Experts say it is becoming more important for patients and clinicians to be better prepared for a colonoscopy or an endoscopy, and this preparation should include a discussion about the safety of the examinations.
In the past six years, at least two-dozen outbreaks of antibiotic-resistant bacterial infections related to reprocessed duodenoscopes have occurred worldwide. In the United States alone, such infections have resulted in at least 20 patient deaths, and this has not escaped the attention of patients scheduled for endoscopies.
The result: While endoscopists have struggled to find ways to prevent scope-related infections, they also have to learn to talk about the safety of the devices with their patients.
Cori L. Ofstead, MSPH
“Patients should be told the truth about the risk of infection before they consent to any procedure,” said Cori L. Ofstead, MSPH, the president and CEO of Ofstead & Associates, in St. Paul, Minn., a health care consultancy. “This discussion should happen well before the patient is prepped for any elective procedures,” she added.
“It behooves a patient to ask the question, ‘How are these [pieces of equipment] reprocessed?’” Ms. McGinty said, adding that she is seeing more and more patients asking that question. “There are some misconceptions that the public thinks they are sterilized. The gold standard for GI endoscopes is still high-level disinfection.” At her hospital, she said, “we reassure them that we keep track of all of our processes. We use traceability. We know for every instrument how we handled it.”
She added that “there should not be any trepidation from the physician in sharing how he or she, in their practice, are making sure all the steps are followed.”
Dr. Hutfless said clinicians should begin to learn to explain the disinfection process so they can tell the patient, “This is the way the scope is supposed to be cleaned, and yes, they are doing it the way they’re supposed to be doing it, so I feel confident.”
Those involved in reprocessing and their supervisors should maintain competencies, but “there are no qualifications or specializations for individuals responsible for reprocessing to my knowledge,” said Dr. Hutfless, referring to CDC guidelines on reprocessing.
Sometimes patients do some research to find out whether the Joint Commission has certified the ambulatory surgery center (ASC) where they are receiving care. By asking questions ahead of time, patients are ready on the day of the procedure, Ms. McGinty said.
Clinicians also need to do homework. “Physicians should work with their teams to make sure they’re following guidelines and implementing quality management systems that increase the likelihood that reprocessing will be effective,” Ms. Ofstead said. “This includes allocating time and resources needed for techs to do all of the steps correctly every time, and not pressuring them to do it faster.”
Information about how scopes are cleaned and infection rates is not always handy, Dr. Hutfless said. “Right now, it wouldn’t be easy for most physicians; even in a hospital, most physicians don’t know their complication rates. No one is providing that to physicians,” she said. “It’s going to be even more difficult to do that at a freestanding facility.”
Dr. Hutfless and Ms. McGinty agreed that patient awareness and demands will help change practice. “Patients drive what happens,” Ms. McGinty said.
Dr. Hutfless predicted that providers eventually will have information on scopes available. “Physicians by nature are very competitive,” she said. “Once other hospitals and ASCs start providing information on cleaning, they’ll come around. This is not a lazy crowd.”
—John Dillon