Nancy Shields

A survey of the costs of flexible endoscope cleaning and disinfection.

A questionnaire was developed and sent to the 860 members of the Society of Gastroenterology Nurses and Associates Lab Management Special Interest Group. Of the 98 (11%) completed responses, the average per-procedure price for cleaning one flexible endoscope was

The transition to video: considerations for the GI laboratory manager.

39.13 for manual disinfecting and

Staffing levels in endoscopy units.

40.56 using an automatic disinfector. Staff costs, including those attributable to cleaning-related delays, accounted for the largest single component of the overall cleaning costs (44%). Cleaning-related damage and maintaining an inventory of endoscopes to offset the effects of reprocessing on procedure scheduling were also found to significantly contribute to cleaning costs.

The role of bronchoscopy in the diagnosis of pulmonary tuberculosis in patients at risk for HIV infection

During the past few years, endoscopic technology has moved increasingly toward the use of video equipment. As a GI laboratory manager, one is confronted with many tasks in converting the unit practice from fiberoptic equipment to video equipment. This article will examine the steps in that process.

Smoking does not contribute to duodenal ulcer relapse after Helicobacter pylori eradication

Staffing the endoscopy area has become increasingly complex. Growth in procedure volumes, changes in technology, and the application of endoscopy in the diagnosis and treatment of disease contribute to the complexities. The manager must deal with these changes, maintain costs, and still provide adequate staffing to ensure patient safety and quality care. The purpose of this article is to present the results of a laboratory manager survey conducted in 1990. Of 51 laboratory managers who responded, those who rated their laboratories to be adequately staffed averaged 4.2 hr per procedure. The survey results may be useful to laboratory managers seeking to calculate staff needs in a typical endoscopy area.

The nurse's guide to biliary prosthesis placement.

The present study was undertaken to clarify the role of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) in the diagnosis of pulmonary tuberculosis in patients at risk for human immunodeficiency virus (HIV) infection. We retrospectively identified 31 patients at risk for HIV who proved to have Mycobacterium tuberculosis on culture of at least one pulmonary specimen. All had pulmonary symptoms but initial sputum smears negative for acid-fast bacilli (AFB). All underwent fiberoptic bronchoscopy (FOB), including BAL and TBB; postbronchoscopy sputum was also collected in 19 patients. A specimen was considered to yield an immediate diagnosis when positive for AFB either on smear or histologic study; granulomas alone were considered positive when no other causes were identified. Overall, an immediate diagnosis was made by bronchoscopic specimens in 15 (48 percent) of 31 cases. TBB was the sole positive specimen in seven patients (23 percent). For comparison, similar specimens from 40 patients in whom M avium complex (MAC) grew on culture were also evaluated. An immediate identification of AFB was made in only four patients (10 percent). We conclude that the finding of AFB on staining of any pulmonary specimen is highly suggestive of tuberculosis, rather than MAC, and warrants institution of antituberculosis therapy. Of all bronchoscopic specimens, TBB provides the highest yield for an immediate diagnosis of tuberculosis.

Liquid disinfecting and sterilizing reprocessors used for flexible endoscopes

Cigarette smoking is believed to be one of the major factors influencing duodenal ulcer (DU) recurrence. However, the influence of cigarette smoking on DU recurrence after the eradication of Helicobacter pylori has not been separately addressed. The aim of this study was to investigate DU relapse rate in smokers and nonsmokers, both with confirmed eradication of H. pylori. Patients with H. pylori eradication, demonstrated at endoscopy 4 wk post-treatment, were included in the study. Smoking history was obtained with a standard questionnaire, and patients were followed endoscopically, both yearly and at symptomatic recurrence, to detect anatomical DU recurrence. Of the 197 (121M:76F) patients enrolled in the study and followed for 1-6 yr, 80 (41%) were smokers, smoking 5-40 cigarettes/day. The 117 (59%) nonsmokers included 31 (26%) patients who had ceased smoking 4-20 yr ago. Another seven (9%) smokers ceased smoking during the follow-up period. In the 197 patients with eradicated H. pylori and cured DU, there has been no recurrence of ulcer, regardless of smoking status. We conclude that in patients with DU in whom H. pylori infection is eradicated, ulcer disease does not recur, as observed for up to 6 yr. Furthermore, cigarette smoking is not a risk factor for DU recurrence, provided H. pylori is eradicated.

Upper gastrointestinal endoscopy: Are preparatory interventions effective?

As a member of the GI team, a well-trained endoscopy nurse is instrumental in the successful placement of a biliary prosthesis. This illustrated guide presents components of the process in a format designed for easy reference.