Safety of personnel working in endoscopy units

AORN Journal,  Jan, 2007  by Nuray Akyuz,  Ayfer Ozbas,  Ikbal Cavdar

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ABSTRACT

* ALL PERSONNEL performing or assisting with endoscopic procedures and those responsible for reprocessing the equipment should be trained in how to handle the infectious and chemical hazards associated with the endoscopic environment.

* ENDOSCOPY PERSONNEL should follow a comprehensive safety program that outlines the steps individuals should take to prevent injuries from the potential hazards they may encounter in endoscopy units.

* SAFETY MEASURES include ensuring that there is adequate lighting and ventilation in the endoscopy unit, cleaning endoscopy instruments thoroughly, and operating equipment safely. AORN J 85 (January 2007) 181-187. [c] AORN, Inc, 2007.

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Ensuring the safety of personnel working in endoscopy units is crucial. The environment itself must be assessed for problems that may result from inadequate or inconvenient physical conditions, (1,2) such as inadequate lighting, but endoscopy personnel also should be aware of hazards they may encounter. Personnel working in endoscopy environments should follow a comprehensive safety program to prevent communication of diseases, address potential hazards from chemicals used in high-level disinfecting procedures, and ensure cleanliness of endoscopic instruments and equipment. (3,4) In addition, necessary measures should be taken to address electrical and fire hazards and prevent negative effects from radiation and lasers. (2,5)

THE ENDOSCOPY ENVIRONMENT

Personnel working in endoscopy units should be assessed regarding their suitability for working in these environments. For example, cleaning and disinfecting endoscopes involves the use of chemicals that can emit toxic fumes and aggravate allergies, so individuals with respiratory problems (eg, asthma, latex allergy, chemical allergy) should be assessed for sensitivity before being employed in these departments. (6) In addition, personnel with dermatitis or exudative skin lesions should not undertake direct patient care or equipment care until the condition resolves.

PHYSICAL CONDITIONS. The space in which endoscopic procedures are performed should be separate from the space used for cleaning, disinfecting, sterilizing, and storing endoscopes and endoscopic equipment. (1,7) Noise levels in the endoscopy room should be substantially lowered by installing sound insulation in walls and doors. The room should be adequately ventilated with general ventilation and air conditioning, and the floor should be kept clean and dry to prevent falls. (1,7)

In the endoscopy procedure room, temperature and moisture should be controlled and proper illumination should be provided. There should be access to natural and full-spectrum lighting in the procedure room. If there are outside windows, blinds or window coverings for darkening a room (eg, solid-panel shutters) and standard and rheostat-controlled overhead lighting systems are useful.

INFECTION RISKS

Personnel working In endoscopic environments are at risk for exposure to infectious microorganisms such as Mycobacterium tuberculosis (M tuberculosis), hepatitis B virus (HBV), HIV, herpes simplex, and enteric pathogens. Endoscopy personnel should understand this risk and also should be aware that a patient's infectious status may be unknown at the time an endoscopy procedure is performed. Patients harboring clinically latent infections (eg, hepatitis, HIV, M tuberculosis, Helicobacter pylori) may not be aware of their carrier status, and therefore, all patients should be considered a potential risk, and the same precautions should be applied to all patients. (8)

IMMUNIZATION. The Occupational Safety and Health Administration (OSHA) in the United States mandates that all employees be offered immunization against HBV. All endoscopy personnel who are at risk for infection with HBV, therefore, should receive the hepatitis B vaccine. (3,4,8,9)

EXPOSURE TO INFECTIOUS MICROORGANISMS. Nonimmunized personnel who are exposed to HBV should be given postexposure prophylaxis with hepatitis B immune globulin within seven days of exposure, followed by vaccination. (7,9,10) The Centers for Disease Control and Prevention has published guidelines outlining the procedure to be followed when HBV status or the source or recipient in a potential exposure is unknown. (11) Similar guidelines also have been published for HIV postexposure follow-up. (12)

Twelve weeks after exposure to a documented case of M tuberculosis, bronchoscopy personnel should be screened for purified protein derivative (PPD) skin test conversion. (13) In addition to an annual PPD skin test (eg, Mantoux test, time test), some authorities, including the Association for Professionals in Infection Control and Epidemiology, also recommend that bronchoscopy personnel be tested more frequently. (3,7,14) Employees with a previous positive PPD skin test who are exposed to M tuberculosis should not be given a chest radiograph or PPD test but should be monitored for symptoms of tuberculosis. (15)