New SGNA Standards Call for Expanded Infection Prevention Efforts in GI Endoscopy

Infection prevention in the GI endoscopy setting took an important step forward with the recently released “Standard of Infection Prevention in the Gastroenterology Setting” (SGNA, 2015).  In issuing its new guidelines, the SGNA (Society for Gastroenterology Nurses and Associates, Inc.) acknowledges that the implementation of comprehensive infection prevention processes across the continuum of care is critical to ensuring the ongoing safety of patients and healthcare personnel in the GI and endoscopy department.  This guidance, which reinforces existing recommendations, including those from the ASGE (ASGE 2014), is particularly applicable in addressing the foreseeable risks inherent to a setting where contact with bacteria, bloodborne pathogens, and secretions from the GI tract is almost a certainty given the sheer nature of the physiology and procedures commonly performed.  This is especially applicable in the endoscopy setting, as GI procedures and surgeries are among the CDC’s known risk factors for acquiring or transmitting enteric infections like C. difficile (CDC, 2003; CDC, 2006; CDC, 2007; CDC, 2012; APIC, 2008).

Recent medical literature and news reports have increased awareness on the potentially infectious GI bacteria and pathogens that can be encountered during even routine endoscopic GI procedures.  Given the established fact many of the most prevalent healthcare-associated infections are caused by enteric bacteria (CDC, 2012), it is both logical and intuitive to ensure that infection control processes implemented during GI procedures adequately recognize these known risks and integrate the necessary measures to prevent their spread.  In the simplest of terms, infection-causing bacteria like CRE (carbapenem-resistant enterobacteriaceae), C. difficile, and VRE (vancomycin-resistant enterococcus) are known to ultimately originate from the GI tract, and are highly transmissible within the healthcare environment.  Unless adequately contained at their origin, these source pathogens can quickly gain entry and extensively spread throughout a hospital environment or patient care area.

These newly established SGNA Standards recognize that comprehensive infection prevention encompasses more than just the reprocessing of the flexible endoscopes.  This direction echoes the recently updated ASGE Guidelines that call for establishment (and documentation) of comprehensive infection control and prevention practices across the continuum of care in gastroenterology and GI endoscopy, including the pre-procedure, intra-procedure, and post-procedure phases (ASGE, 2014).

The SGNA Standards state that “the entire environment must be considered when developing infection prevention processes (SGNA, 2015; Day and Kelsey, 2013).”  Based on current guidelines from the ASGE, APIC, CDC, OSHA and SGNA, in addition to having established standards in place for the reprocessing and validation of the techniques used to clean and disinfect the endoscopes themselves, facilities should carefully consider and include the following in their documented policies and procedures:

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