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DECONTAMINATION & STERILISATION


undertaken and any potential reactions – biopsies documented, as well as the team involved in the procedure. There is also a requirement to keep detailed trace and tracking of the specific endoscope used for a specific patient as well as through its decontamination processes, so that there is a complete history of the instrument and the patients on whom it has been used. Fortunately this is now mostly using computer based systems which enable easier look-backs, should they be necessary.


Staff to meet additional demand


There have been nurse endoscopists for many years, since it was possible to expand the scope of nursing practice and undertake advanced practice. They are very skilful and have added to the numbers of gastroenterologists and colorectal surgeons who undertake regular endoscopy clinics. It is said that nurse endoscopists already undertake as much as 20% of the workload and NHS Improving Quality initiatives have estimated that up to 40% of low risk, high volume endoscopic procedures could potentially be carried out by nurse e ndoscopists – or a new role recently created. In recent times, job descriptions and training packages for clinical endosocopists have been developed, a programme which is designed to add measured skills to an already registered NMC or HPC professionals’ skill base, who have undertaken one modality of further training in endoscopy.


The courses are academic as well as practical and ensure supervised practice until competence is assured. This has enables many medical staff to be available for more complex endoscopy and has helped to meet the clinical demand, reduce the waiting lists and contributed to a better patient experience.8


Conclusion


While all that has been written has demonstrated that the service is having to adapt to new realities, in effect, the changes are the predictable evolution of science and evidence based practice in order to deliver a vital area of diagnosis. There is nothing particularly unexpected about the changes described. Patients undergoing endoscopy will still need to be carefully observed, some sedated, monitored and recovered and the instrument used to assess their condition very carefully cleaned and processed to make it acceptable for future patients.


There has been in the literature some consideration of whether, in the future, it may be possible to move away from high level disinfection to sterilisation of every scope. Currently there is not the combination of scopes or methods of sterilisation which would satisfactorily combine for endoscopes, but technology is developing all the time. Evolution of the service is bound to happen and, with patient demand balanced with patient safety, this is always required. CSJ


References


1 NHS England July 2016 NHS Diagnostic Waiting times and activity data. https://www.england.nhs.uk/ statistics/wp-content/uploads/sites/2/2016/06/ May-2016-Statistical-Report-PDF-2.24mb-1.pdf


2 Ibid 3 Advisory Committee on Dangerous Pathogens – Transmissible Spongiform Encephalopathy Sub Group. 2015 Annexe C – general principles of decontamination and waste disposal. Accessed at https://assets.publishing.service. gov.uk/government/uploads/system/uploads/ attachment_data/file/427855/Annex_C_v3.0.pdf


4 Advisory Committee on Dangerous Pathogens – Transmissible Spongiform Encephalopathy Sub Group. 2015 Annexe F - Endoscopy. Accessed at https://www.gov.uk/government/ publications/guidance-from-the-acdp-tse-risk- management-subgroup-formerly-tse-working-group


5 British Society of Gastroenterology. BSG Guidance for Decontamination of Equipment of Gastrointestinal Endoscopy. Nov 2016 Accessed at https:// www.bsg.org.uk/resource/guidance-on- decontamination-of-equipment-for-gastrointestinal- endoscopy-2017-edition.html


6 HTM 01-06 Decontamination of flexible endoscopes Part A Policy and Management, March 2016 Accessed at https://www.gov.uk/government/ publications/management-and-decontamination- of-flexible-endoscopes


7 Ibid 8 Health Education England. Clinical Endoscopist Training programme Accessed at https:// www.hee.nhs.uk/printpdf/our-work/endoscopy/ clinical-endoscopist-training-programme


MAY 2019


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