New Endoscopy Safety Guidelines

The American Society for Gastrointestinal Endoscopy has issued new, endoscopy-specific guidelines to establish accepted practices at GI facilities.

Their publication comes in response to CMS's Ambulatory Surgical Center Conditions for Coverage, which had accreditors holding endo suites to the same standards as sterile ORs, even though clinical and staffing requirements for surgery aren't necessarily applicable or necessary in endoscopy settings.

Here's a list of the ASGE's new recommendations:

  • Have a designated flow for the safe physical movement of dirty endoscopes and other equipment.
  • Assign more complex procedures to larger procedure rooms with space for more specialized equipment and, in some cases, additional staff.
  • Before starting an endoscopic procedure, the patient, staff and performing physician must verify the correct patient and procedure to be performed.
  • A qualified staff member must implement a specific infection prevention plan.
  • Staff engaged in direct patient care must wear gloves and impervious gowns.
  • Have a terminal cleansing plan that includes methods and chemical agents for cleansing and disinfecting the procedural space at the end of the day.
  • In addition to the performing physician, a single nurse is required in the procedure room during routine endoscopy involving moderate sedation.
  • Complex procedures may require additional staff for efficiency, but not necessarily for safety.
  • At a minimum, perform patient monitoring before the procedure, after administration of sedatives, at regular intervals during the procedure, during initial recovery and before discharge.
  • For cases involving moderate sedation, the individual responsible for patient monitoring may perform brief, interruptible tasks.
  • Current data does not support the routine use of capnography during cases involving moderate sedation.

For full explanations of the recommendations, including the ASGE's position and rationale for each, check out the complete document.

Daniel Cook

Bariatric Technique May Not Resolve Reflux

Laparoscopic sleeve gastrectomy, a weight-loss surgery that removes much of the stomach and forms the remainder into a tube, does not resolve or relieve patients' acid reflux conditions as reliably as gastric bypass surgery does, say researchers.

For their study, published online by JAMA Surgery on Feb. 5, a team of researchers from the Madigan Army Medical Center in Tacoma, Wash., reviewed a national database of bariatric surgery outcomes. The database followed up on patients who'd undergone weight-loss procedures from 2007 to 2010.

They found that out of 4,832 laparoscopic sleeve gastrectomy patients, 84.1% of those who'd reported gastroesophageal reflux disease before the surgery continued to suffer the symptoms afterward and 8.6% developed GERD symptoms post-operatively.

However, 62.8% of the GERD sufferers among the 33,867 gastric bypass surgery patients reported a complete resolution of their symptoms, with 17.6% seeing their symptoms stabilize and only 2.2% seeing them worsen. The gastrectomy GERD patients also saw reduced outcomes in terms of weight loss.

David Bernard

Tonsillectomies as Safe for Adults as for Children

Tonsillectomies performed on adults are about as safe as those performed on pediatric patients, finds a new study published in JAMA Otolarynology Head & Neck Surgery.

The study's authors examined the outcomes of nearly 6,000 of the procedures performed on adults between 2005 and 2011. They found a reoperation rate of 3.2%, a complication rate of 1.2% and a 30-day mortality rate of 0.03%. Most (83%) of the patients had chronic tonsillitis and/or adenoiditis. The most common complications were pneumonia (27%), urinary tract infection (27%), and superficial site infections (16%).

The study is believed to be the first of its kind, say the authors, adding that the rates of complication and death are similar to those of children who have tonsillectomies.

Jim Burger

InstaPoll: Do EMRs Improve Patient Care?

Besides making your surgical facility more efficient, can electronic medical records also improve your patient care by giving you and your surgeons access to more information, more quickly? Share your views in this week's InstaPoll, then check back next week for the results.

Two-thirds (66%) of the 552 respondents to last week's poll instruct patients not to eat or drink after midnight, but allow morning medications to be swallowed with a sip of water. The results:

What do you tell your patients about fasting for surgery?

  • NPO at midnight: 8%
  • NPO at midnight, but they can take morning medications with a sip of water: 66%
  • They can have clear liquids 6 hours before surgery: 13%
  • They can have clear liquids up to 2 hours before surgery: 13%

Dan O'Connor

News & Notes
  • Nurses' leading frustrations Hospital-based nurses are frustrated by the demands of increased paperwork and the time it takes away from direct patient care, according to a recent survey by a healthcare staffing agency. Most of the 1,333 respondents said they were generally satisfied with their jobs, although most said the profession has changed for the worse. Additionally, nearly three-quarters said they felt pressure to positively influence patient satisfaction surveys and nearly a third said they felt bullied at work, either by superiors, peers or physicians.
  • Uterine morcellation dangerous? Electric tissue morcellation — the fragmenting of tissue for removal through ports smaller than 2cm — during minimally invasive gynecologic procedures has raised patient safety concerns, according to a report in JAMA. The authors note there are no good methods for detecting uterine sarcomas, which could be inadvertently dispersed throughout the peritoneal cavity during morcellation and which could result in advanced cancer. Responding to this risk must involve scientifically informed actions and shouldn't include abandoning the known advantages of laparoscopy, the authors add, although they believe a more conservative use of morcellation is prudent.
  • A solution for ortho SSIs? Coating metal hip and knee implants with antibiotic-impregnated, biodegradable polymer "microspheres" could prevent post-op infections with direct, targeted action, say a team of Texas biomedical researchers exploring the technology through a small, pre-clinical animal study. The microscopic beads, which would be released from porous metal implants in the weeks following hip and knee replacement, prevented infections in all of the staph-contaminated specimens in which they were used. In contrast, contaminated specimens that didn't use microsphere-coated implants saw a 64% infection rate. They reported their findings in the Jan. 15 issue of the Journal of Bone and Joint Surgery.