Clinical News

Guidance on Decontamination of Equipment for Gastrointestinal Endoscopy: 2017 Edition

Tuesday, 25 April 2017 08:36

The Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee

April 2017

Flexible endoscopes are complex reusable instruments that require unique consideration with respect to decontamination. Their external surfaces and internal channels for air, water, aspiration and accessories are all potentially exposed to body fluids and other contaminants.

In contrast to rigid endoscopes, flexible endoscopes are heat labile and cannot be autoclaved. Most flexible endoscopes are classed as "semi-critical devices" as they come into contact with mucous membranes during use and present a moderate degree of infection risk if contaminated at the time of use. The process of flexible endoscope decontamination is referred to as "high level disinfection". This is the term given to a process that eliminates or kills all vegetative bacteria, mycobacteria, fungi and viruses, except for small numbers of bacterial spores.

The Health and Social Care Act: Code of Practice on the prevention and control of infections and related guidance was published in England in 2008 (updated in 2015). This stipulates the roles of decontamination leads and decontamination programmes. It emphasises the need for staff to be trained in decontamination processes and to hold appropriate competencies for their role. It decrees the need for monitoring systems to ensure that decontamination processes are fit for purpose and meet required standards. Finally it requires that there are systems in place for tracking reusable medical devices (such as endoscopes and reusable accessories) through decontamination processes, not only to assist with assuring their quality, but also to enable the identification of patients on whom the medical devices have been used. Similar guidance is employed in the other UK devolved nations.

The BSG first published guidelines on decontamination in 1998. Over the years many changes have occurred in recommendations for the decontamination of flexible endoscopes. In order to be responsive to these changes this document has been revised as guidance, this allows the flexibility to update this document in line with changes issued by Government agencies and other professional bodies.

 

BSG statement on "Use of intravenous Hyoscine Butylbromide (Buscopan) during Gastrointestinal Endoscopy"

Tuesday, 04 April 2017 11:02

The MHRA has recently circulated a Drug Safety Update regarding the risk of serious adverse events following the use of intravenous Hyoscine Butylbromide (Buscopan) in patients with underlying cardiac disease.

Buscopan is commonly used during endoscopic procedures. It induces smooth muscle relaxation and reduces spasm in the gastrointestinal tract. It is used during upper GI Endoscopy and small bowel enteroscopy to reduce contraction and aid mucosal visualisation. During endoscopic retrograde cholangiopancreatography, it is used to facilitate access to the common bile duct during cannulation of the Ampulla of Vater. During colonoscopy, it is used to reduce haustral definition to optimise mucosal visualisation and lesion detection.

 

'FIT for symptomatic patients' workshop - NHSE in partnership with the BSG and ACPGBI

Tuesday, 04 April 2017 09:20

NHSE in partnership with BSG and ACPGBI ran a workshop on the 8th March, with clinicians from across the colorectal pathway, to scope activity and opinions on the potential use of FIT in symptomatic patients. Discussions focused on: what data collection was ongoing already, what the gaps were in our knowledge of FIT, and how clinicians could work collaboratively to fill the gaps in a timely manner. If you would like to find out more please see the summary of the meeting on the website, or contact Sophie Lumley at NHS England This e-mail address is being protected from spambots. You need JavaScript enabled to view it . We are interested to hear about other projects that are either ongoing (as research or service evaluation) or currently in the planning stages, or hear from areas interested in collecting data on FIT in symptomatic patients.

Simethicone Residue in Endoscopes

Tuesday, 28 March 2017 07:44

March 2017

Dr Helen Griffiths, Nurse Consultant & Decontamination Advisor British Society of Gastroenterology

A publication in 2016 in the American Journal of Infection control (Ofstead et al) outlined a potential risk following the identification of residual simethicone in endoscopes following the decontamination process in the United States.

At that time expert opinion in the UK concluded that the decontamination process was not well described and that bacteria found on processed scopes were suggestive of operator contamination and not compromised decontamination. Whilst not seen as a basis for modifying the use of simethicone at that time it has continued to be monitored.

Recently there has been an issue identified in the Republic of Ireland when a colonoscope was sent to Olympus for repair. Preliminary investigation showed what appeared to be signs of Simethicone residue ( Hypromellose, an ingredient of Infacol) in the auxiliary water channel of that colonoscope and subsequently a further two colonoscopes. At this time investigation is ongoing but evidence suggests that scopes were reprocessed in accordance with manufacturers instructions including use of MH-946 injection tube (octopus device).

Simethicone was administered via the flushing pump at a dilution of 25mls (40mgs/ml) in 2 litres of water.

There has been no evidence of resultant infection but until further investigation and testing on compatibility and following discussion with the Decontamination Professional Expert Communication Forum (DPECF) it is advised that Simethicone is administered either orally or via the biopsy port of endoscopes and NOT via either the water bottle or flushing pump devices. This will ensure that manual brushing of relevant channels can take place post procedure. The strength of the dilutent should also be kept to a minimum to achieve the desired effect.

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