ASGE Repetitive Use Syndrome Survey

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ASGE Repetitive Use Syndrome Survey

  1. 1. REPORT TO THE SGNA BOARD OF DIRECTORS February 2000FROM: Paulette Smith, RN, BSN, CGRN X___ Action SecretarySUBJECT: December1999 Board Meeting Minutes.RECOMMENDATION: That the SGNA Board of Directors accept the minutes from the December BODmeeting via teleconference.Relevant Strategic Goal/Objective: noneAction: ____ Approved ____ Deferred ____ Rejected ____ Refer back to Committee ____ Amend and Adopt SGNA Board of Directors Meeting December 7, 1999 Via TeleconferenceVoting ParticipantsKaren Laing, RN CGRN, PresidentNancy Schlossberg, BSN RN CGRN, President ElectDonna Reeves, LPN CGN, TreasurerPaulette Smith, BS RN CGRN, SecretaryMarilyn Schaffner, MSN RN CGRN, Immediate Past PresidentTheresa Morse, BSN RN CGRN, Director of EducationMargaret Coffey, BSN RN CGRN, Director of PracticeCarol Stevens, BSN RN, Director of ProgramVirginia Walter, MS RN CGRN, Director of Communications & CollaborationCathy Dykes, MS RN CGRN, Speaker of the House of DelegatesMaureen Wright, RN CGRN, Director of GovernmentNon-Voting Participants/Guests:Cathleen Ferarro, CBGNA PresidentMary Beth Hepp, Interim Executive DirectorKathleen Domkowski, MS RN C, Director of Nursing EducationHeather Bagby, Operations ManagerAllison Cline, Member Services CoordinatorKathy Wright, MS RN CGRN, GNJ Editor1) Roll Call/AgendaCall to Order/Roll CallSGNA President Karen Laing, RN CGRN, called the meeting to order at 6:05 p.m. on Tuesday, December 7,1999. Secretary Paulette Smith, BS RN CGRN, called the roll of voting and non-voting members.2) Approval of MinutesFebruary 2000 – SGNABoard Book 1
  2. 2. >>APPROVED the minutes from the October 14-17, 1999 Board of Directors Meeting with the followingadditions/corrections:• Maureen Wright was added to voting participants• Kathy Wright and Nancy Shields were added to non-voting participants• Under the heading “Membership Retention and Recruitment Plan” paragraph 2, sentence 2, remove the word “plan.”• Under the heading “Foreign Affairs” paragraph 3, sentence 1, edit the word development to read develop• Under the heading “Foreign Affairs” paragraph 4, sentence 1, edit the word development to read develop3) Approve AgendaMs. Smith recommended that the meeting agenda be approved.>>APPROVED the December Board meeting Action agenda with the following changes:• Consent report Policy D-4 moved to the Action agenda• SIG Needs Assessment Survey Information report moved to Action agenda4) Action Agenda2000 BudgetTreasurer Donna Reeves, LPN CGN, recommended that the 2000 budget be approved pending final contractapproval by legal counsel and auditors report.Director Theresa Morse, BSN RN CGRN, noted that the education committee may not meet in 2000; therefore,the estimated $10k in meeting expenses may be saved. Ms. Smith noted that secretary travel might be anotherarea for potential savings. It was also explained that the increase in honorarium was accounted for in the proposed2000 budget.>>APPROVED the 2000 budget pending final contract approval by legal counsel and auditors report.ASGE Repetitive Use Syndrome SurveyMs. Smith recommended that the SGNA BOD approve participation with ASGE in the formation of a surveyregarding repetitive use syndromes by Gastroenterologists and GI Nurses and Associates.Ms. Smith reiterated that there is no financial commitment at this time. Director Virginia Walter, MS RN CGRN,expressed concern regarding publishing rights. Ms. Smith acknowledged her concern, but noted that it is too earlyin the process to negotiate. Ms. Laing expressed support.>>APPROVED that the SGNA BOD participate with ASGE in the formation of a survey regarding repetitive usesyndromes by Gastroenterologists and GI Nurses and AssociatesEndorsement of the Academy of Medical-Surgical Nurses (AMSN) position statementsPresident Elect Nancy Schlossberg, BSN RN CGRN, recommended that the SGNA BOD vote to endorse theAcademy of Medical-Surgical Nurses (AMSN) position statements:• Unlicensed Assistive Personnel (UAP)• Political Awareness of the Registered Nurse• General Health & Wellness• Identification of the Registered Nurse in the Workplace• Code of Conduct/EthicsIt was noted that these position statements come from NOLF/NFSNO.>>APPROVED that the SGNA BOD endorse the Academy of Medical-Surgical Nurses (AMSN) positionstatements:• Unlicensed Assistive Personnel (UAP)• Political Awareness of the Registered NurseFebruary 2000 – SGNABoard Book 2
  3. 3. • General Health & Wellness• Identification of the Registered Nurse in the Workplace• Code of Conduct/EthicsNurse in Washington InternshipMs. Schlossberg recommended that the SGNA BOD fund $1500 for the President-elect to attend the Nurse inWashington Internship (NIWI) program on a yearly basis, with initial funds to come from the 2000 Strategic Planbudget.It was noted that Ms. Schlossberg and Ms. Laing feel this is a good opportunity because other NOLF/NFSNOorganizations have raved about it. Immediate Past President, Marilyn Schaffner, MS RN CGRN, expressed theneed to capture a detailed report regarding knowledge gained to the BOD. Ms. Schlossberg explained that thereare scholarships available.>>APPROVED that the SGNA BOD fund $1500 for the President-elect to attend the Nurse in WashingtonInternship (NIWI) program on a yearly basis, with initial funds to come from the 2000 Strategic Plan budget.Provide SGNA Materials to Vendors ElectronicallyMs. Schlossberg recommended that the SGNA provide Frank Bass with an electronic copy of SGNA’s Standardsfor Infection Control and Reprocessing of Flexible Gastrointestinal Endoscopes, under a written agreement that isfor view-only purposes on his laptop not to be printed or reproduced.Interim Executive Director, Mary Beth Hepp, noted that legal counsel has reviewed this recommendation andbelieves permission can be granted provided a person who wants this type of information in this manner signs awritten agreement.>>APPROVED that the SGNA provide Frank Bass with an electronic copy of SGNA’s Standards for InfectionControl and Reprocessing of Flexible Gastrointestinal Endoscopes, under a written agreement that is for view-only purposes on his laptop not to be printed or reproduced.Teleconference on sclerotherapy for the treatment of esophageal varicesMs. Schlossberg recommended that the SGNA Board of Directors approve assisting McCarthy Medical Marketingin developing a teleconference on sclerotherapy for the treatment of esophageal varices by recommendingmembers experienced in this topic as potential faculty, and to participate in program planning.Director of Nursing Education, Kathleen Domkowski, MS RN C, explained that McCarthy Medical Marketing isworking with a vendor that is looking for content experts to help them. It was explained that SGNA would beacting as a referral service.Ms. Hepp noted that the staff would develop a procedure and bring it to the board. Ms. Smith recommended thatthe staff put the call out on the web page, if we don’t get the responses needed we would know then if we have thecapability to provide experts.>>APPROVED assisting McCarthy Medical Marketing in developing a teleconference on sclerotherapy for thetreatment of esophageal varices by recommending members experienced in this topic as potential faculty, and toparticipate in program planning.Palliative CareMs. Schlossberg recommended that the SGNA Board of Directors vote to join 31 other Specialty NursingOrganizations in support of the position Statement on Palliative Care.Ms. Laing noted that this came from the NOLF/NFSNO meeting.>>APPROVED that the SGNA Board of Directors joins 31 other Specialty Nursing Organizations in support ofthe position Statement on Palliative Care.February 2000 – SGNABoard Book 3
  4. 4. Nursing ShortageMs. Schlossberg recommended that the SGNA Board of Directors vote to support the “Nurses for a HealthierTomorrow” coalition.Ms. Schlossberg explained that this is a global message that will provide good public relations in specialtynursing. This came from the NOLF/NFSNO meeting. Ms. Walter noted that this is a good initiative to share withthe regionals. Ms. Reeves explained that we do not have funds to allocate at this time. Ms. Schaffner stated thatif members and/or regionals want to donate, they might do so via the SGNA Foundation.>>APPROVED that the SGNA Board of Directors support the“ Nurses for a Healthier Tomorrow” coalition.Multi-State Compact for Nursing LicensureMs. Schlossberg recommended that the SGNA Board of Directors vote to support the American Academy ofAmbulatory Care (AAACN) position statement of Multi-State Nursing Licensure.>>APPROVED that the SGNA Board of Directors support the American Academy of Ambulatory Care(AAACN) position statement of Multi-State Nursing Licensure.Policy A-9Ms. Smith recommended that policy A-9 “Termination of Membership” be approved.It was noted that this has had legal review.>>APPROVED policy A-9.Deletion of Policies A-6 and A-8Ms. Smith recommended that policies A-6 & A-8 be deleted.It was noted that both of these policies are addressed in detail via bylaws Articles V and XXIV.>>APPROVED that policies A-6 and A-8 be deleted.Policy D-4Ms. Smith recommended that the board approve revisions made to Policy D-4.It was noted that 5.3 should be deleted as well. The numeral 5 will be added under the heading Per DiemExpenses.>>APPROVED the revisions made to Policy D-4.Endoscope Reprocessing Wall ChartMs. Schlossberg recommended that the SGNA BOD approve the recommended revisions to the wall chart “thesteps necessary to thoroughly clean and high level disinfect immersible GI Flexible Endoscopes.”It was noted that ASP currently sponsors the wall chart. It was recommend that the revision be laminated.>>APPROVED the recommended revisions to the wall chart “the steps necessary to thoroughly clean and highlevel disinfect immersible GI Flexible Endoscopes.”Performance of Flexible Sigmoidoscopy by Registered Nurses for the Purposes of ColorectalCancer Screening(Guideline )Ms. Schlossberg recommended that the SGNA BOD approve the recommended revisions to the guidelineperformance of flexible sigmoidoscopy by registered nurses for the purposes of colorectal cancer screening.A lengthy discussion occurred regarding supporting certification. The overall sentiment was that we havesidestepped the issue of certification and think it is time the SGNA BOD support the certification board. It wasfurther noted that this is a recommendation, not the law.February 2000 – SGNABoard Book 4
  5. 5. >>REJECTED that the SGNA BOD approve the recommended revisions to the guideline performance of flexiblesigmoidoscopy by registered nurses for the purposes of colorectal cancer screening.Ms. Schlossberg recommended that the SGNA BOD approve the recommended revisions to the guidelineperformance of flexible sigmoidoscopy by registered nurses for the purposes of colorectal cancer screening withthe following addition:• SGNA recommends that the procedure be performed by a registered nurse who holds current certification as a CGRN.>>APPROVED the recommended revisions to the guideline performance of flexible sigmoidoscopy by registerednurses for the purposes of colorectal cancer screening with the following addition:• SGNA recommends that the procedure be performed by a registered nurse who holds current certification as a CGRN.ONS MeetingMs. Schlossberg recommended that the SGNA BOD send one staff member and one volunteer to attend the ONSmeeting, and the Board should determine which volunteer would attend.>>APPROVED SGNA will send one staff member and one volunteer to attend the ONS meeting.SIG Needs Assessment SurveyDirector Margaret Coffey, BSN RN CGRN, recommended that the SIG Needs Assessment Survey be withdrawnfrom the Action agenda.>>WITHDRAWN to review the SIG Needs Assessment Survey.5) OtherMs. Reeves reminded that BOD to submit any outstanding expense reports from fiscal year 1999.Ms. Schlossberg announced that the President passed into law that March will be Colon Cancer Awareness Month.It was also announced that SGNA may use the Caring Star.There being no further business, the meeting was adjourned at 7:46 p.m.February 2000 – SGNABoard Book 5
  6. 6. REPORT TO THE SGNA BOARD OF DIRECTORS February 2000FROM: Margaret Coffey X__ Action Chair of SIG Task ForceSUBJECT: Special Interest Group Task ForceRECOMMENDATION(S):1) Recommend that the chairperson of each SIG be invited to the leadership conference in the year 2000 , todevelop a leadership track for each Sig to follow2)Recommend that a Web page be developed for each SIG (linked off SGNA.ORG)3)Recommend that SGNA not support future Hepatology SIG Meetings with AASLD4) Recommend that the Special Interest Task force be disbandedRelevant Strategic Goal/Objective: Goal 3, SGNA will be a relevant organization through successfuluse of Internet resources in order to communicate with the Gastroenterology and Endoscopy community.Objective 3.1b Identify and within financial boundaries and with BOD approval, update any new internettechnology on the SGNA Web site.Justification: The SIG survey showed the most important benefit for SIG members are: newsletters,networking and education. 1) The task force realized that many of the Sig was struggling to survive and felt thata leadership track would offer new benefit to the SIG leaders and assist them to become future leaders in SGNA.2) Many of the SIG members expressed the desire for a Web page for their newsletter3) Hepatology SIG has a membership of 128, only 49 attended the 1999 HEP SIG conference. SIG survey showedthat the majority of the members were not interested in meeting more than one a year at the annual course4) SIG task force has completed its assignmentTime Frame/Target Date for Completion: Leadership meeting, fall of 2000; SIG WEB page, August 2000;Hepatology Meeting , Immediately. SIG task force be disbanded immediately.Financial Impact: Budget projection for the SIG leadership course are for 17 SIG chairs and 4 SIG coordinators:Airfare: 21 @ 360 = $7560Hotel 21 @ $75 ( 2/room) = 1575Per Diem 2 1 @ 100 (assumes 2 days @ $50 ) = 2100Materials: 21 @ $30 = 630 TOTAL $11865Staff Impact: Can be absorbed by current staffRelation to Strategic Plan: Goal 2. These actions will provide current and expanded educational opportunitiesto SGNA members and customers by maintaining and enhancing delivery mechanisms. Goal 3. SGNA will berelevant organization through successful use of Internet resources in order to communicate with theGastroenterology and Endoscopy community.Action: ____ Approved ____ Deferred ____ Rejected ____ Refer back to Committee ____ Amend and AdoptFebruary 2000 – SGNABoard Book 6
  7. 7. REPORT TO THE SGNA BOARD OF DIRECTORS February 2000 FROM: Nancy Shields, President, SGNA Foundation X__ ActionSUBJECT: Don Wilson Memorial ScholarshipRECOMMENDATION(S): That the SGNA establish an educational scholarship in Don Wilson’s name. SGNAwould make an initial contribution of $1,000 to establish the fund, but contributions would be accepted from othersources as well, including SGNA members, physicians, Wilson-Cook Medical Inc. and their internationalaffiliates. SGNA would contribute $1,000 annually to the fund.Criteria for disbursement are based upon areas of interest in Don’s professional life.Criteria for disbursement would include some or all of the following:1. Fund SGNA members to international educational meetings2. Fund international GI nurses to attend SGNA educational meetings3. Fund nurses to attend specialty procedure courses, ie: ERCP sponsored by other organizations or in other countries.4. Fund research projects for nurses involved in innovative procedures or techniques5. Fund certification scholarships for SGNA members in the U.S. and for international nurses who may wish to take the U.S. certification examAfter the Scholarship Fund has been established, a letter from the SGNA Foundation President and SGNAPresident will notify Wilson-Cook Medical Inc. and Mrs. Minda Wilson that the fund has been established inDon’s name.Relevant Strategic Goal/Objective:Goal 2.2, Objective 2.1, 2.4Justification: Establishment of this scholarship fund serves as a public declaration to honor Don’s contribution tothe field of professional gastroenterology/endoscopy nursing both within the U.S. and around the world.Time Frame/Target Date for Completion: Initial contribution to be made as soon as possible so at least onescholarship can be awarded in May 2000. Announce scholarship creation in SGNA newsletter immediately priorto Annual Meeting.Financial Impact: Annual SGNA contribution of $1,000.Staff Impact: No additional impact.Relation to Strategic Plan: Public identity with the pursuit of excellence in our professionalfield and SGNA’s acknowledgement that the contributions of others have helped to shape oursuccess as individual practitioners as well as enhanced the success of the professional society.Action: ____ Approved ____ Deferred ____ Rejected ____ Refer back to Committee ____ Amend and AdoptFebruary 2000 – SGNABoard Book 7
  8. 8. REPORT TO THE SGNA BOARD OF DIRECTORS February 2000FROM: Budget and Finance Committee x Action Members: Donna Reeves, Chair Marilyn Schaffner, Karen Laing, Nancy Schlossberg, Margaret Coffey, Theresa Morse, Heather Bagby, Mary Beth HeppSUBJECT: Budget and Finance ReportRECOMMENDATION: That the 1999 Audited Surplus funds be designated to the Permanent Fund,deposited at Merrill Lynch.Relevant Strategic Goal/Objective: Goal 6, Fiscal Resources: SGNA will maintain a well-managed, dynamicand financially stable organization responsive to members needs.Justification: The approved Investment Policy D-2, states that the SGNA will allocate 1% of its annual revenueto the Permanent Fund. This 1% is budgeted in the Operating Budget. Ideally, the Society should have up to 50%of its annual operating budget in the Permanent Fund. We recommend the audited 1999 surplus over the 1% bedeposited in the Merrill Lynch SGNA Permanent Fund.Financial Impact: The Permanent Fund is at $737,832 with our goal of 50% of the Operating Budget($2,602,439) $1,201,219. Staff Impact: NoneFebruary 2000 – SGNABoard Book 8
  9. 9. REPORT TO THE SGNA BOARD OF DIRECTORS February 2000FROM: Mary Beth Hepp, Executive Director X__ ActionSUBJECT: SGNA 2000 Organizational PrioritiesRECOMMENDATION(S): That the SGNA Board of Directors approve the 2000 Organizational Priorities.Relevant Strategic Goal/Objective: The Organizational Priorities focus on assisting the SGNA to meetall Strategic Plan goals:-Coordinated fund-raising efforts.-Provide current and expanded educational opportunities to SGNA members and customers by maintaining andenhancing delivery mechanisms.-SGNA will be a relevant organization through successful use of Internet resources in order to communicate withthe Gastroenterology and Endoscopy community.-Enhance SGNA’s ability to increase scientific research and the number of scientist’s within our speciality.-SGNA is positioned as the expert provider of information and data on practice issues within our specialty, andidentifies bridges between the scientific community and the practicing GI nurse.Justification: The Organizational Priorities provides guidance to the SGNA staff and an evaluation tool to theBoard of Directors in order to evaluate Smith, Bucklin and Associates.Time Frame/Target Date for Completion: January – December 2000.Financial Impact: As determined each year by the SGNA and SBA annual contract.Staff Impact: The Organizational Priorities great affects staff because it outlines what they are to accomplisheach year in working with the SGNA.Relation to Strategic Plan: See above.Action: ____ Approved ____ Deferred ____ Rejected ____ Refer back to Committee ____ Amend and AdoptFebruary 2000 – SGNABoard Book 9
  10. 10. 2000 ORGANIZATIONAL PRIORITIESPriority A: Membership Growth and Stability Continue to recruit and retain members based upon staff-developed, Board- approved recruitment and retention plan. In 2000, increased emphasis should be placed on membership retention, particularly those individuals joining via the 18- month and 2-year renewal options as well as those taking advantage of the incentives for large groupOutcomes:Rate contribution to progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goal2 = Met goal3 = Partially met goal4 = Did not meet goal( ) 1. Continue the SGNA Share-the-Wealth member-get-a-member campaign with a goal of 300 new members by campaign’s end—March 2000.( ) 2. Launch and complete the 2000 dues renewal initiatives by May 15, 2000, with a minimum goal of 80 percent retention based on 1999 year-end membership.( ) 3. Implement the 18 month and 24 month, and on-line dues renewal options; evaluate the progress and implications of offering these options and report to BOD in Summer Board Meeting.( ) 4. Implement the incentive renewal program for large numbers of memberships; evaluate the progress and implications of offering these incentives and report to BOD in Summer Board meeting.( ) 5. Determine a realistic annual retention rate for SGNA through ongoing data collection and analysis; report to BOD at the Fall 2000 BOD meeting.Priority B: Finances Work with the SGNA Board of Directors to develop and maintain a 1999 – 2000 balanced operating budget and to effectively manage the Strategic Plan Fund.Outcomes:Rate contribution to the progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goalFebruary 2000 – SGNABoard Book 10
  11. 11. 2 = Met goal3 = Partially met goal4 = Did not meet goal( ) 1. Continue to work on increasing non-dues revenue through increased product and publication sales, Annual Course registrations, and securing increased sponsorship dollars.( ) 2. Maintain high quality financial reporting, standardization of financial processes, and budget planning. Sustain a consistent level of communication with the SGNA Treasurer and Board of Directors on the Society’s financial status, such communication to include providing the Treasurer and President a monthly written analysis of the SGNA financial statements.( ) 3. Ensure through SGNA staff and Board cooperation that operational expenses are within budget and budget overages are anticipated.( ) 4. Work to maintain/increase the SGNA bottom line through effective management of financial resources. Goal: Increase the 2000 year-end net by 3-5%.Priority C: Governance Ensure that governing tools are in place to effectively guide the Society.Outcomes:Rate contribution to progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goal2 = Met goal3 = Partially met goal4 = Did not meet goal( ) 1. Publish an SGNA Policy Manual by March 2000.( ) 2. Maintain manual via sgna.org Board Members only web page.( ) 3. Implement Board Members Only page on the SGNA Website by May 2000. Use this site for Board communications and preparation for Board meetings. Evaluate use and report to BOD at Winter Board meeting.( ) 4. Increase and enhance electronic communications between Board of Directors, SGNA staff, and SGNA members; continue e-mailing BOD books and electronic voting when needed. Provide SGNA E-Scope monthly to all SGNA members with e-mail addresses.February 2000 – SGNABoard Book 11
  12. 12. Priority D: Leadership Work with the SGNA Board of Directors in their ongoing efforts to recruit and develop leaders. Work with the SGNA President and President-Elect on ways to provide greater leadership development and discussion of global issues important to the future of the gastroenterology nursing specialty.Outcomes:Rate contribution to progress or success of each item by placing corresponding number inparentheses on left-hand margin:1=Exceeded goal2=Met goal3=Partially met goal4=Did not meet goal( ) 1. Work with SGNA President-Elect on continued improvement and enhancement of the Board/Committee Chair Orientation held in conjunction with the Winter 2000 Board meeting.( ) 2. Continue to offer a Regional Presidents Leadership Conference in conjunction with the Fall 2000 SGNA Board meeting.( ) 3. As needed, bring outside speakers to address the Board on environmental issues and member expectations in order to expand the Board’s information base on which it draws to make decisions.( ) 4. Continue the work of the Unified Partnership Task Force in the joint fundraising project; evaluate and report results of the project at the Fall 2000 Board meeting.( ) 5. Continue the work of the Unified Partnership Task Force in the joint –800number project; evaluate and report results of the project at the Fall 2000 Board meeting.( ) 6. Support the SIGs via 2 bi-annual newsletter publications and distribution as well as staff support to all annual SIG meetings at the Annual Course. Provide support to any Board of Directors approved SIG meetings outside the Annual Course. Follow the recommendations of the SIG Task Force and/or SIG liasion inworking with SIG activitiesPriority E: Performance and Quality of Staff ServicesFebruary 2000 – SGNABoard Book 12
  13. 13. Ensure that members perceive SGNA as an effective and efficient organization as measured by functional objectives.Outcomes:Rate contribution to progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goal2 = Met goal3 = Partially met goal4 = Did not meet goal( ) 1. Consistently deliver top-quality, contracted services in an accurate and timely manner. Member feedback mechanisms including postcards and regional presidents survey will be used as part of the evaluation process.( ) 2. Continue to enhance staff “friendliness” at all levels of the organization. Staff to work at continuing to anticipate members needs and identifying trends;acting as a resource and providing guidance/direction to members.( ) 3. Work with SGNA Board of Directors to increase their level of trust and confidence in the SGNA staff, which will free up the Board to focus on organizational planning, direction and policy setting, therebyhelping the Society to develop to its full potential.( ) 4. Share with BOD the SGNA Administrative staff Key Responsibilities andprovide an overall progress report to the Board of Directors at Fall 2000 Board meeting.( ) 5. Continue to identify course sites and negotiate hotel arrangements on a “five-year- out” basis. Work in 2000 should focus on identifying and negotiating the 2005 Annual Course site.( ) 6.. Clearly communicate to the Board specific timelines for completion of allprojects and status reports on implementation of projects in order to assist them in accurately measuring completion dates.( ) 7. MARCOM will successfully complete all 2000 budgeted MARCOM projects; specifically adhering to timelines and budget, while providing high qualityworkFebruary 2000 – SGNABoard Book 13
  14. 14. Priority F: Education Maximize the abilities and presence of SGNA’s nursing educator in order to identify and develop up-to-date continuing education materials and practice products based on identified member needs, thereby increasing SGNA’s non-dues revenue.Outcomes:Rate contribution to progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goal2 = Met goal3 = Partially met goal4 = Did not meet goal( ) 1. Work with the Certification Review Task Force to offer at least one SGNA- sponsored certification review course by December 2000.( ) 2. Revise and publish the SGNA High-Level Disinfection Module working in conjunction with the SGNA Practice Committee by May 2000( ) 3. Publish the revised SGNA Manual of Gastrointestinal Procedures (4th Ed.) by Jan. 30, 2000.( ) 4. Conduct the ANCC re-accreditation process with ANCC visit in Spring 2000. Entire process to be completed in 2000.( ) 5. Videotape plenary sessions at the Annual Course in Anaheim and develop at least two new CE modules in for sale by September, 2000.( ) 6. Develop at least 5 additional audiotape study modules from popular 1999 and 2000 Annual Course sessions; Have at least 2 audio study modules ready for sale by May 2000 and 3 more by Sept. 2000.( ) 7. Develop at least 4 videotaped sessions as CE modules available for viewing on the Internet and for sale via the SGNA Website by September, 2000.( ) 8. Develop with the Journal Editor and Publisher improved strategies for using Gastroenterology Nursing articles for independent study CE Credit. Report with specific recommendations and budgetary implications due to SGNA Board by May 2000.( ) 9. By Dec, 31, 2000, SGNA will help at least 10 regionals conduct programs themselves that specifically focus on increasing hands-on learning at regional meetings.Priority G: Marketing and CommunicationsFebruary 2000 – SGNABoard Book 14
  15. 15. Provide SGNA with quality marketing and communications services.Outcomes:Rate contribution to progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goal2 = Met goal3 = Partially met goal4 = Did not meet goal( ) 1. Develop and adhere to an annual newsletter publication schedule and budget.( ) 2. Develop and publish all Annual Course marketing materials in a consistent and high quality manner.( ) 3. Develop and publish SGNA Membership Directory according to schedule and budget.( ) 4. Develop and publish SGNA Joint-Sponsorship Opportunities booklet according to schedule and budget.( ) 5. Continue implementing the comprehensive strategic plan for expanding the information and services available through the SGNA Web site. Services to include; shopping cart, auditorium chats, discussion forums, BOD only page, and on-line learning.( ) 6. Continue to effectively plan and manage budgets for all other Marketing and Communications-related projects.Priority H: Alliances Increase visibility and promote practice through alliances with other nursing organizations, GI physician groups, government, vendors, other health professional groups and the public.Outcomes:Rate contribution to progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goal2 = Met goal3 = Partially met goalFebruary 2000 – SGNABoard Book 15
  16. 16. 4 = Did not meet goal( ) 1. Continue and enhance the relationship between the SGNA, CBGNA and the Foundation via joint projects, common meetings, and shared information. Conduct monthly conference calls with all three organizations.( ) 2. Develop relationships with other specialty nursing organizations such as NFSNO members; become a member of a NFSNO Work Group; support other specialty nursing organization missions when possible and appropriate.( ) 3. Explore opportunities to increase SGNA visibility internationally via vendors, international meetings, and increasing international membership.( ) 4. Provide staff support as the Board of Directors continue to evaluate alliances with physician groups and governmental alliances.Priority I: Use of Technology SGNA will be a relevant organization through successful use of Internet resources in order to communicate with the Gastroenterology and Endoscopy community.Outcomes:Rate contribution to progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goal2 = Met goal3 = Partially met goal4 = Did not meet goal( ) 1. Increase the number of overall SGNA transactions via E-commerce by 50% from 1999 to 2000.( ) 2. Increase use of Internet to hold virtual meetings and discussions; in 2000 conduct at least 2 Board discussion forums, 4 Auditorium chats, and increase activity in member discussion forums by 20% over 1999 volume.( ) 3. Assist our members in the utilization of Internet technology by providing an education program for members who need assistance understanding Internet uses.( ) 4. Obtain evaluations and recommendations about SGNA Web site features from at least 5% of our Web site visitors.February 2000 – SGNABoard Book 16
  17. 17. Priority J: Research Enhance SGNA’s ability to increase scientific research and the number of scientists within our speciality.Outcomes:Rate contribution to progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goal2 = Met goal3 = Partially met goal4 = Did not meet goal( ) 1. Support investigators by helping SGNAFER offer grant funding and establishing a New Investigator Award.( ) 2. Develop and explore a Director of Research role for SGNA by May 2000.( ) 3. Further the education of SGNA members in research and science via Annual Course sessions, assisting in the development of advanced practice scholarships, and posting grant applications.Priority K: Practice Issues SGNA is positioned as the expert provider of information and data on practice issues within our specialty, and identifies bridges between the scientific community and the practicing GI nurse.Outcomes:Rate contribution to progress or success for each item by placing corresponding number inparentheses on left-hand margin:1 = Exceeded goal2 = Met goal3 = Partially met goal4 = Did not meet goal( ) 1. By 6.30.00, identify at least 3 practice issues and their clinical outcomes.( ) 2. By 12.31.00, develop a plan that allows SGNA to provide information and dataon the 3 practice issues identified.February 2000 – SGNABoard Book 17
  18. 18. ( ) 3. By 12.31.00, develop a plan that allows SGNA to better link the practicing GI community with the scientific GI communityFebruary 2000 – SGNABoard Book 18
  19. 19. REPORT TO THE SGNA BOARD OF DIRECTORS Feb 2000FROM: Allison Cline, Member Services Coordinator X__ Action Heather Bagby, Operations ManagerSUBJECT: Special Interest Group and Regional Society Website PagesRECOMMENDATION(S): That SGNA approve the development and implementation of pages onwww.sgna.org for each individual Special Interest Group and Regional Society.Relevant Strategic Goal/Objective: 3: SGNA will be a relevant organization through successful use ofInternet resources in order to communicate with the Gastroenterology .Justification: This would allow Special Interest Groups access to group rosters and archived SIG newsletters, andallow for more in-depth and individualized information for both SIGs and Regionals.Time Frame/Target Date for Completion: July 2000Financial Impact: Can be absorbed in current staff and web budget.Staff Impact: Can be absorbed in current staff time.Relation to Strategic Plan: This will enable members and non-members access to more information aboutSGNA electronically.Action: ____ Approved ____ Deferred ____ Rejected ____ Refer back to Committee ____ Amend and AdoptFebruary 2000 – SGNABoard Book 19
  20. 20. REPORT TO THE SGNA BOARD OF DIRECTORS February 2000FROM: Mary Beth Hepp X__ Action Executive DirectorSUBJECT: NFSNO and NOLF Task ForceRECOMMENDATION(S): That SGNA sign the attached letter to the NFSNO and NOLF board of directorsformally requesting that a work group / task force be formed to pursue closer collaboration and better alignment ofeffort between NFSNO and NOLF.Relevant Strategic Goal/Objective: This recommendation helps SGNA in its work with alliances withother nursing specialty groups as well as Goal 5: SGNA is positioned as the expert provider of information anddata on practice issues within our specialty, and identifies bridges between the scientific community and thepracticing GI Nurse.Justification: NFSNO and NOLF participating organizations see too much over-lap with these two organizations,especially when paying fees to belong to both organizations. We need a task force to investigate the purpose ofhaving two separate groups. See attached letter for further justification. Currently SGNA is a NFSNO and NOLFmember. SGNA paid both fees in 1999 and budgeted to pay both in 2000. NFSNO fees are $1550 per year andNOLF fees are $450 per year.Time Frame/Target Date for Completion: Send the letter as soon as possible. Work group to be formed byNFSNO and NOLF and meet by Nov. 2000.Financial Impact: No financial impact to send the letter. Could lead to improved expenses in fees to NFSNOand NOLF. Although currently SGNA is only paying NFSNO fees.Staff Impact: Can be absorbed by current staff; need ½ additional full-time employee; will need part-time helpfor 3 months; etc. Also include total cost.Relation to Strategic Plan: This helps identify the purpose of each group (NFSNO and NOLF) and thereforehelps SGNA determine which group to be a part of (of both) in helping SGNA meet all of its strategic plan goals.Action: ____ Approved ____ Deferred ____ Rejected ____ Refer back to Committee ____ Amend and Adopt DRAFT December 3, 2010Letter to NOLF and NFSNO boards of directors from the boards of directors of specialtynursing organizations.Dear NOLF or NFSNO Director, When the members of the National Federation of Nursing Specialty Organizations (NFSNO) and theNursing Organizations Leadership Forum (NOLF) met together in Washington, DC in November 1999,they discussed forming a joint task force to pursue closer collaboration and better alignment of effortbetween NFSNO and NOLF. As a member of NFSNO [NOLF] since 19__, we are writing to you today, asa followup to this discussion, to formally request that such a working group be formed as soon asFebruary 2000 – SGNABoard Book 20
  21. 21. possible. Further, we ask that this group be charged with the broader (and more meaningful) task ofexamining the collective and collaborative needs of the specialty nursing community in general. It is our observation that both NFSNO and NOLF have, to a greater or lesser degree, moved awayfrom their original purpose and mission, and evolved structures that may no longer serve our sharedgoals effectively. It is evident to us that both inefficiency and significant overlap exist between andwithin both groups, with the clear and present danger of working at cross-purposes. We believe thatspecialty nursing’s needs will be better met through a unified structure – either by melding the twogroups or by conceiving and forming an entirely new group. In terms of composition, we respectfully request that the working group include representation fromboth the NOLF and NFSNO leadership and that its members include a wide variety of specialty nursingorganizations. Also, to help ensure that its recommendations represent the best functional solutions, weask that the group include nonbiased third party members with no vested interest in the outcome. We urge the NFSNO and NOLF leaderships to address without delay the feasibility of forming a groupthat could meet between now and the next joint NFSNO/NOLF meeting in November 2000, and couldpresent some preliminary direction for discussion and further action at that joint meeting. Understandingthe importance of this effort, [MY ORG] would consider supporting this group as appropriate, alwaysacknowledging limited financial and volunteer resources. Now, more than ever, the nursing community must speak with one voice in forming and influencingpolicy that will affect the delivery of nursing care across all specialties and settings. We believe thatspecialty nursing must participate fully in this national agenda to improve patient care, while maintaininga vehicle to effectively and efficiently serve the special needs of its members, customers and otherconstituencies. We feel strongly that the time is right, and the need urgent, for the formation of a working groupthat will address the best vehicle for such collaborative and collective work. We appreciate the timelyconsideration of this request, and we look forward to your response. With best wishes, Sincerely, [Name] 2000 Presidentcc: David Hennage Executive Director, ANAFebruary 2000 – SGNABoard Book 21
  22. 22. REPORT TO THE SGNA BOARD OF DIRECTORS February 2000FROM: Karen Laing RN, CGRN X_Action PresidentSUBJECT: Board of Directors AwardRECOMMENDATION: SGNA Board of Directors Give This Award to M. Eileen Widmer CAEJustification: Eileen led us for three + years. She guided us to and through our first strategic plan and helped usto see the need for our new strategic plan. She helped us to gain financial stability by educating us in the oftenconfusing process of budgeting and encouraged us to settle for nothing less than a balanced budget.Eileen taught us to see the SGNA as a business and served a coach and mentor to several Presidents and President-elects.Time Frame/Target Date for Completion: May 2000Financial Impact: Hotel for 2 nights $300.00 Airfare $360.00 Per Diem $150.00 Cost of award TBDStaff Impact: noneRelation to Strategic Plan:Action: ____ Approved ____Deferred ____Rejected ____Refer back to Committee ____Amend and AdoptFebruary 2000 – SGNABoard Book 22
  23. 23. REPORT TO THE SGNA BOARD OF DIRECTORS FEBRUARY 2000FROM: Sallie Walker, BA RN CGRN X Action Chair, Practice CommitteeSUBJECT: Guideline on the Use of High Level Disinfectants and Sterilants for Reprocessing Of Flexible Gastrointestinal EndoscopesRECOMMENDATIONS: Practice Committee recommends that the SGNA Board of Directors approvethe attached recommended revisions to Guideline on the Use of High Level Disinfectants and Sterilants forReprocessing of Flexible Gastrointestinal Endoscopes.Because additional compatibility statements are anticipated from a major endoscope manufacturer in the very nearfuture, Practice Committee recommends that should these statements become available prior to publicationdeadline for this document, that these compatibility statements be incorporated into the guideline.Relevant Strategic Goal/Objective: Goal 5: SGNA is positioned as the expert provider of information and dataon practice issues within our specialty and identifies bridges between the scientific community and the practicingGI nurse.Justification: Since the adoption of this guideline in February 1999, significant changes have occurred withchanges in compatibility statements from a major endoscope manufacturer and with the introduction of a new highlevel disinfectant, 0.55% ortho-phthalaldehyde. These changes are reflected in the revision of this document.SGNA’s membership needs current information as they make purchasing decisions for endoscopes and thechemicals used to reprocess them.This guideline is part of SGNA’s Self-Study Module on Reprocessing. Revisions of the other components of thismodule are also being presented to the Board at this time.Time Frame: With the Board’s approval the revised guideline can be forwarded to Gastroenterology Nursingfor publication in the next available issue. Reprints can be made available for purchase via Headquarters and theweb site. The revised guideline will be incorporated into the third edition of SGNA’s Self- Study Module onReprocessing at the same time as other updates are made.Financial Impact: This guideline is made available for purchase alone and as part of the Self-Study Module. Bothhave generated income for SGNA. Because the cost of producing this item is carried as an inventory item onSGNA’s balance sheet, it requires no additional budgeted monies for production. In anticipation of changes toseveral components of the module, its inventory is down to one copy.Staff Impact: Can be absorbed by current staff.Action: _____ Approved _____ Deferred _____ Rejected _____ Refer back to Committee _____ Amend and AdoptDRAFT Guideline for the Use of High-Level DisinfectantsFebruary 2000 – SGNABoard Book 23
  24. 24. and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes Society of Gastroenterology Nurses and Associates, Inc. DisclaimerThis document is based on current published data available at the time of publication. TheSociety of Gastroenterology Nurses and Associates, Inc. (SGNA) assumes no responsibilityfor the practices and recommendations of any member or other practitioner, or for thepolicies and procedures of any practice setting. The nurse and associate function within thelimitations of licensure, state nurse practice act and/or institutional policy.AcknowledgmentsPrepared and written by the Society of Gastroenterology Nurses and Associates, Inc. PracticeCommittee, Chaired by Sallie B. Walker, RN CGRN, and adopted by the Society ofGastroenterology Nurses and Associates, Inc. Board of Directors, February 19992000.Published as a service to members by the Society of Gastroenterology Nurses and Associates,Inc.Copyright © 19992000, Society of Gastroenterology Nurses and Associates, Inc. Additionalreprints are available for purchase from the Society of Gastroenterology Nurses andAssociates, Inc. (SGNA) Headquarters. To order, contact SGNA. Department of Membership Services Society of Gastroenterology Nurses and Associates, Inc. 401 N. Michigan Avenue3620 Swenson AvenueSt. Charles, IL 60174 800/245-SGNA (in Illinois, 312/321-5165) Email: SGNA@sba.com www.SGNA.orgFebruary 2000 – SGNABoard Book 24
  25. 25. GUIDELINE FOR THE USE OF HIGH LEVEL DISINFECTANTS AND STERILANTS FORREPROCESSING OF FLEXIBLE GASTROINTESTINAL ENDOSCOPESPreface Professional associations and regulatory agencies recognize high level disinfection as the standard ofcare in reprocessing flexible endoscopes (American Society for Gastrointestinal Endoscopy [ASGE],1996). Four Five chemicals are currently cleared by the Food and Drug Administration (FDA) as highlevel disinfectants and/or sterilants with general claims for reprocessing reusable medical devices:glutaraldehyde, 0.2 % peracetic acid, 7.5% hydrogen peroxide, and 0.08% peracetic acid/1% hydrogenperoxide, and 0.55% ortho-phthalaldehyde. This guideline provides information about the properties ofthese solutions, their safe and effective use and their compatibility with flexible endoscopes.Definition of Terms Endoscope. In this document, refers only to flexible gastrointestinal endoscopes. High level disinfection (HLD). A process that results in the destruction of all vegetative bacteria,viruses, fungi, and mycobacteria but not necessarily all bacterial spores. The Spaulding Classificationidentifies HLD as the standard for medical devices that touch mucous membranes, such as endoscopes(Association of Professionals in Infection Control and Epidemiology [APIC], 1996). High level disinfectant/sterilant. A chemical germicide which has been cleared by the FDA as capableof destroying all microorganisms, including all bacterial spores, which when used at a shorter exposuretime destroys all viruses, vegetative bacteria, fungi, mycobacteria and some, but not all, bacterial spores. Material Safety Data Sheet (MSDS). A descriptive sheet that accompanies a chemical or chemicalmixture, providing the identity of the material; physical hazard, such as flammability; acute and chronichealth hazards associated with contact with or exposure to the compound. Minimum effective concentration (MEC). The lowest concentration of active ingredient necessary tomeet the label claim of a reusable high level disinfectant/sterilant. Mutagen. A substance capable of inducing or accelerating changes in a gene or chromosome. Sterilant. A chemical germicide which has been cleared by the FDA as capable of destroying allmicroorganisms, including all bacterial spores. Sterile. The state of being free from all living organisms. Sterilization. A process that results in the complete elimination or destruction of all forms ofmicrobial life. The Spaulding Classification identifies sterilization as the standard for medical devicesthat enter the vascular system or sterile tissue, such as biopsy forceps (APIC, 1996). Teratogen. An agent that increases the incidence of a congenital malformation. Threshold limit value ceiling (TLV-C). The airborne concentration of a substance that should not beexceeded during any part of the work experience. Threshold limit value time-weighted average (TLV-TWA). The airborne concentration of a substance towhich all workers may be exposed day after day without experiencing any adverse health effects.February 2000 – SGNABoard Book 25
  26. 26. Use-life. Statement by the manufacturer of the maximum number of days a reusable high leveldisinfectant/sterilant might be effective.General Principles Common to the Use of All High Level Disinfectants and/or SterilantsProduct Safety None of the four five chemicals addressed in this document is listed as a carcinogen. Glutaraldehyde isneither a mutagen nor a teratogen (Union Carbide, 1995a). The Material Safety Data Sheet (MSDS) forperacetic acid lists information on mutagenicity and teratogenicity as “not available” (STERIS, 1997b). TheMSDS for hydrogen peroxide does not address mutagenicity or teratogenicity (Reckitt & Colman, 1997).The MSDS for ortho-phthalaldehyde states the product is not reported to produce mutagenic, embryogenic,teratogenic or reproductive effects in humans. It is imperative that healthcare workers who use any high level disinfectant and/or sterilant be familiarwith and have readily accessible the product/brand-specific MSDS for all chemicals used, followOccupational Safety and Health Administration (OSHA) guidelines, and keep current with developments inproducts, protective equipment, and practice.Manual Cleaning Meticulous manual cleaning of all instruments must precede exposure to any high level disinfectantor sterilant. (Association of Operating Room Nurses [AORN], 1996a; APIC, 1996; ASGE, 1996; Society ofGastroenterology Nurses and Associates, Inc. [SGNA], 1996). Inadequate cleaning of instruments hasbeen one factor cited in transmission of infection by flexible endoscopes (APIC, 1996; Akamatsu, Tabita,Hironga, Kawakami, and Uyeda 1996; Bronowicki, et al., 1997; Spach, Silverstein, and Stamm, 1993).Studies demonstrate that appropriate cleaning reduces the number of microorganisms and organic loadby 4 logs or 99.9% (Rutala and Weber, 1995; Chu, McAlister, and Antonoplos, 1998). This significantlyreduces the organic and microbial challenge to the high level disinfectant or sterilant. A detailedcleaning protocol for endoscopes is found in SGNA’s Standards for Infection Control and Reprocessing ofFlexible Gastrointestinal Endoscopes (1997). Endoscope manufacturers’ guidelines should always beconsulted for design features unique to a particular instrument. Cleaning of endoscopes prior to chemical exposure includes purging the air/water channel, usingenzymatic detergent solution for cleaning the exterior of the instrument, and brushing all valves andaccessible channels. The endoscope must then be immersed in fresh enzymatic detergent solution,which is flushed through all channels. Some automated reprocessors provide for irrigation of enzymaticsolution. If not, this step must be done manually prior to beginning the automated cycle.Determining Minimum Effective Concentration Glutaraldehyde, 7.5% hydrogen peroxide, and 0.08% peracetic acid/1% hydrogen peroxide andortho-phthalaldehyde are reusable products. The challenges of microbes and organic matter, dilution byrinse water and age of the chemical solution result in a gradual reduction of the effectiveness of reusablehigh level disinfectant/sterilants. Reusable high level disinfectant/sterilants must be changed wheneverthe MEC fails or the use life expires, whichever comes first. The appropriate number of reuses of each ofthese products must be determined by testing that the solution is at or above its MEC. Use product-specific test strips. MEC should be monitored at least each day of use and more frequently as dictatedby the number of endoscopes reprocessed (SGNA, 1997). Maintain a log of test results. [See AppendixA for a sample log.]February 2000 – SGNABoard Book 26
  27. 27. Final Rinse/Alcohol Purge All high level disinfectants or sterilants used to reprocess flexible endoscopes have the potential to injuremucous membranes if not thoroughly rinsed from the endoscope. In addition, rinse water may contaminate theendoscope following chemical exposure. Sterile water is ideal for the final rinse but is impractical in mostsettings. Clean water may be used for the final rinse of the endoscope and its channels, followed by air-drying, arinse with 70% isopropyl alcohol obtained from a tightly-closed container, and a second air drying of theinstrument. Most automated reprocessors incorporate an optional water filtration system. Such systems mayreduce the number of tap water contaminants but do not eliminate the need for the air/alcohol/air purge as thefinal step prior to storage.Personal Protective Equipment Use personal protective equipment when reprocessing endoscopes, as exposure to high leveldisinfectants, sterilants and/or body fluids may occur. Gowns, gloves and protective eyewear arerecommended when handling glutaraldehyde, 0.2% peracetic acid, 7.5% hydrogen peroxide, or 0.08%peracetic acid/1%hydrogen peroxide, or ortho-phthalaldehyde. Gowns should be impervious to fluid,have long sleeves that fit snugly around the wrist, and wrap to cover as much of the body as possible.Dispose of or launder gowns if they become wet or are exposed to contaminated material. Inspect glovesfor tears or holes before use. Do not use an imperfect glove or reuse disposable gloves. Gloves should belong enough to extend up the arm to protect the forearm or clothing from splashes or seepage. To avoidcross-contamination, change gloves and wash hands whenever moving from a dirty to clean task orenvironment. Eye and/or face protection is necessary to protect against all four chemicals. Contact lensesare not sufficient eye protection. A face shield (or safety glasses in combination with a facemaskallowing for ventilation) is recommended. Each reprocessing area must contain an eyewash station. TheMSDS for each high level disinfectant and sterilant recommends evaluation by a physician in the eventof eye exposure. Do not use high filtration masks since they may actually trap vapors.Material Compatibility Endoscopes and automated reprocessors are composed of a variety of materials such as rubbers,plastics and metals that may be affected by ingredients in high level disinfectants or sterilants. Consultmanufacturers of endoscopes and reprocessors for results of compatibility studies as part of the processof choosing a product. Incompatibility may result in changes in appearance and function of anendoscope. Use of a high level disinfectant or sterilant for which a manufacturer has not issued acompatibility statement may void the instrument’s warranty. Third-party repair companies may usedifferent materials in replacement components than those of the original equipment manufacturer. Ifusing the services of a third party for repairs, consult them for compatibility and warranty information.See Appendix B for a chart summarizing compatibility listing of endoscope manufacturers.Susceptibility of Resistant Organisms Organisms such as gram negative rods and gram positive bacteria, which are frequent contaminantsof gastrointestinal endoscopes (Chu, McAlister, and Antonoplos, 1998), are susceptible to 2%glutaraldehyde, 0.2% peracetic acid, 7.5% hydrogen peroxide, and 0.08% peracetic acid/1% hydrogenperoxide. Other microorganisms of concern in gastroenterology settings, such as Clostridium difficile,Helicobacter pylori, Hepatitis C virus, Hepatitis B virus, Human immunodeficiency virus (HIV),Vancomycin-resistant enterococcus, Methicillin-resistant Staphylococcus aureus, and multi-drug-resistanttuberculosis are also sensitive to these products (APIC, 1996). It is not necessary to deviate from routinereprocessing protocols when exposure to such organisms is suspected, since to do so would constitute a“double standard” of care (APIC, 1996; Rutala, 1998b).February 2000 – SGNABoard Book 27
  28. 28. Glutaraldehyde Glutaraldehyde has been used for more than 30 years in many health care settings for high leveldisinfection and cold sterilization. It is the most widely used high-level disinfectant/sterilant forreprocessing gastrointestinal endoscopes. Glutaraldehyde products are marketed under a variety ofbrand names and are available in a variety of concentrations, with and without surfactants. Forreprocessing of endoscopes, a 2% glutaraldehyde solution that does not contain surfactant isrecommended (ASGE, 1996). Glutaraldehyde has excellent biocidal activity, is active in the presence oforganic matter and is non-corrosive to metals, rubbers and plastics (APIC, 1996). Glutaraldehyde maybe used in manual or automated reprocessing protocols. Olympus, Pentax and Fujinon listglutaraldehyde as compatible with their endoscopes. Glutaraldehyde is compatible with automatedreprocessors except STERIS SYSTEM 1. In 1995 the Society of Gastroenterology Nurses and Associates, Inc. (SGNA), in collaboration withthe American Society for Gastrointestinal Endoscopy (ASGE), the American GastroenterologicalAssociation (AGA), the American College of Gastroenterology (ACG), and the Association forProfessionals in Infection Control and Epidemiology (APIC) adopted the position, based on scientificdata, that after meticulous manual cleaning, high level disinfection is achievable with a 20 minuteexposure at 20°C (room temperature) in a 2% glutaraldehyde solution which does not contain surfactantand which tests above its minimum effective concentration (ASGE, 1996). The Association of OperatingRoom Nurses (AORN, 1996b) concurs. These conditions may not be extended to other glutaraldehydesolutions. This recommendation differs from the label claims on 2% glutaraldehyde stating a 45-minuteexposure at 25°C for HLD because the current federal labeling regulation assumes no cleaning of themedical device prior to chemical exposure. Two percent glutaraldehyde solutions range in concentration from 2.4 – 2.6% and have variablemaximum use lives. For example, the maximum use life of an alkaline (activated) 2% glutaraldehydewithout surfactants is 14 days. The actual use life of any reusable HLD/sterilant must be determined bytesting for MEC with product-specific test strips. Labeling regulations require the manufacturer to placethe MEC on the container. For example, test strips for 2.4% glutaraldehyde products are constructed toshow failure when the concentration drops below 1.5% (Cotrell, Ltd., 1994). Glutaraldehyde is an irritant and some individuals develop acute sensitivities (Union Carbide,1995b). These sensitivities may be displayed as itching of the skin with slight redness, to redness andswelling or yellowing of the skin with prolonged exposure, or irritation to eyes and nasal membranes,headache, coughing, sneezing, and asthma-like symptoms. Glutaraldehyde can be absorbed byinhalation, ingestion and through the skin. It has a detectable odor at 0.04 parts per million volume(ppmv) and is irritating to skin and mucous membranes at 0.3 ppmv. Vapors are released wheneversolutions are disturbed and the surface tension is broken. Mixing, adding and removing equipment, ordisposing of a glutaraldehyde solution can cause a break in the surface tension (Notarianni, 1992).Whenever the glutaraldehyde solution is not being accessed, it should be covered with a tight-fitting lid. Provide adequate ventilation in areas where glutaraldehyde is in use. Ventilation systems should beinstalled by certified heating, ventilation and air conditioning (HVAC) professionals to ensure that thesystem designed for removal of glutaraldehyde does not interfere with other HVAC systems in thefacility (Burkhart, 1991). Adequate ventilation, as described by AAMI (1995) and Burkhart (1991),includes the following: • Room large enough to ensure adequate dilution of vapors. • 10 air exchanges per hour to allow volume flow rate of air moving through the room to be at least 1.0 to 2.0 cubic feet per minute per square foot of floor area (Burton, 1994). • Exhaust located at the source of the discharge of vapors (pulling vapors away from the user’s breathing zone). This can be done by placing the exhaust fan at foot level or on a countertop and venting the vapors to the outside. • Fresh air return entering at ceiling level across the room from the exhaust vents. • Routine maintenance and surveillance of the system to ensure continued proper functioning.February 2000 – SGNABoard Book 28
  29. 29. • Elimination of cross-draft effects. • Care should be taken to ensure that the discharge of the vapors is sufficiently removed from windows, outside air intakes or other such openings to prevent reentry of the discharged air. Air must not be recirculated. In areas where local exhaust ventilation systems are not in place, use ductless fume ventilation devicesthat contain filters to absorb glutaraldehyde vapors from the air. These hoods should achieve a face velocityof at least 100 feet per minute with the airflow directed toward the back of the hood, away from the user’sbreathing zone (Burkhart, 1991). In 1998, the American Conference of Governmental Industrial Hygienists (ACGIH) lowered itsrecommended TLV-C from 0.2ppm to 0.05ppm. Monitor glutaraldehyde vapors if there is reason to believethe TLV-C exceeds the recommendation, if an employee exhibits symptoms of overexposure, or followingany corrective action taken to lower vapor levels. Devices are available for area monitoring and formonitoring of an employee’s breathing zone. Follow manufacturer’s directions to ensure that the device isused in a manner that will achieve the most accurate analysis. Monitor at the peak time of exposure, such aswhen fresh solutions are being mixed and transferred to containers. Changing latex gloves every 15 minutes during periods of glutaraldehyde exposure or using doublegloves provides up to a four-fold increase in permeation time compared with single latex gloves. Onehundred percent nitrile rubber or 100% butyl rubber gloves are recommended for the best protection fromglutaraldehyde. Neoprene and polyvinyl chloride (PVC) gloves are not recommended as these materialsabsorb and retain glutaraldehyde (Jordan, 1995). Glutaraldehyde spills small enough not to cause tearing of the eyes and/or respiratory discomfort can becleaned up with a mop, sponge or towel. Discard the saturated item in a tightly sealed biohazard bag. Rinsesurfaces thoroughly with water. Large spills may require neutralization with sodium bisulfite or 2% dibasicammonium phosphate. Have one of these chemicals available wherever glutaraldehyde is used. Be familiarwith the MSDS recommendations for spill or leak procedures and consult with the institution’s SafetyOfficer to prepare a plan for handling spills. In most states, glutaraldehyde solutions that have failed MEC tests can be discarded down the drain andflushed with large amounts of water. Triple-rinse empty containers from freshly activated solutions withwater prior to disposal. Consult state and local regulations for possible differences in disposal requirements.0.2% Peracetic Acid Peracetic acid is part of the family of peryoxygen compounds. The STERIS Corporation has marketedSTERIS 20 Sterilant Concentrate™, a 35% peroxyacetic acid concentrate, for use in the STERIS SYSTEM1 for 10 years. STERIS SYSTEM 1 is FDA-cleared as a liquid chemical sterilization processor for medicaldevices. The processor dilutes and mixes this concentrate to its final concentration of 0.2% peracetic acidwith a neutral pH, which is sporocidal at 50°C. The processing cycle is approximately 30 minutes andreaches temperatures of 50° C-55.5°C (122° F-131.9°F) during exposure time. (STERIS Corporation, 1997a).The STERIS SYSTEM 1 has become widely used for reprocessing of flexible gastrointestinal endoscopes.Instruments processed with 0.2% peracetic acid must be handled and stored in a sterile manner uponremoval from the STERIS SYSTEM 1 in order to be considered sterile at the point of next use. A concentration of 0.2% peracetic acid is rapidly active against all microorganisms including bacterialspores, and is effective in the presence of organic matter. It is only available in the United States inconjunction with the automated STERIS SYSTEM 1. A chemical indicator for each cycle measures theionic strength of buffering agents. A biological indicator is available, but may not be suitable for routinemonitoring of liquid sterilants. Two criticisms are that the indicator is not able to be placed in the leastaccessible location of an endoscope, and that liquid sterilants are thought to cause spores to wash off theindicator strip (Rutala, 1998a; Rutala and Weber, in press). Fuselier and Mason (1997) published a studycomparing STERIS SYSTEM 1 and manual reprocessing with a 2% glutaraldehyde solution for flexiblecystoscopes. They concluded that clinical outcomes were the same. When handled properly, the peracetic acid used in the STERIS SYSTEM 1 is self-contained, circulatedaround and through the endoscope via channel connectors, and discarded down the drain. The processorthen rinses the instrument with large amounts of filtered water. Unlike other automated reprocessors,STERIS SYSTEM 1 has no capability of circulating enzymatic detergent solutions. Pentax lists the STERIS SYSTEM 1 as compatible with its endoscopes. Olympus, in a letter to healthcare practitioners dated October 19, 1998 states, Steris System I is not currently listed as a compatible product for use in reprocessing Olympus flexibleFebruary 2000 – SGNABoard Book 29
  30. 30. endoscopes. However Olympus is currently engaged in a program to evaluate the compatibility of its flexible endoscopes with the Steris System I. Although Olympus lists as compatible only those products which have completed and passed our testing process, use of an unlisted disinfectant product does not automatically void the Olympus standard warranty. However, Olympus cannot accept the responsibility for damage or functional impairment attributable to the use of unlisted products, just as we cannot be responsible for damage or functional impairment which results for the improper use of a listed product. Such situations are not covered under the terms of our warranty (Goldstine, 1998). As of the date of this publication, no compatibility data is available from Fujinon. Cartons of the peracetic acid concentrate should be stored upright in a cool, dry area (<86°F). Careshould be taken not to damage the STERIS 20 Concentrate™ sealed container. The concentrate may causeirritation of the nose, throat and lungs, and is corrosive to the eye and skin, potentially causing irreversibleeye damage or severe burns. General or local exhaust ventilation systems are adequate. In the event of aspill or leak of the concentrate, increase ventilation and shut off ignition sources. Wearing protectiveequipment, flush spilled material with large quantities of water (at least 20 times the volume spilled).Consult the STERIS SYSTEM 1 user manual for information to assist in preparing a spill cleanup plan.Once diluted to 0.2%, peracetic acid is not considered a hazardous waste and can be safely discarded downthe drain (STERIS Corporation, 1997b).7.5% Hydrogen Peroxide In 1998 a 7.5% hydrogen peroxide solution was reintroduced by Reckitt & Colman under the brandname SPOROX™. This product is a reusable high level disinfectant/sterilant cleared by the FDA for HLDat a contact time of 30 minutes at 20°C (room temperature) when the MEC is validated by SPOROX™ teststrips. No mixing or activation is required. Hydrogen peroxide is a rapid oxidizer and has wide biocidalproperties. Two studies have favorably compared hydrogen peroxide with alkaline glutaraldehyde (Vesley,Norlien, Nelson, Ott, and Streifel, 1992; Sattar, Taylor, Paquette, and Rabino, 1996). As with all other high level disinfectants or sterilants, meticulous manual cleaning is required prior toexposure to the high level disinfectant or sterilant. The maximum use-life of 7.5% hydrogen peroxide is 21days but the actual use-life must be determined by validating that the minimum effective concentration of6% is present. The 7.5% solution may be used in manual or automated reprocessing protocols. If using anautomated reprocessor, check with the manufacturer for specific brand and model compatibility. Hydrogen peroxide can cause damage to rubbers and plastics and can corrode aluminum, nickel-silveralloy and chrome plated steel (Reckitt & Coleman, Inc., 1998). In a technical bulletin dated October 15,1999 covering all models of fiberoptic and videoendoscopes, Olympus withdrew its April and November1998 compatibility statements regarding SPOROX™ (Olympus, 1999). Noting observed damage toinsertion tubes in both clinical and laboratory settings, the technical bulletin concludes At the present time it is not possible to predict if all models of Olympus flexible endoscopes or all clinical sites using Sporox will experience durability problems. However, the results of current investigations of damage to rhinolaryngoscopes and colonoscopes, and observations of damage to gastroscopes and flexible cystoscopes, form the basis for the current decision not to list Sporox or Sporox II as a compatible sterilant/disinfectant for any Olympus flexible endoscope. Olympus lists SPOROX™ as compatible with 40 series, 140 series and 240 series endoscopes.Cosmetic changes, including corrosion of the model name and serial number plates, progressive lighteningof black anodized metal finishes and peeling of painted portions of the control body, particularly theeyepiece, and light guide connector were observed in 100-, 130-, 200- and 230-series GI videoscopes, 10-, 20-and 30-series fiberscopes and 10-, 20- and 30-series fiberoptic bronchoscopes and 200-seriesvideobronchoscopes. SPOROX™ is not compatible with OSF or OSF-2 sigmoidoscopes. Olympus furthernotes that flexible endoscopes are not compatible with SPOROX™ at elevated temperatures (Olympus,1998). Pentax states the compatibility studies for SPOROX™ are still being performed by the parentcompany in Japan. As of the date of this publication, nNo compatibility data information is available fromFujinon. Hydrogen peroxide in a 7.5% concentration is a clear colorless liquid with an odor characteristic ofperoxide. The TLV-TWA is established by ACGIH at 1ppm. A face shield or protective eyewear ismandatory, since this concentration can cause irreversible eye damage. Due to its corrosive nature it maybe harmful or fatal if swallowed. Contact with skin may result in temporary whitening. Latex glovesprovide protection (Reckitt & Colman, Inc, 1997).February 2000 – SGNABoard Book 30
  31. 31. Hydrogen peroxide solutions that have failed MEC tests can be discarded down the drain and flushedwith large amounts of water. Triple-rinse empty containers with water prior to disposal. Consult state andlocal regulations for possible differences in disposal requirements.0.08% Peracetic Acid/1% Hydrogen Peroxide Also introduced as a high level disinfectant/sterilant in 1998 is a 0.08% peracetic acid/1% hydrogenperoxide formula marketed by Advanced Sterilization Products as CIDEX*PA™. Manufacturer’s datademonstrates that this formula has wide biocidal activity at a 25-minute exposure time. This product isFDA-cleared as a high level disinfectant at 20°C at an immersion time of 25 minutes. No mixing oractivation is required. It may be used in manual or automated reprocessing protocols. If using anautomated reprocessor, check with the manufacturer for specific brand and model compatibility. As withall other high level disinfectants and sterilants, meticulous manual cleaning is required prior to exposure tothe high level disinfectant or sterilant. CIDEX*PA™ has a maximum use-life of 14 days. Its actual use-life must be determined by testing thatthe solution remains at or above its minimum effective concentration of 500 ppm. The manufactureradvises using three CIDEX*PA™ test strips each time the MEC is checked. CIDEX*PA™ is incompatible with iron, copper alloys, and brass but has no affect on polyethylene,polypropylene, Teflon™, polyvinyl chloride, annodized aluminum or stainless steel (Advanced SterilizationProducts, 1998a). Pentax states that compatibility testing with CIDEX*PA™ is still being performed by theparent company in Japan. Olympus (1988) has issued a technical bulletin with the following summarystatement: The use of CIDEX*PA™ Solution on Olympus endoscopes will not automatically void your standard Olympus warranty covering original materials and workmanship. However, due to the observed internal corrosion, Olympus does not endorse the use of CIDEX*PA™ on any Olympus endoscope and will not assume any liability for chemical damage to your Olympus endoscopes as a result of its use. Data from the manufacturer of CIDEX*PA™ on compatibility testing with Olympus and Pentaxendoscopes found that the solution had no deleterious affects on plastics, anodized aluminum or stainlesssteel. Endoscope failures that were noted were deterioration of the seals in the control head allowing fluidinvasion and also failure of the bending rubber attributed to device handling (Advanced SterilizationProducts, 1998b). Advanced Sterilization Products (1998, June 8) has advised users of CIDEX*PA™ thatthey . . . will reimburse the user for repair of any functional damage to flexible endoscopes, not including accessories, processed exclusively with CIDEX*PA™ solution, when such damage is shown to be caused by CIDEX*PA™ solution in excess of the rate of damage historically experienced and documented by the user with alkaline glutaraldehydes used for high level disinfection. As of the date of this publication, no compatibility data is available from Fujinon. The solution is a clear colorless liquid with a mild vinegar odor. The TLV-TWA is established byACGIH at 1ppm. Environmental toxicity testing has found 0.08% peracetic acid/1% hydrogen peroxidehas no known respiratory toxicity, and under normal use conditions special ventilation is not required. Itmay cause skin irritation. The solution is corrosive to eye tissue; face shield or protective eyewear ismandatory. Prior to use, the product should be stored in its original container, away from direct sunlight, and intemperature-controlled conditions (15-30° C). Avoid contact with combustible materials. Empty containersof 0.08% peracetic acid/1% hydrogen peroxide should be triple rinsed prior to disposal. Residual solutionbreaks down into water, oxygen, acetic acid (vinegar) and hydrogen peroxide and can be disposed of downthe drain.0.55% Ortho-phthalaldehyde In late 1999, 0.55% ortho-phthalaldehyde (OPA) was introduced to market as CIDEX® OPASOLUTION. It is cleared by the FDA as a high level disinfectant at 20°C at an immersion time of 12minutes (Advanced Sterilization Products, 1999). CIDEX® OPA is not intended nor is it cleared for useas a sterilant. No mixing or activation is required. A hospital-based study of ortho-phthalaldehydeFebruary 2000 – SGNABoard Book 31
  32. 32. found it to be effective in eradicating vegetative bacteria, fungi and parasites from bronchoscopes,gastroscopes and colonoscopes (Alfa and Sitter, 1994). Two studies have assessed its tubercuclocidalproperties. One found it to be more rapidly tuberculocidal than glutaraldehyde in the laboratory setting(Gregory, Schaalje, Smart, and Robison, 1999). The other suggests that OPA is effective againstglutaraldehyde resistant mycobacteria (Walsh, Maillard, and Russel). CIDEX® OPA is a reusable product with a maximum use life of 14 days. Like all other reusableproducts, its actual use life must be ermined by testing that the solution remains at or above itsminimum effective concentration of 0.3%. Studies indicate that OPA may remain above its MEC despitereuse and dilution better than glutaraldehyde (Gregory, Schaalje, Smart, and Robison, 1999; Alfa andSitter, 1994). Like other high level disinfectants, meticulous manual cleaning of medical devices must precedeexposure to this product. CIDEX® OPA may be used in manual or automated reprocessing protocols.Check with manufacturers of automated reprocessors for specific compatibility statements. Ortho-phthalaldehyde has a wide range of material compatibility. Pentax lists it as a compatibleproduct. Olympus has not issued a compatibility statement at this time. No information is availablefrom Fujinon. CIDEX® OPA is a clear blue solution with little odor. It is a potential irritant of eyes, skin, nose andother tissues resulting in symptoms such as stinging, excessive tearing, coughing and sneezing. It is apotential skin and respiratory sensitizer that may cause dermatitis with prolonged or repeated contactand may aggravate pre-existing bronchitis or asthma. In addition, the product stains proteins onsurfaces to grey/black. Small spills may be cleaned up with a damp sponge or absorbent pad. Larger spills should bedeactivated with 25 grams of glycine (free base) powder per gallon over 5 minutes. See the MSDS forspecific control measures. Triple rinse empty containers with water prior to disposal. Spent solutions ofortho-phthalaldehyde may be disposed of down the drain unless prohibited by state and localregulations.Summary Glutaraldehyde, 0.2% peracetic acid, 7.5% hydrogen peroxide, and 0.08% peracetic acid/1% hydrogenperoxide, and 0.55% ortho-phthalaldehyde are cleared by the FDA for reprocessing flexible gastrointestinalendoscopes. Each product has advantages and disadvantages. All require adherence to publishedreprocessing protocols in order to maintain the integrity of equipment while providing the public withendoscopic instruments that are safe and effective. All chemicals must be handled with respect. Selection ofa product must be weighed against the needs of a particular setting, taking into consideration factors such ascompatibility, toxicity, environmental controls and cost. ReferencesAdvances Sterilization Products. (1999). Cidex® OPA solution material safety data sheet (015, revision C). Irvine, CA: Author.Advanced Sterilization Products. (1998a). Cidex™PA material safety data sheet (011). Irvine, CA: Author.Advanced Sterilization Products. (1998b). Compatibility of Cidex™PA solution with endoscopes (AD-07732). Irvine, CA: Author.Advanced Sterilization Products. (1998, June 8). Materials compatibility warranty. Irvine, CA: Author.Akamatsu, T, Tabita, K, Hironga, M., Kawakami, H., & Uyeda, M. (1996). Transmission of Helicobacter pylori infection via flexible fiberoptic endoscopy. American Journal of Infection Control, 24, 396-401.Alfa, M., & Sitter, D. (1994). In-hospital evaluataion of orthophthalaldehyde as a high level disinfectant for flexible endoscopes. Journal of Hospital Infection, 26, 15-26.American Conference of Governmental Industrial Hygienists. (1998). Threshold limit value and biological exposure indices. Cincinnati, OH: Author, 40.American Society for Gastrointestinal Endoscopy. (1996). Reprocessing of flexible gastrointestinal endoscopes. Gastroenterology Nursing, 19, 109-112.February 2000 – SGNABoard Book 32
  33. 33. Association for the Advancement of Medical Instrumentation. (1995). Glutaraldehyde: Safe use and handling document. Philadelphia: Author.Association of Operating Room Nurses. (1996a). Recommended practices for chemical disinfection. In Standards and recommended practices (pp.147-150). Denver, CO: Author.Association of Operating Room Nurses. (1996b). Top 10 most frequently asked questions: Disinfection/glutaraldehyde. Denver, CO: AORN Center for Nursing Practice, Research and Health Policy.Association of Professionals in Infection Control and Epidemiology. (1996). APIC guideline for selection and use of disinfectants. American Journal of Infection Control 24, 313-342.Bronowicki, J., Venard, V., Botté, C., Monhoven, N., Gastin, I., Chloné, L., Hudziak, H., Rhin, B., Delanoë, C., LeFau, A., Bigard, M., & Gaucher, P. (1997). Patient to patient transmission of hepatitis C virus during colonoscopy. New England Journal Medicine 337, 237-240.Burkhart, J. (1991). NIOSH health hazard evaluation report (NIOSH Report No. 90-296). Washington, DC: U. S. Government Printing Office, 12.Burton, J. (1994). Laboratory ventilation workbook (2nd ed.). Bountiful, UT: IVE, Inc.Chu, N., McAlister, D., & Antonoplos, P. (1998). Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and manual cleaning. Gastrointestinal Endoscopy, 48, 137-142.Cotrell, Ltd. (1994). ProCide® 14 N.S. activated dialdehyde material safety data sheet. Englewood, CO: Author.Fuselier, H., & Mason, C. (1997). Liquid sterilization versus HLD in the urologic office. Urology, 50, 338-340.Goldstine, Steve. (1998, October 19). Dear healthcare practitioner [information memo]. Melville, NY: Olympus America.Gregory, A., Schalje, G., Smart, J., & Robison, R. (1999). The mycobactericidal efficacy of orthyphthalaldehyde and the comparative resistances of Mycobacterium bovis, Mycobacterium terrae, and Mycobacterium chelonae. Infection Control and Hospital Epidemiology, 20, 324-330.Jordan, S. (1995). The correct use of glutaraldehyde in the healthcare environment. Gastroenterology Nursing, 18, 142-145. Notarianni, G. (1992). Glutaraldehyde overexposure: Myth or reality? Libertyville, IL: Passim Publishing, 20, 22, and 24. (Reprinted from Notarianni, G. (1992). Glutaraldehyde overexposure: Myth or reality? Journal of Healthcare Materials Management, 10.)Olympus America. (1999, October 15). Compatibility of Olypus flexible endoscopes with Sporox and Sporox II (Covered Models: All fiberoptic and videoendoscopes). (Technical bulletin.). Mellville, NY: Author.Olympus America. (1998, November 2). Compatibility testing of Sporox™ with Olympus flexible endoscopes (technical bulletin). Melville, NY: Author.Olympus America. (1998, April 15). Compatibility of Cidex*PA™ solution with Olympus flexible endoscopes (technical bulletin). Melville, NY: Author.Reckitt & Colman, Inc. (1997). Sporox™ material safety data sheet. Wayne, NJ: Author.Reckitt & Colman, Inc. (1998). Sporox™ package insert. Wayne, NJ: Author.Rutala, W. (Ed.). (1998a). Disinfection, sterilization and antisepsis in health care. Washington, DC: Association for Professional in Infection Control and Epidemiology, Inc.Rutala, W. (1998b, May). Infection control update. Lecture presented at 25th Annual SGNA Educational course, Denver, CO.Rutala, W., & Weber, D. J. (1995). FDA Labeling requirements for disinfection of endoscopes: A counterpoint. Infection Control & Hospital Epidemiology 16, 231-235.Rutala, W., & Weber, D. J. (1999). Disinfection of endoscopes: Review of new chemical sterilants used for HLD. Infection Control and Hospital Epidemiology, 20, 69-76.Sattar, S., Taylor, Y., Paquette, M., & Rabino, J. (1996). In-hospital evaluation of 7.5% hydrogen peroxide as a disinfectant for flexible endoscopes. Canada Journal of Infection Control, 11:51-54.February 2000 – SGNABoard Book 33
  34. 34. Society of Gastroenterology Nurses and Associates. (1997). Standards for infection control and reprocessing of flexible gastrointestinal endoscopes [Monograph]. Gastroenterology Nursing, 20, insert after 70 .Spach, D., Silverstein, F., Stamm, W. (1993). Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Annals of Internal Medicine, 118, 117-128.STERIS Corporation. (1997a). STERIS SYSTEM 1™ operator manual (612025 REV. F). Mentor, OH: Author.STERIS Corporation. (1997b). STERIS 20™ material safety data sheet (No: 612038 REV.E). Mentor, OH: Author.Union Carbide. (1995a). Long-term human health hazard evaluation of glutaraldehyde. Bioshare Focus Sheet (UC 508). Danbury, CT: Author.Union Carbide. (1995b). Skin contact, irritation, sensitization, & prevention of glutaraldehyde. Bioshare Focus Sheet (UC-504). Danbury, CT: AuthorVesley, D., Norlien, K., Nelson, B., Ott, B., & Streifel, A. (1992). Significant factors in the disinfection and sterilization of flexible endoscopes. American Journal of Infection Control, 20, 291-300.Walsh, S., Maillard, J-Y., & Russel, A. (1999). Ortho-phthalaldehyde: A possible alternative to glutaraldehyde for high level disinfection. Journal of Applied Microbiology, 86, 1039-1046.Appendix A: Sample MEC Log Facility Name MINIMUM EFFECTIVE CONCENTRATION LOG FOR :________________________ Pan/Reprocessor: _____DATE # USES PASS/FAIL MEC INITIALS COMMENTEXAMPLE: Smith Endoscopy Center MINIMUM EFFECTIVE CONCENTRATION LOG FOR : 2.4% GLUTARALDEHYDE Pan/Reprocessor: BDATE # USES PASS/FAIL MEC INITIALS COMMENT 2/1/99 16 Pass MJ Last changed on 1/26/99 2/2/99 24 Pass MJFebruary 2000 – SGNABoard Book 34
  35. 35. 2/3/99 31 Pass MJ 2/4/99 38 Pass MJ 2/4/99 39 Pass MJ 2/4/99 40 Pass MJ 2/4/99 41 Fail MJ Changed 11am 2/4/99 2/5/99 3 Pass MJAppendix B: HLD Compatibility with Endoscopes (Data provided by endoscope manufacturers) Olympus Pentax FujinonGlutaraldehyde C C C0.2% Peracetic Acid NC C NS7.5% Hydrogen peroxide NC* NC NS0.08% peracetic acid/1% hydrogen peroxide NC NC NS0.55% Orthy-phthalaldehyde NS C NSC = company lists as compatibleNC = company does not list as compatibleNS = no statement* with most series endoscopes; see Olympus Technical Bulletin for specific modelsAppendix C Sterilants and High Level Disinfectants cleared by FDA in a 510(k) as of 10/1/98 with General Claims for Processing Reusable Medical and Dental Devices CENTER FOR DEVICES AND RADIOLOGICAL HEALTH OFFICE OF DEVICE EVALUATION DIVISION OF DENTAL, INFECTION CONTROL AND GENERAL HOSPITAL DEVICES Sporicidin InternationalSporicidin Sterilizing and Disinfecting Solution (0.95% glut and 1.64% phenol/phenate),K983194 Sterilant Claim - 12 hours at 25 ° C, maximum reuse of 7 days High Level Disinfection Claim - 20 minutes at 25 ° C, maximum reuse of 7 daysFebruary 2000 – SGNABoard Book 35

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