Occupational risk prevention in endoscopy units: a pending issue

How and how much do endoscopy professionals protect themselves against infection?

PURPOSE

It is aimed to identify, the educations given to professionals working in endoscopy units against infectious risks during the endoscopic procedures and awareness of professionals for protection from these infections.

MATERIAL AND METHOD

After obtaining the required ethic committee permissions, 50 physicians and 34 nurses, working in the endoscopy units of three university and one training and research hospital, were included in this study. A survey with 37 questions, prepared in accordance with the literature was applied to the participating endoscopist (E) and endoscopy nurses (EN). SPSS (Statistical Package for Social Sciences) for Windows 16.0 program was used for statistical evaluation of the obtained data.

FINDINGS

Forty-four (52%) of the subjects were female and 40 (48%) were male, and their average age was 39 (±6.82) years. When trainings on endoscopy of E and EN were evaluated, it was found that 44% (n = 37) of them precise an endoscopy course on endoscopy training, %56 (n = 47) received no training and they learned through master/apprentice system. Furthermore, it was found that 65% (n = 55) of the E and EN received no training on universal precautions procedures, infection and risks endoscopic procedures and only 35% (n = 29) received a specific course or on-the-job training. Nevertheless, rates of wearing protective gowns and gloves were high both for E and EN; but rate of other precautions such as wearing mask, using special gloves and face shields were found to be low. It was found that the rate of "receiving an education on endoscopy" for E was significantly higher than that of EN (p < 0001). The rate of reporting emergency situations such as contact with blood/body fluids or percutaneous injuries and the rate of taking universal precautions of EN who received an education, was statistically higher than that of EN who did not (p < 0.001 and p < 0008).

RESULTS

As a result of our investigation, it was determined that the endoscopists and endoscopy nurses did not effectively apply the universal precautions against infectious risks faced during endoscopic procedures and did not receive the basic trainings. The professionals who received training were more responsive for this issue. According to our results, organizing continuous training programs through endoscopy professionals is necessary to provide the universal precautions of avoiding exposure to blood and body fluids.

Adverse staff health outcomes associated with endoscope reprocessing

There are occupational challenges associated with cleaning, disinfecting, storing, and transporting flexible endoscopes. Although the Occupational Safety and Health Administration (OSHA) has set standards to protect the safety of health workers in the United States, the standards are not specific to endoscope reprocessing, and the general standards that are in place are not fully implemented. Furthermore, adverse staff outcomes may not be fully preventable. To assess the evidence for adverse outcomes in staff associated with endoscope reprocessing, a literature review was performed in the PubMed database for articles on this topic published between Jan. 1, 2007 and March 7, 2012. Eight studies were identified, mainly European, which reported numerous adverse outcomes to healthcare personnel associated with endoscope reprocessing including respiratory ailments and physical discomfort. More scientifically rigorous studies are required to comprehensively describe adverse health outcomes in personnel engaged in reprocessing, particularly in the United States, and examine whether increased automation of the reprocessing process leads to decreased adverse health outcomes for staff.