Numerous regulations govern the disinfection of endoscopes, premises and operating devices. Learn about proper care and handling in this article.
Endoscopy
Endoscopy is a medical discipline in which the endoscopy nurse has an important role in the care of the patient before, during and after the examination, in the disinfection and maintenance of medical equipment, and in endoscopic instrumentation. To do so, he/she must acquire new skills, maintain them through trained practice, know and comply with the various regulations governing the activity, and finally, adapt to a constantly changing professional field.
Endoscopy concerns different medical and surgical sectors such as gastroenterology, pneumology, urology, intensive care units, cardiology, visceral surgery and ENT.
Disinfection and Hygiene is also an important part of the activity of Endoscopy.
Numerous regulations govern the disinfection of endoscopes, premises and operating devices. Precise knowledge and application of these texts are essential. In the fight against nosocomial infections by the medical and health authorities, the nurse is the foot soldier, i.e. the first line actor to avoid contamination, complications and the spread of germs.
They ensure patient safety by rigorously applying the decontamination and disinfection steps for endoscopes. It is important to know that a disinfection cycle is performed on an endoscope before its use if it has been stored for more than twelve hours, as well as a complete treatment if it has not been used for more than 7 days. After the endoscopic procedure, a double manual cleaning is carried out (brushing, swabbing and irrigation of the channels, then rinsing), followed by disinfection in a washer-disinfector according to cycles well defined by the "Guide to good practice for the use of endoscope washer-disinfectors" of November 2003, which constitutes an essential regulatory basis for the treatment of endoscopes.
Disinfection levels (intermediate or high level) are required depending on the endoscopes (gastroscopes, colonoscopes, bronchoscopes, choledocoscopes...) and their clean use (in sterile or non-sterile environment). The level is defined by the immersion time in the disinfectant solution.
The risks of transmission of Creutzfeldt-Jakob disease are reduced by the use of a per-acetic acid-based disinfectant, and by a medical investigation to assess whether the patient is suspected of having contracted this pathology. Any suspicion leads to the sequestration or even the destruction of the material if it is proven. Increased vigilance, knowledge and precise application of the procedures by the endoscopy nurse, allows this risk of transmission to be further limited.
The endoscopy nurse takes regular microbiological samples from endoscopes, washer-disinfectors, and water points used for cleaning endoscopes, according to the techniques defined in a text from the General Health Directorate: "Elements of quality assurance in hygiene relating to the microbiological control of endoscopes and traceability in endoscopy" published in March 2007.
It ensures traceability of endoscopy procedures and disinfections performed and ensures rigorous storage of endoscopes.
The Equipment
The maintenance of equipment also concerns its activity. Endoscopy equipment is delicate, fragile, very expensive to purchase, maintain, and to repair. Familiarity with the handling, a knowledge of these devices, by trained personnel, constitutes a real saving for a hospital because errors and shocks are limited and the early detection of failures or leaks in the endoscope avoids aggravated and very costly breakdowns
The Relationship with the Patient
After having made sure that the required equipment is prepared and available to meet all needs and eventualities (scopy, electric scalpel...), the endoscopy nurse ensures that the patient is installed in a rigorous and adapted manner (on a scopy table or stretcher, in dorsal or lateral decubitus position....).
Endoscopy without general anaesthesia is a painful examination for the patient. By an appropriate welcome, an answer to possible questions, a hand given, advice whispered in the ear to better support the examination, the endoscopy nurse actively participates in the good realization of the endoscopic act. He/she gives back to this invasive act a note of humanity, this little air of warmth, of contact and accompaniment which makes it no longer an unpleasant scientific investigation, but attentive care.
After the examination, the endoscopy nurse must monitor the patient and ensure that there are no complications.
Sometimes, after the announcement of a painful diagnosis, he/she may have to answer some questions that still arise after the doctor's explanations, and try to bring comfort...
The different samples (biopsies, punctures...) are labelled, managed in a rigorous way to be sent to the different analysis laboratories.
The information will be transmitted to the care unit where the patient will be taken back.
Interventional Techniques
Afterwards, he/she assists the endoscopic physician in the handling of devices that are more and more diversified and complex.
Thus, today, it is possible to perform biopsies, to extract foreign bodies, whether they are round, sharp, prickly, etc., to perform elastic ligations, to inject various medicinal products, biological glues, to perform hemostasis by various means (use of argon plasma coagulation, bipolar probes, clips.... ), polypectomies with different models of handles, of various sizes, according to techniques that vary, to place digestive prostheses (duodenal, esophageal, colonic) which also have their particularities, to place gastrostomy tubes by perforating the abdominal wall.
Recently, the techniques of mucosectomy and dissection, helped by technical progress and the evolution of optics, have been developed and allow the removal of flat and/or very large digestive lesions, thus avoiding transparietal surgery.
Access to the bile and pancreatic ducts from the duodenum has also opened up a wider range of actions. It is now possible to remove stones from the bile ducts, perform cholangiographies, pancreatographies, dilate, place prostheses, drain...
Various organs, tumors, ganglions, cysts... surrounding the digestive tract, are also accessible in endoscopy. An ultrasound probe is associated with the endoscopy system. Thus it is also possible to perform punctures and drainages through prostheses that intentionally perforate the digestive walls.
Other techniques such as phototherapy, radiofrequency and enteroscopy exist. All of them require, on the part of the doctor and the endoscopy nurse, expertise in the gesture and in the knowledge of the material. Needles, guide wires, catheters, snares, dilators, etc.... are all tools that are part of the endoscopy nurse's daily routine and which he or she must still have perfect mastery of.
In addition to the pure instrumentation, with a certain degree of experience and knowledge, the endoscopy nurse helps the operating physician to advance the endoscope into the colon. By muscular support and a precise positioning of the hands on different parts of the abdomen, he prevents the appearance of "loops" in the colon with the help of compressions, thus allowing the sometimes difficult progression of the endoscope.
It should also be noted that endoscopy has a place of first choice in certain emergency situations such as digestive hemorrhage, angiocholitis, digestive obstruction by foreign bodies or tumors. Here again, speed, anticipation, and technical performance are qualities specific to nurses competent in endoscopy.
The endoscopy teams are therefore sometimes required to travel, with equipment specifically dedicated to emergencies, to other departments such as intensive care units, the emergency department, other operating theatres, etc. The working hours are therefore adapted and flexible. On-call nurses are sometimes put in place for night or weekend interventions.
The discipline of digestive endoscopy is traditionally associated, on the technical platform, with the examinations of functional digestive exploration and proctology.
Certain examinations such as pHmetry, esophageal manometry, anorectal manometry, video-capsule, fibroscan, often require the active participation of the endoscopy nurse. The nurse's own role will be required, particularly in the context of reception, respect for privacy and dignity, in the installation and comfort of the patient, while respecting professional secrecy. He will also have a role as an assistant or even as a helper in the instrumentation.
Indeed, this work is dynamic, motivating, exciting, because it brings every day its share of gratification but also, less often, fortunately, its share of disappointment. Why is this so? Because the success of the endoscopy procedure is directly linked to the competence of the endoscopy nurse. A well-positioned prosthesis, a drained biliary tract, efficient and well-managed haemostasis, a polyp removed to the right extent etc., and it is the success of a doctor/nurse tandem who have been able to reach their main objective in the harmony of gestures, precision and measure: to treat!
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