Here are five steps that will ensure your GI-driven ASC has great quality and infection control.
1. Put together a comprehensive infection control program tailored to the ASC. ASCs must keep in mind that best practices will vary from facility to facility. In order to implement the best infection control program, ASCs must look to a number of factors to ensure its infection control program is effective and cost- and time-efficient.
"Everyone is struggling with infection control, and everyone is wondering how to hire an infection control officer, how many hours does this officer have to spend on infection control issues and how much money should go toward the program, but the key is to put together a succinct program that takes care of all the compliance issues and also fits the organization," says Louise Dechesser, a surveyor for the Accreditation Association for Ambulatory Health Care. "Certainly, not every ASC can afford to pay a full-time infection control nurse, and there are no rules as to how many hours that nurse should spend on that issue."
2. Check that pre-owned equipment is in good condition. Making sure pre-owned equipment is in good condition before using it is imperative in preventing infection at your ASC, says Ray Midlam, product manager, certified pre-owned equipment for Olympus America. Be sure to find out if the model is still supported by the OEM, otherwise you may end up with a product with no access to replacement parts. And don't be lulled into complacency by a product sporting a "certified" or "CPO" label. This is an unregulated term with no standards to support it. So ask the supplier what, in fact, their "certified" label means and how the product was repaired.
For example, if the equipment is an endoscope, did it undergo a rigorous refurbishment process with all parts inspected? Were the insertion tube and other worn or damaged parts replaced with OEM parts? If not, buyers beware: A scope that has been altered with third-party parts — even those purporting to be reverse engineered or "OEM-like" — is no longer FDA 510(k) compliant, which means it is no longer validated for reprocessing. Therefore, unless you are purchasing the pre-owned scope from the OEM, make sure to ask the seller for reprocessing validation for any of its modified parts. Also check with your facility's infection control department for any specific instructions relative to modified medical equipment.
3. Don't quantify a certain number of times to brush a scope. Shaun Sweeney, vice president of sales and marketing for Cygnus Medical, says another pitfall GI/endoscopy-driven ASCs run into is brushing scopes with a preconceived notion of how many times to brush. Some manufacturers present this as a marketing benefit, suggesting a brush only needs one pass through a channel. The number of times a scope must be brushed is completely dependent on how much gross contamination is present in the scope and whether it has had time to dry in the channels. The number of passes of the brush will depend on a multitude of factors, such as the amount of contamination, size of the brush, number of bristles and density of the bristles. Considering the variance in brush features and given that there is no published standard on how many times to brush a scope, Mr. Sweeney says GI/endoscopy-driven ASCs shouldn't quantify the number of times to brush but instead brush until there is no more debris exiting the scope.
"When you look at Society of Gastroenterology Nurses and Associates' video, they make it very clear not to pre-quantify the number of passes," Mr. Sweeney says. "Brushing is done underwater, so while you are brushing your scope, you can see if anything is coming out because it will float around in the water. Brushing underwater allows some visibility, and that's a standard that each manager of an endoscopy suites needs to address with their decontamination technicians."
Mr. Sweeney adds GI/endoscopy-driven ASCs should take extra precaution in ensuring brushing is always done underwater. Not doing so will lead to flicking of contaminated water particles into the air, causing reintroduction of contamination into an ASC facility.
4. Conduct regular in-services for staff members. A good practice for ASCs to adopt is to regularly provide continuing education about infection control to staff members. Marie Boyd, administrator at Cape and Islands Endoscopy Center in Hyannis, Mass., says in-services are held on a monthly basis at Cape and Islands that occasionally cover infection control topics, but a weekly meeting is always dedicated to infection control discussions.
"During our monthly in-services, we may have a representative some in from OSHA to talk about infections or a representative from Olympus come in to talk about scope cleaning, but our weekly infection control meetings are entirely devoted to raising awareness on infection control," Ms. Boyd says. "Our infection control nurse, the nurse manager and myself review our facility's infection control policies during these meetings. All of our weekly sessions are documented and inserted into a book that is available in the nurse's lounge."
The infection control book also includes related articles or studies. Every time new material is added to the book, staff members are required to spend some time reviewing the material and then sign a sheet confirming they had reviewed it."
5. Belong to a GI registry. "I do think ASCs should think about reporting things through a registry," says Brian Jacobson, MD, FASGE, associate director of endoscopy services at Boston Medical Center and associate professor of medicine at Boston University School of Medicine. "I think it makes it easier to participate in quality reporting endeavors that are being set up by CMS and private payors as well. If you get the electronic systems now, you can work out the kinks before it's required."
Two that he recommends considering are the GIQuIC registry, organized by the American College of Gastroenterology and ASGE, and the American Gastroenterology Association's Digestive Health Outcomes Registry.
1. Put together a comprehensive infection control program tailored to the ASC. ASCs must keep in mind that best practices will vary from facility to facility. In order to implement the best infection control program, ASCs must look to a number of factors to ensure its infection control program is effective and cost- and time-efficient.
"Everyone is struggling with infection control, and everyone is wondering how to hire an infection control officer, how many hours does this officer have to spend on infection control issues and how much money should go toward the program, but the key is to put together a succinct program that takes care of all the compliance issues and also fits the organization," says Louise Dechesser, a surveyor for the Accreditation Association for Ambulatory Health Care. "Certainly, not every ASC can afford to pay a full-time infection control nurse, and there are no rules as to how many hours that nurse should spend on that issue."
2. Check that pre-owned equipment is in good condition. Making sure pre-owned equipment is in good condition before using it is imperative in preventing infection at your ASC, says Ray Midlam, product manager, certified pre-owned equipment for Olympus America. Be sure to find out if the model is still supported by the OEM, otherwise you may end up with a product with no access to replacement parts. And don't be lulled into complacency by a product sporting a "certified" or "CPO" label. This is an unregulated term with no standards to support it. So ask the supplier what, in fact, their "certified" label means and how the product was repaired.
For example, if the equipment is an endoscope, did it undergo a rigorous refurbishment process with all parts inspected? Were the insertion tube and other worn or damaged parts replaced with OEM parts? If not, buyers beware: A scope that has been altered with third-party parts — even those purporting to be reverse engineered or "OEM-like" — is no longer FDA 510(k) compliant, which means it is no longer validated for reprocessing. Therefore, unless you are purchasing the pre-owned scope from the OEM, make sure to ask the seller for reprocessing validation for any of its modified parts. Also check with your facility's infection control department for any specific instructions relative to modified medical equipment.
3. Don't quantify a certain number of times to brush a scope. Shaun Sweeney, vice president of sales and marketing for Cygnus Medical, says another pitfall GI/endoscopy-driven ASCs run into is brushing scopes with a preconceived notion of how many times to brush. Some manufacturers present this as a marketing benefit, suggesting a brush only needs one pass through a channel. The number of times a scope must be brushed is completely dependent on how much gross contamination is present in the scope and whether it has had time to dry in the channels. The number of passes of the brush will depend on a multitude of factors, such as the amount of contamination, size of the brush, number of bristles and density of the bristles. Considering the variance in brush features and given that there is no published standard on how many times to brush a scope, Mr. Sweeney says GI/endoscopy-driven ASCs shouldn't quantify the number of times to brush but instead brush until there is no more debris exiting the scope.
"When you look at Society of Gastroenterology Nurses and Associates' video, they make it very clear not to pre-quantify the number of passes," Mr. Sweeney says. "Brushing is done underwater, so while you are brushing your scope, you can see if anything is coming out because it will float around in the water. Brushing underwater allows some visibility, and that's a standard that each manager of an endoscopy suites needs to address with their decontamination technicians."
Mr. Sweeney adds GI/endoscopy-driven ASCs should take extra precaution in ensuring brushing is always done underwater. Not doing so will lead to flicking of contaminated water particles into the air, causing reintroduction of contamination into an ASC facility.
4. Conduct regular in-services for staff members. A good practice for ASCs to adopt is to regularly provide continuing education about infection control to staff members. Marie Boyd, administrator at Cape and Islands Endoscopy Center in Hyannis, Mass., says in-services are held on a monthly basis at Cape and Islands that occasionally cover infection control topics, but a weekly meeting is always dedicated to infection control discussions.
"During our monthly in-services, we may have a representative some in from OSHA to talk about infections or a representative from Olympus come in to talk about scope cleaning, but our weekly infection control meetings are entirely devoted to raising awareness on infection control," Ms. Boyd says. "Our infection control nurse, the nurse manager and myself review our facility's infection control policies during these meetings. All of our weekly sessions are documented and inserted into a book that is available in the nurse's lounge."
The infection control book also includes related articles or studies. Every time new material is added to the book, staff members are required to spend some time reviewing the material and then sign a sheet confirming they had reviewed it."
5. Belong to a GI registry. "I do think ASCs should think about reporting things through a registry," says Brian Jacobson, MD, FASGE, associate director of endoscopy services at Boston Medical Center and associate professor of medicine at Boston University School of Medicine. "I think it makes it easier to participate in quality reporting endeavors that are being set up by CMS and private payors as well. If you get the electronic systems now, you can work out the kinks before it's required."
Two that he recommends considering are the GIQuIC registry, organized by the American College of Gastroenterology and ASGE, and the American Gastroenterology Association's Digestive Health Outcomes Registry.