One of the main hazards to those reprocessing endoscopes and accessories is that posed by the risk of acquiring an infectious disease from blood and other body fluid exposure. For a discussion of the infectious agents that can contaminate endoscopes see the Microorganisms section.
The risk relates to the handling of a used endoscope and the potential for splashing and the production of aerosols during manual cleaning. Aerosols create three risks during cleaning:
It is imperative that techniques of cleaning should be designed to avoid splashing and the generation of aerosols.
When cleaning and handling used items, follow Standard Precautions at all stages of handling to prevent exposure to blood and body substances. Standard Precautions involve treating blood and body substances of all persons as potential sources of infection independent of diagnosis or perceived risk.
If you are unsure how Standard Precautions impact on your practice discuss this with your facility's infection control practitioner or the state or territory's infection control practitioner. Appropriate PPE, such as gloves, specifically designed fluid repellent masks/eye protection/face shields and fluid resistant aprons or gowns should be worn when handling used endoscopes and accessories. PPE is discussed in more detail later in this module.
The reprocessing area is potentially a contaminated area and as such non-essential personnel should be excluded and food should not be consumed in this area.
All endoscopy units should have an appropriate sharps disposal policy. Sharps injury poses a very real threat of disease and careless practices by medical or nursing staff should not be tolerated.
All endoscopy units should have a clearly defined policy for sharps injuries and blood and body fluid exposures. In general this should follow the protocols laid out in the NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare. Section B1.3 covers handling and disposal of sharps.
It is essential that prompt action be taken to report an occupational exposure so that immediate counselling, evaluation and treatment can be instigated. When it has been recommended, anti-retro viral therapy is most effective when commenced as soon as possible.
As previously stated bronchoscopy should be avoided wherever possible in patients with known or suspected tuberculosis. There is a significant risk of nursing and medical staff contracting Mycobacterium tuberculosis when bronchoscopy is carried out on tubercular patients without proper precautions.
Where this is unavoidable Additional Precautions should be utilised:
See also the discussion of Mycobacteria in the Microorganisms section of the Disease Transmission and Control module.
Strict adherence to the appropriate standard precautions when reprocessing all bronchoscopes and accessories will prevent occupational exposure.
Immunisation is a measure by which some protection from infection due to occupational exposure can be given to health care workers (HCWs). It is important that you are aware of your own immune status.
The National Health and Medical Research Council (NHMRC) in their most recent edition of The Australian Immunisation Handbook 9th ed. provides detailed information on immunisation schedules and vaccines. Staff vaccination programs should comply with these procedures which acknowledge that there may be some circumstances that require special consideration before vaccination, for example, where a HCW is pregnant.
The NHMRC recommendations state that HCWs should be vaccinated against infections they may encounter. These may include hepatitis B, hepatitis A, measles, mumps, rubella, influenza, varicella and tuberculosis.
Section C2.2 of The Australian Guidelines for the Prevention and Control of Infection in Healthcare sets out more specific guidelines for immunisation of HCWs.
From this document a recommendation of particular importance in endoscopy is:
In some special circumstances these may also apply:
Each State or Territory may also have their own guidelines for immunisation of HCWs that should also be followed.