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4 results

  • Reply to Whiteley et al

  • Kavel H. Visrodia, Cori L. Ofstead, Harry P. Wetzler, Pritish K. Tosh, Todd H. Baron
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 36 / Issue 2 / February 2015
    Published online by Cambridge University Press:
    05 January 2015, pp. 237-238
    Print publication:
    February 2015
    • Article
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  • The Use of Rapid Indicators for the Detection of Organic Residues on Clinically Used Gastrointestinal Endoscopes with and without Visually Apparent Debris

  • Kavel H. Visrodia, Cori L. Ofstead, Hannah L. Yellin, Harry P. Wetzler, Pritish K. Tosh, Todd H. Baron
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 35 / Issue 8 / August 2014
    Published online by Cambridge University Press:
    10 May 2016, pp. 987-994
    Print publication:
    August 2014
  • Background

    Outbreaks of multidrug-resistant organisms have been linked to endoscope reprocessing lapses. Meticulous manual cleaning before high-level disinfection (HLD) is essential in reducing residual contamination that can interfere with HLD. Current reprocessing guidelines state that visual inspection is sufficient to confirm adequate cleaning.

    Objective

    Our aim was to evaluate contamination of clinically used endoscopes, using visual inspection and rapid indicator tests before and after manual cleaning. A second objective was to determine which rapid indicator instruments and methods could be used for quality improvement initiatives in endoscope reprocessing.

    Design

    Clinical use study of endoscope reprocessing effectiveness.

    Setting

    Tertiary care teaching hospital with an inpatient endoscopy center.

    Methods

    Researchers sampled endoscopes used for gastrointestinal procedures before and after manual cleaning. The external surfaces and 1 channel of each endoscope were visually inspected and tested with rapid indicators to measure protein, blood, and adenosine triphosphate (ATP) contamination levels.

    Results

    Multiple components were sampled during 37 encounters with 12 unique endoscopes. All bedside-cleaned endoscopes had high levels of ATP and detectable blood or protein, whether or not any residue was visible. Although there was no visible residue on any endoscopes after manual cleaning, 82% had at least 1 positive rapid indicator test.

    Conclusions

    Relying solely on visual inspection of endoscopes prior to HLD is insufficient to ensure reprocessing effectiveness. For quality assurance initiatives, tests of different endoscope components using more than 1 indicator may be necessary. Additional research is needed to validate specific monitoring protocols.

  • 43 - Gastrointestinal Stenting

  • from PART IV - SPECIALIZED INTERVENTIONAL TECHNIQUES IN CANCER CARE
    • By Todd H. Baron, Professor of Medicine Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book:
    Interventional Oncology
    Published online:
    18 May 2010
    Print publication:
    15 September 2008, pp 544-551

  • Summary

    Endoscopic palliation of biliary and luminal obstruction can be achieved with the use of gastrointestinal stents. Although rigid esophageal stents were initially employed for palliation of dysphagia, self-expandable stents (plastic and metal) are almost exclusively used currently. Self-expandable metal stents (SEMS) are used for palliation of malignant gastroduodenal and colonic obstruction and can be deployed as far distally or proximally in the gastrointestinal tract as can be reached with long-length endoscopes passed orally or rectally, respectively. The use of biliary stents for malignant biliary obstruction is discussed in Chapter 31. This chapter will outline the use of stents in the gastrointestinal tract to provide endoluminal palliation.

    BASIC PRINCIPLES

    SEMS are composed of a variety of metal alloys with varying shapes and sizes depending on the individual manufacturer and organ of placement (1). SEMS are preloaded in a collapsed (constrained) position, mounted on a small-diameter delivery catheter. A central lumen within the delivery system allows for passage over a guidewire. Once the guidewire has been advanced beyond the obstruction, the constrained stent is passed over the guidewire and positioned across the stricture. The constraint system is released or withdrawn, which allows radial expansion of the stent and of the stenosed lumen during deployment. The radial expansile forces and degree of shortening differ between stent types (2). Metal SEMS may also have a covering membrane (covered stents) to prevent tumor ingrowth through the mesh wall and to close fistulas.