Patient Safety Alert: Naloxone
Friday, 30 October 2015 10:35
Resources to minimise the risk of distress and death from inappropriate doses of naloxone
A Stage One: Warning Alert was issued 20 November 2014 drawing attention to the safety implications of inappropriate doses of the opioid/opiate antagonist naloxone. Whilst naloxone use can be life-saving in respiratory depression and respiratory arrest, the previous Stage One Alert highlighted that use of naloxone in patients where it is not indicated, or in larger than recommended doses, can cause a rapid reversal of the physiological effects for pain control, leading to intense pain and distress, and an increase in sympathetic nervous stimulation and cytokine release precipitating an acute withdrawal syndrome. Hypertension, cardiac arrhythmias, pulmonary oedema and cardiac arrest may result from inappropriate doses of naloxone being used for these types of patients.
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Potential transmission of multi resistant bacteria and duodenoscopes
Thursday, 22 October 2015 08:30
Recent reports in the media have highlighted the potential for transmission of infection associated with duodenoscopes. A recent peer reviewed publication (Endoscopy (2015) 47: 493-502) described an outbreak of VIM-2 producing Pseudomonas aeruginosa and identified an issue with the design and reprocessing of a recently introduced duodenoscope with a specific modified design. This may be similar to the outbreaks in the US (Gastrointestinal Endoscopy (2015) 82(3): 477-83).
The BSG would like to highlight the following points to staff carrying out the decontamination of flexible endoscopes, in particular duodenoscopes:
- Adherence to manufacturers' instructions at all times is essential.
- The pre clean procedure should take place at the patient bedside, as described in the instructions from the UK suppliers and BSG guidance.
- The cover on the raiser bridge mechanism at the distal tip should be removed prior to brushing all areas of the distal tip and cleaning with detergent and replaced on completion of the decontamination process. The brush must be used on all surface areas of the distal tip ensure that all debris is removed.
- The elevator wire channel should be flushed with detergent during the manual cleaning ensuring the correct size syringe is used. If automated flushing systems are used for this stage of the process, staff should ensure that this channel is included.
- Staff should ensure that the endoscope washer disinfector has the capability of flushing the elevator wire channel with detergent, disinfectant and rinse water.
- If stored in a drying cabinet, the elevator wire channel should be flushed with HEPA filtered air along with all the other channels. If this channel is not flushed with air, the endoscope should be used within 3 hours or the endoscope reprocessed before patient use. Not all cabinets have this facility. An EN standard, EN 16442, has now been published for endoscope storage drying cabinets.
- Routine microbiological surveillance of processed endoscopes is not recommended. However, this may be carried out on advice from the infection prevention and control team if an outbreak is known or suspected.
- Staff should receive comprehensive training, and a record retained, on all aspects of the decontamination of endoscopes, in particular, duodenoscopes.
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Royal College of Nursing launches framework to improve care for liver disease patients
Wednesday, 07 October 2015 11:53
The Royal College of Nursing (RCN) has launched a revised competence framework to help improve nursing care for people with liver disease. The framework, published on 18th September and launched at the British Liver Nurses' Forum 17th Annual Conference, aims to promote education and training in this area.
The framework is authored by RCN members Lynda Greenslade, Clinical Nurse Specialist in Hepatology at the Royal Free London NHS Foundation Trust, and Michelle Clayton, Lecturer in Liver Care at the University of Leeds. It describes the professional standards expected of practitioners when caring for adults and young people across England with liver disease. The framework is applicable to nursing staff in primary and secondary care settings, and is also suitable for use by healthcare practitioners such as GPs and liver dieticians.
The framework also highlights how liver disease was formerly considered to be a rare disease, but now is the fifth most common cause of death in the UK, namely as a result of alcohol, viral hepatitis and obesity leading to non-alcoholic fatty liver disease (NAFLD).
Guidance on Decontamination of Equipment for Gastrointestinal Endoscopy: 2014 Edition
Thursday, 10 July 2014 13:58
The Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee
The 2008 guidance has been updated so as to incorporate the following developments:
- The English Department of Health "Choice Frameworks for Local Policies and Procedures (CFPPs)" and equivalent documents from the devolved administrations.
- Implications arising from moving decontamination facilities out of endoscopy units to centralised facilities, in some cases outside of the hospital campus; in particular the need to ensure a moist environment for endoscopes following last patient use and before decontamination, and conversely the maintenance of a dry storage state following decontamination and before next patient use.
- Review of vCJD transmission risks, given that at the time of writing there are no known examples of vCJD arising as a result of endoscopy or surgery; guidance on decontamination of endoscopes following the performance of procedures in at-risk individuals is discussed, and quarantining of endoscopes is now deemed rarely necessary.
- Some references to newer technologies such as NOTES and cholangioscopy.
- A move away from enzymatic detergents, which have been linked to occupational dermatitis and asthma.
- The introduction of audit tools, workforce recommendations and educational frameworks.
It is also acknowledged that there are many "stakeholders" in the field of decontamination. This, together with varying guidance from the devolved administrations, has frequently led to inconsistencies and misunderstandings. Against this background BSG Council has agreed that BSG will no longer co-ordinate revisions of its guidance, but a member of BSG Endoscopy will represent the Society on the Professional Expert Organisation Forum that has been established under the auspices of the Institute of Decontamination Sciences.
Finally Miles Allison would like to acknowledge the help and support of so many colleagues during his 12 years of involvement in this arena, in particular Tina Bradley, Helen Griffiths, Libby Thomson, Geoff Ridgway, Mike Bramble and the late Prof Don Jeffries.
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Decontamination Alert - August 2013
Thursday, 22 August 2013 08:19
Choice Framework for local Policy and Procedures 01-06: Decontamination of flexible endoscopes details that manufacturer's instructions must be followed at all times when using an Endoscope Washer Disinfector (EWD), and selecting chemicals for use.
All units are asked to check that the chemicals (detergents and disinfectants) used in their EWDs are those tested by the machine manufacturer at the type-test stage with supporting evidence of efficacy. Under no circumstances should a chemical (i.e. disinfectant) be used that was not included in the type test data for that machine, this supports the need to follow manufacturer's instructions, as non-type tested chemicals may damage the internal mechanics of the EWD, therefore a possible risk to patients may occur.
If you are unsure which chemicals are recommended in your EWD please speak to your manufacturer requesting information specifically on 'type tested' chemicals.
Dr Helen Griffiths
Nurse Consultant Gastroenterology
Decontamination representative BSG Endoscopy Committee
On behalf of the Professional Expert Communications Forum: Decontamination of Medical Devices.
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