice will be discussed.
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50
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Day LW, Muthusamy VR, Collins J, Kushnir VM, Sawhney MS, Thosani NC, Wani S. Multisociety guideline on reprocessing flexible GI endoscopes and accessories. Gastrointest Endosc 2021; 93:11-33.e6. [PMID: 33353611 DOI: 10.1016/j.gie.2020.09.048] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | | | - James Collins
- Department of Digestive Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University, St Louis, Missouri, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav C Thosani
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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