Assuntos
Clostridioides difficile , Infecção Hospitalar/prevenção & controle , Endoscopia/efeitos adversos , Enterocolite Pseudomembranosa/prevenção & controle , Higiene das Mãos , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/prevenção & controle , Infecção Hospitalar/microbiologia , Endoscopia/educação , Enterocolite Pseudomembranosa/microbiologia , Humanos , Grupo Associado , Indicadores de Qualidade em Assistência à Saúde , Autoeficácia , Infecções Estafilocócicas/microbiologiaAssuntos
Anestesiologia/educação , Sedação Consciente/normas , Sedação Profunda/normas , Educação Médica/normas , Educação em Enfermagem/normas , Endoscopia Gastrointestinal/educação , Hipnóticos e Sedativos/administração & dosagem , Europa (Continente) , Humanos , Sociedades Médicas , Sociedades de EnfermagemRESUMO
INTRODUCTION: After the S3 Guideline Sedation in Gastrointestinal Endoscopy was published, a training curriculum for a three-day course for endoscopy nurses was developed. The aim of this study was to investigate what effect the course participation had on the daily routine process and structure quality by implementing a German-wide survey in gastroenterology practices and clinics. METHODS: A questionnaire with a total of 44 individual questions on personnel, space, and equipment structure, sedation, peri- and post-interventional monitoring, as well as discharge and complication management in endoscopy departments was sent to a total of 2113 course participants (1056 Institutions). They had completed the seminar between December 2008/January 2009 and June 2010. RESULTS: The response rate was 21.2 % (224 /1056). Fifty-four percent were from clinic endoscopy departments, 46 % from practices. Overall, some form of structural change occurred in 86.8 % of the clinics and in 84.5 % of the practices. New staff was hired in 28.1 % of the clinics and 12.6 % of the practices. Rosters were changed in 11.6 % of the clinics and 7.8 % of the practices. Almost all issues improved after course participation. However, they did not reach statistic significance with the exception of the availability of peri-interventional ECG-monitoring in practices. The "performance of sedation in threesomes" increased in clinics by more than 20 % and in practices by more than 15 %. The use of the ASA-classification to assess risk increased significantly in clinics (before 24 %, after 50 %) as well as practices (before 40 %, after 60 %) by more than 20 % (p = 0.0007 and p = 0.0385, respectively). The documentation of the discharge status (e. g. using checklists) more than doubled in clinics (before 19 %, after 41.3 %) and practices (before 17.5 %, after 38.8 %) after course completion. CONCLUSION: The only nationwide endoscopy nurses' survey on structure and process quality in endoscopy so far, shows that since the publication of the S3 guideline in 2008 numerous processes and structures have improved with respect to patient safety.
Assuntos
Sedação Consciente/normas , Educação em Enfermagem/estatística & dados numéricos , Educação em Enfermagem/normas , Enfermagem em Emergência/normas , Endoscopia Gastrointestinal/educação , Endoscopia Gastrointestinal/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Adulto , Sedação Consciente/estatística & dados numéricos , Currículo/normas , Coleta de Dados , Avaliação Educacional , Enfermagem em Emergência/estatística & dados numéricos , Endoscopia Gastrointestinal/estatística & dados numéricos , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Biliary stenting is widely used to palliate malignant obstruction or to treat benign biliary diseases. Recently, the most important changes have related to self-expandable metal stents (SEMSs), which are now available in a wide variety of designs, and to treatment techniques. This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic biliary stenting: a technology review describes the stent models and stenting techniques, and a separate clinical guideline states the evidence and recommendations regarding stenting.
Assuntos
Doenças Biliares/cirurgia , Endoscopia do Sistema Digestório/métodos , Stents , Endoscopia do Sistema Digestório/instrumentação , HumanosRESUMO
Propofol sedation by non-anaesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this evidence- and consensus-based set of guideline is to provide non-anaesthesiologists with a comprehensive framework for propofol sedation during digestive endoscopy. This guideline results from a collaborative effort from representatives of the European Society of Gastrointestinal Endoscopy (ESGE), the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) and the European Society of Anaesthesiology (ESA). These three societies have endorsed the present guideline.The guideline is published simultaneously in the Journals Endoscopy and European Journal of Anaesthesiology.
Assuntos
Endoscopia Gastrointestinal/métodos , Hipnóticos e Sedativos/administração & dosagem , Propofol/administração & dosagem , Consenso , Comportamento Cooperativo , Medicina Baseada em Evidências , Humanos , Hipnóticos e Sedativos/efeitos adversos , Propofol/efeitos adversos , Sociedades MédicasRESUMO
Propofol sedation by non-anesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this evidence- and consensus-based set of guideline is to provide non-anesthesiologists with a comprehensive framework for propofol sedation during digestive endoscopy. This guideline results from a collaborative effort from representatives of the European Society of Gastrointestinal Endoscopy (ESGE), the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) and the European Society of Anaesthesiology (ESA). These three societies have endorsed the present guideline.
Assuntos
Anestésicos Intravenosos/administração & dosagem , Endoscopia Gastrointestinal , Propofol/administração & dosagem , HumanosRESUMO
Electrosurgery is used in the majority of endoscopic therapeutic procedures. An understanding of the fundamental electrosurgical principles and various settings available on electrosurgical units is essential for the safe and effective use of electrosurgery during endoscopy. The aims of these technical guidelines are to: (1) expose physical principles relevant to the understanding of electrosurgery during endoscopy; (2) describe and provide practical recommendations regarding electrosurgical units that are commonly in use; (3) discuss the clinical relevance of technologies recently implemented in newer electrosurgical units; and (4) review factors relevant to commonly performed therapeutic procedures, including polypectomy, sphincterotomy, contact thermal hemostasis, and argon plasma coagulation.
Assuntos
Eletrocirurgia/normas , Endoscopia Gastrointestinal/normas , Pólipos do Colo/cirurgia , Dissecação , Eletrocirurgia/instrumentação , Eletrocirurgia/métodos , Endoscopia Gastrointestinal/métodos , Hemostase Endoscópica , Humanos , Mucosa Intestinal/cirurgia , Esfinterotomia Endoscópica , Equipamentos CirúrgicosAssuntos
Anestésicos , Sedação Consciente/métodos , Endoscopia Gastrointestinal/métodos , Hipnóticos e Sedativos , Anestésicos/efeitos adversos , Quimioterapia Combinada , Medicina Baseada em Evidências , Humanos , Hipnóticos e Sedativos/efeitos adversos , Equipe de Assistência ao Paciente , Garantia da Qualidade dos Cuidados de Saúde , Medição de RiscoAssuntos
Infecção Hospitalar/prevenção & controle , Desinfecção/normas , Endoscópios/microbiologia , Endoscopia Gastrointestinal , Contaminação de Equipamentos/prevenção & controle , Reutilização de Equipamento/normas , Garantia da Qualidade dos Cuidados de Saúde , Contagem de Colônia Microbiana , Infecção Hospitalar/microbiologia , Europa (Continente) , HumanosAssuntos
Educação Médica Continuada/ética , Endoscopia do Sistema Digestório/ética , Experimentação Humana/ética , Segurança/normas , Educação Médica Continuada/organização & administração , Endoscopia do Sistema Digestório/enfermagem , Humanos , Assistência ao Paciente/ética , Assistência ao Paciente/normasRESUMO
BACKGROUND AND STUDY AIMS: National and international guidelines recommend that a standardized protocol consisting of cleaning, ultrasound cleaning, and sterilization should be used for the reprocessing of endoscopic accessories in order to reduce the risk of transmission of microorganisms. This German multicenter study investigated the efficacy of standardized reprocessing of reusable biopsy forceps used during colonoscopy. MATERIALS AND METHODS: Ten endoscopy centers (eight hospitals and two private practices) used 330 biopsy forceps during routine colonoscopy. The forceps were used once, five times, or 20 times for colonoscopy, based on a randomization plan. The reprocessing protocol consisted of manual cleaning with an enzymatic agent, ultrasound cleaning with an enzymatic agent (30 min, 40 degrees C, 47 Hz), neutralization, drying, and sterilization (5 min, 134 degrees C). Aldehydes were not used, and the protocol did not include a disinfection step. The biopsy forceps were sent to three microbiological institutes, based on a randomization plan, to have them tested for the presence of organisms, including identification of bacteria. RESULTS: A total of 318 of the 330 forceps were evaluable; 314 forceps (98.74 %) were sterile after use once, five times, or 20 times. Four forceps were contaminated with Staphylococcus epidermidis (n = 2), Bacillus licheniformis (n = 1) and Corynebacterium aquaticum (n = 2). All of 25 forceps were sterile after being used 20 times. CONCLUSION: Colonoscopy biopsy forceps can be reliably reprocessed following this standardized protocol, even without aldehydes.