Screening

[JEEMA]

Hi! I am very grateful to have encountered such a good forum.

I am new in Endoscopy and have some things to ask. I was told ours was not an ideal set-up so I have to bear with it; however, I found out some things which doesnt seem right and made me ask if I made the right decision to transfer in this area.

First, our unit is not strict with HIV/ Hepatitis screening with the patients booked for endoscopy. There seemed to have no strict rule with it. They are more concerned of how much should a patient will pay for these tests since most of our patients are laborers who can't afford the cost. Thankfully, the procedure is still free of charge.

Second, if ever a patient is HBsAg or Hepa C reactive, the scope is just being disinfected using the washer-disinfector machine, just like what is done with the other scopes used in all patients.

Third, the biopsy forceps used for infected patients is also just being processed in the dinsinfector machine with the cidex.

We are the one doing all these things (aftercare of the scopes)

Since there are plenty of bookings we have per day, we will only disinfect the scope thru the machine then use it in the next lucky pt.

Things are never sent for sterilization, saying they have less equipments and they might need it during the call.

Can HIV/Hep B and C Virus be eliminated by cleaning and disinfecting with cidex and alcohol flush alone?

We are also using expired simethicone for flushing. Rationale: They are being suctioned anyway.

With these things I've observed, i will never recommend a friend to undergo endoscopy.

[caroladybelle, BSN, RN]

This question might do better in the Infectious Disease forum or with a slightly different title, as far as gathering the responses that you need. "Screening" probably will not gather as many responses.

I have undergone colonoscopy at least yearly in the US, since age 19 (close to twenty years now) and have never had a GI MD do an HIV/Hep screening prior to the test. I have had Hep A as a teenager and they are aware of that. The theory is that (a) Universal precautions and proper sterilization techniques will protect from transmitting the disease and (b) Even if you did screen, there would be some newly infected antibody negative pts slip through. Also, those tests are rather expensive - and as you list that you are in the Mideast (Middle East?) - how cultural sensitive would it be to ask for an HIV test.

The patients that generally undergo Endo also frequently are a population that have other diseases, perhaps less dire, but more frequently passed through the GI tract (C-Diff anyone?). So good sterilization is a must. As a nurse that sends BMT patients to endo for checks for Graft versus host disease of the gut after sterile preps and sterile enemas, I would be appalled if the sterilization of the equipment was not adequate. My patients can die from "benign" infections of their own flora - they can pickup/transmit / incubate almost any disease.

An infectious disease nurse would be your best bet on sterilization technique advice.

I have a problem with "This is not the optimal setup" line. Why does the people in charge not have the optimal setup - perhaps you should move on to a facility that does have the optimal setup. Do not become discouraged with Endo just because of this experience.

Unfortunately, where Endo is concerned, some of us have no choice but undergo it as it is the best/ frequently only option for the care we require. There is frequently no "recommending" about it - but we as nurses have to facilitate/support safe practices regarding it.