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Good morning brains trust,
I would really appreciate some advice:
Through routine water testing in CSD our soluscope water returned Bacterial endotoxins were above the Reference range 30 EU/mL
I have reviewed GESA guidelines but cannot determine what we should be doing with the potentially contaminated scopes;
can we continue to use them with no further action
should we microtest each and quarantine pending appropriate results
should we quarantine all scopes until water line issue is fixed through engineering – we have no other means of cleaning the scopes
Kind regards,
PamPamela Boon | Clinical Nurse Manager
Infection Prevention and Management Unit
Royal Darwin Palmerston Hospitals | Top End Health ServiceNorthern Territory Government
2nd Floor, Royal Darwin Hospital, Rocklands Drive, Tiwi
GPO Box 41326, Casuarina, NT 0811p …08 892 28045
f … 08 892 28889
e … Pamela.Boon@nt.gov.au
w… http://www.nt.gov.au/healthOur Vision: Building Better Care | Better Health | Better Communities Together
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Good afternoon Pam,
The reference to endotoxins is within ISO 15883-4, please see below.
“4.5.3 Depending upon the intended site of use of the endoscope (e.g. sterile body site) the level of
bacterial endotoxins in the final rinse water shall be controlled and monitored within the limits specified
in national regulations, using the method described in ISO 15883-1:2006+Amd 1:2014, 6.4.2.3.NOTE It is the dose of endotoxin that ultimately impacts on the patient and this includes the exposure
surface area of an endoscope as well as the endotoxin concentration in the final rinse water.”The advice would be to risk assess the patients these scopes will be use for. It is for the hospital to determine the potential risk to patients. I would avoid using the scopes for sterile cavities and immunocompromised patients.
My understanding with Endotoxins is, when they are introduced to the body, your body does not know they are dead bacteria and this triggers an immune response. These symptoms are usually mild in healthy patients but can be worse for patients with underlying health conditions.
In the long term, you need to determine where the endotoxins are coming from and what is killing the bacteria/biofilm. At some stage there is live bacteria that is being killed. Are the Soluscope machines colonised? Are the endotoxins high in your incoming water? What water sampling procedure are you following? If the machines self-disinfect cycle is being used directly before taking the samples, is that impacting the endotoxin levels?
Until you can ascertain the route cause, it is very difficult to find a long term solution.
Kind regards,
Stephen Adnams
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Save a tree. Don’t print this email unless it’s really necessary.Good morning brains trust,
I would really appreciate some advice:
Through routine water testing in CSD our soluscope water returned Bacterial endotoxins were above the Reference range 30 EU/mL
I have reviewed GESA guidelines but cannot determine what we should be doing with the potentially contaminated scopes;
* can we continue to use them with no further action
* should we microtest each and quarantine pending appropriate results
* should we quarantine all scopes until water line issue is fixed through engineering – we have no other means of cleaning the scopesKind regards,
PamPamela Boon | Clinical Nurse Manager
Infection Prevention and Management Unit
Royal Darwin Palmerston Hospitals | Top End Health ServiceNorthern Territory Government
2nd Floor, Royal Darwin Hospital, Rocklands Drive, Tiwi
GPO Box 41326, Casuarina, NT 0811p …08 892 28045
f … 08 892 28889
e … Pamela.Boon@nt.gov.au
w… http://www.nt.gov.au/healthOur Vision: Building Better Care | Better Health | Better Communities Together
Our Values: Teamwork and Trust | Excellence and Equity | Honesty and Accountability | Service and InnovationMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Pam
Hi, I found some of the back ground information discussed in the UK HTM 01-06 guidelines useful.
Management and decontamination of flexible endoscopes (HTM 01-06) – GOV.UK (www.gov.uk)
Hope this helps. Our AER’s have all been within limits, so thankfully haven’t had to manage just yet!
Good luck
Kind regards
Mandy Davidson
RN; GCert Inf Pre & Cont; MPHTM; Cert III Sterilisation; Cert IV TAE; Immunisation cred; CICP-A
Clinical Nurse Consultant – 4187 compliance & PPE Stores
Infection Prevention & Control[cid:image005.png@01D72F9F.14B15330]
T
07 4433 1873 | 0402 987 432
E
Mandy.Davidson@health.qld.gov.au
W
http://www.health.qld.gov.au/townsvilleTownsville Hospital and Health Service
100 Angus Smith Drive, Douglas, QLD 4814
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Good morning brains trust,I would really appreciate some advice:
Through routine water testing in CSD our soluscope water returned Bacterial endotoxins were above the Reference range 30 EU/mL
I have reviewed GESA guidelines but cannot determine what we should be doing with the potentially contaminated scopes;
* can we continue to use them with no further action
* should we microtest each and quarantine pending appropriate results
* should we quarantine all scopes until water line issue is fixed through engineering – we have no other means of cleaning the scopesKind regards,
PamPamela Boon | Clinical Nurse Manager
Infection Prevention and Management Unit
Royal Darwin Palmerston Hospitals | Top End Health ServiceNorthern Territory Government
2nd Floor, Royal Darwin Hospital, Rocklands Drive, Tiwi
GPO Box 41326, Casuarina, NT 0811p …08 892 28045
f … 08 892 28889
e … Pamela.Boon@nt.gov.au
w… http://www.nt.gov.au/healthOur Vision: Building Better Care | Better Health | Better Communities Together
Our Values: Teamwork and Trust | Excellence and Equity | Honesty and Accountability | Service and InnovationMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au
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Please see advice from our Endoscopy Unit Manager
Good Morning All,
The scopes that have been reprocessed through the contaminated AFER would need to be quarantined and swabbed to ensure they are not contaminated before use on a patient.
You need to work with the microbiology department to identify the organism that has grown.
The soluscope machine needs to be quarantined and a disinfection of the water line on the soluscope machine needs to be carried out and clear results on water samples before placing it back into use.
Refer to the flow chart on page 43, 44, 45 of the infection control in endoscopy document which are on the GENCA website at genca.org
Look at the manufacturer’s instructions for the soluscope machine and a technician from soluscope may need to be contacted if the contamination cannot be cleared. It is beneficial to talk to the service technician who carries out the regular service of the machine.
The duodenoscope and bronchoscopes are critical instruments follow the flow chart for action to be taken.
In the past I have managed a biofilm in the medivator and quarantined the machine and had to involve the medivator technician who had to replace the water line; also check all the scopes were not contaminated before placing them into use.Cate Coffey
RN BaAScN MPH&TM Grad Cert Infection Control Nursing
Clinical Nurse ManagerCentral Australia Health Service
Department of Health
Northern Territory GovernmentInfection Prevention and Control Unit
Alice Springs Hospital
PO Box 2234, Alice Springs, NT 0871
cate.coffey@nt.gov.aut. 08 8951 7737
http://www.health.nt.gov.auGood morning brains trust,
I would really appreciate some advice:
Through routine water testing in CSD our soluscope water returned Bacterial endotoxins were above the Reference range 30 EU/mL
I have reviewed GESA guidelines but cannot determine what we should be doing with the potentially contaminated scopes;
can we continue to use them with no further action
should we microtest each and quarantine pending appropriate results
should we quarantine all scopes until water line issue is fixed through engineering – we have no other means of cleaning the scopes
Kind regards,
PamPamela Boon | Clinical Nurse Manager
Infection Prevention and Management Unit
Royal Darwin Palmerston Hospitals | Top End Health ServiceNorthern Territory Government
2nd Floor, Royal Darwin Hospital, Rocklands Drive, Tiwi
GPO Box 41326, Casuarina, NT 0811p …08 892 28045
f … 08 892 28889
e … Pamela.Boon@nt.gov.au
w… http://www.nt.gov.au/healthOur Vision: Building Better Care | Better Health | Better Communities Together
Our Values: Teamwork and Trust | Excellence and Equity | Honesty and Accountability | Service and InnovationMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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