The Colonoscopy Workstation

Layout and instrumentation in modern endoscopy units, where colonoscopy is performed under quality control, are designed according to normative standards, and also conduct regular hygiene checks.

■ Examination Room Set-up

The design of the colonoscopy workstation should meet not only the requirements of an ergonomic examination procedure and a patient-friendly atmosphere, but also must comply with regulations concerning ventilation and installation of electrical equipment. Keeping dust, micro-organisms and odors to a minimum is just as important for personnel as it is for the patient (Fig. 2.21).

Every examination room must have a hygienic area for hand washing. Direct access to a patient bathroom is also desirable.

The room where the preparations for endoscopy take place must be in the immediate vicinity of the examination room and must be able to be divided into clean and unclean zones.

■ Hygiene Standards for Reprocessing Equipment

Automated reprocessing. After use, the endoscope is wiped off in the examination room and placed in a container with a ten-side-based (e.g., Bodedex forte) cleansing solution where it is

Colonoscopy Room
Fig. 2.20 EASIE model for training in endoscopic interventions (courtesy of Dr. Maiss, University Clinic Erlangen).
Endoscopy Room Layout
Fig. 2.21 Colonoscopy workstation. Examining table (1), Radiography equipment (2), Video tower (3), Power unit, endoscope with video processor (4), Light source (5), Air supply/pump (6), Suction pump (7), Instrument table for accessories (8) (courtesy of Mr. Wirth, photo archive, Augsburg Clinic).

The Colonoscopy Workstation flushed. Aldehyde should not be used as it may cause protein fixations in the instrument channels. The endoscope is then disconnected from the power unit and brought to the storage area where it is again immersed in a cleansing solution and checked for leakages. A careful brush cleaning can reduce bacterial count by four log levels (Fig. 2.22). The valves should be removed and, together with the accessories, cleaned mechanically and enzy-matically using an ultrasonic cleaner.

Reprocessing and disinfection procedures. Further cleaning of the endoscope can, in theory, be accomplished manually or automatically. However, automatic-washer disinfectors have distinct advantages with regard to protecting personnel from potential health hazards, as well for standardization of disinfection procedures (12).

The instrument and accessories are loaded separately into baskets or trays in the automatic-washer disinfector and the endoscope is attached to the automatic cleaning system (Fig. 2.23). A solution of either 2.4% glutaraldehyde or 10% succine dialde-hyde is used for disinfection. The final rinse cycle is completed using sterilized water.

After thermochemical reprocessing and disinfection have been completed (ca. 40 minutes) the endoscope can be removed and allowed to dry. Air can be aspirated through all channels to speed up the drying process.

The endoscope is stored in a hanging position and without reattaching the valves to avoid recontamination resulting from residual dampness (Fig. 2.24).

ified personnel with up-to-date training (2). Hygiene standards exist for cleaning and disinfecting flexible endoscopes and accessories (13). Conducting quarterly tests as a quality control measure for equipment cleaning is recommended (9) (Fig. 2.24). This includes checking cleaning, disinfection, testing for microorganisms in all endoscope channels and lens washing systems. Detection of Escherichia coli or other enterobacteria or entero-cocci, in particular, is evidence of inadequate reprocessing. Correct endoscope reprocessing, disinfection and sterilization procedures are essential, and the health and safety of the patient, users and third parties must not be endangered.

■ Radiography Equipment Regulations

Radiographic screening is occasionally used to determine the position of the instrument in the patient. Commonly, a mobile radiograph is used, which is passed briefly over the patient's abdomen. The examination room must comply to specific standards, for example, must be large enough so that the axis of the radiographic path is at least 1.5 m from the nearest wall in order to avoid hazardous reflection of the ray.

Operating knowledge of radiography equipment (professional certification) is mandatory as is the wearing of appropriate protective clothing. A radiographic dosimeter must be worn on an appropriate position on the upper body, underneath the protective apron (Fig. 2.25).

Hygiene standards and tests. The majority of infections cited in the literature result from lacking hygiene, so it is vital that cleaning and disinfecting the instrument be conducted only by qual-

Fig. 2.22 Brush cleaning the endoscope after use (courtesy of Mr. Wirth, photo archive, Augsburg Clinic).

Fig. 2.23 Loading the endoscope in the automatic washer-disinfector (courtesy of Mr. Wirth, photo archive, Augsburg Clinic).

Colonoscopy Body Position

Fig. 2.25 Using radiography during colonoscopy (courtesy of Mr. Wirth, photo archive, Augsburg Clinic).

Fig. 2.24 Quarterly hygiene tests are essential (courtesy of Mr. Wirth, photo archive, Augsburg Clinic).

Fig. 2.25 Using radiography during colonoscopy (courtesy of Mr. Wirth, photo archive, Augsburg Clinic).

Pump Disinfection Endoscope
Fig. 2.26 Storing the endoscopes in lockers (courtesy of Mr. Wirth, photo archive, Augsburg Clinic).

References

1. American Society For Gastrointestinal Endoscopy. Complications of 10. colonoscopy. Gastrointest Endosc 2003;57:441-5.

2. Ayliffe G. Nosocomial infections associated with endoscopy. In: Mayhall G (ed.). Hospital Epidemiology and Infection Control. 11. Philadelphia: Lippincott, Williams & Wilkins, 1999, pp. 881-95.

3. Cappell MS. Safety and efficacy of colonoscopy after myocardial infarction: an analysis of 100 study patients and 100 control patients 12. at tertiary cardiac referral hospitals. Gastrointest. Endoscopy 2004;60:901-9. 13.

4. Dafnis G, Ekbom A, Pahlmann L, Blomqvist P. Complications of diagnostic and therapeutic colonoscopy within a defined population in Sweden. Gastrointest Endosc 2001;54:302-9.

5. Farley DR, Bannon MP, Ziellow SP, PauberlonJH, Illstrup DM, Larson 14. DR. Management of colonoscopy perforations. Mayo Clin Proc 1997;72:729-33.

6. Ferlitsch A, Glauninger P, Gupper A et al. Evaluation of a virtual en-doscopy simulator for training in gastrointestinal endoscopy. En- 15. doscopy 2002;34:698-702.

7. HochbergerJ, MaissJ, Hahn EG. The use of simulators for Training in

GI Endoscopy. Endoscopy 2002;34:727-9. 16.

8. Lazzaroni M, Bianchi Porro G. Preparation, Premedication and Surveillance. Endoscopy 2003;35:103-11. 17.

9. Leiß O, Beilenhoff U, Bader L, Jung M, Exner M. Leitlinien zur Aufbereitung flexibler Endoskope und endoskopischen Zu satzinstrumentariums im internationalen Vergleich. Z Gastroenterol 2002;40:531-42.

Levin TR, Conell C, Shapiro JA, Chazan SG, Nadel MR, SelbyJV. Complications of screening flexible sigmoidoscopy. Gastroenterology 2002;123:1786-92.

Liebermann DA, Weiß DG, Bond JH, Ahnen DJ et al. Use of colonos-copy to screen asymptomatic adults for colorectal cancer. New Engl J Med 2000;343:162-8.

Rey JF et al. ESGE/ESGENA Technical note on cleaning and disinfection. Endoscopy 2003;35:869-877.

RKI-Empfehlungen „Anforderungen an die Hygiene bei der Aufbereitung flexibler Endoskope und endoskopischen Zu-satzinstrumentariums„, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2002;45:395-411. Schmiegel W, Adler G, Fölsch U, Langer P, Pox C, Sauerbruch T. Kolorektale Karzinome, Prävention und Früherkennung in der asymptomatischen Bevölkerung - Vorsorge bei Risikogruppen. Dtsch Ärztebl 2000;97:1906-12.

Seeff LC et al. Is there endoscopy capacity to provide colorectal cancer screening to the unscreened population in the united states? Gastroenterology 2004;127:1661-1669.

Watanabe H, Narasaka T, Uezu T. Colonfiberoscopy. Stomach, Intestine 1971;6:1333-6.

Winawer SJ, Zauber AG, Ho MN, O'Brien MJ et al. Prevention of colorectal cancer by colonoscopic polypectomy. New Engl J Med 1993;329:1977-81.

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