Developing an audit checklist to assess the hygiene of gastroenterology endoscpoy examination sites

Abstract

The number of gastrointestinal endoscopic procedures performed each year exceeds 20 million in the United States and tens of millions in Europe. In our country, 120,958 colonoscopies and sigmoidoscopies were performed in 2019 under the health insurance scheme, while no such reported data are available for gastroscopy. This figure is further increased by the growing private health care sector, which also performs a large number of endoscopic procedures, so that the number of endoscopic procedures in Hungary may exceed several hundred thousand per year. The Government of Hungary has decided to introduce a nationwide programme of targeted, organised colonoscopy for public health purposes, which is expected to increase the number of colonoscopies, so it is crucial that the infection control activities of endoscopy workplaces are of the highest possible standard.

During endoscopic procedures, transmission of infection is possible through different routes. By following current instrument cleaning and disinfection procedures, using disposable accessories, disinfecting examination rooms and using the appropriate level of personal protective equipment, the risk of infection can be minimised.

The aim was to develop a specific checklist, in line with international and national regulations, to assist in the monitoring of compliance with infection control regulations, which can be used in clinical audit investigations, and which any endoscopy unit can tailor to its own operational processes, while at the same time using it for regular internal quality assessment.

After researching and comparing international and national literature recommendations and guidelines, a working group of healthcare professionals (chief hygienist, gastroenterologists, senior endoscopic assistant, public health inspector) developed an audit checklist to monitor infection control activities. No rating system has been defined for the results obtained, as the aim is not to give the health care provider under audit a rating (e.g. excellent, adequate, etc.), but to encourage the provider to strive to achieve the best possible quality of care. In order to ensure that the checklist delivers the desired results, a user guide has also been prepared. The checklist and the guide will be tested in a subsequent phase.

The checklist consists of 6 main sections: general data, methods, staff, criteria, summary and feedback. The criteria section consists of 10 main groups of questions summarizing the infection control activities of endoscopy units: 1. policies and procedures, 2. education and training, 3. physical environment, 4. cleaning procedures, 5. high level disinfection, 6. sterilizers and automated endoscope reprocessing equipment, 7. endoscope storage, 8. endoscope transport, 9. record keeping, 10. occupational health and safety. Each group of questions defines a total of 158 criteria.

A clinical audit based on a checklist provides an opportunity to identify the causes of failures in a given healthcare provider by conducting a desk review, root cause analysis, reviewing processes and, if necessary, reengineering, developing recommendations for solutions, and implementing changes to ensure patient safety and prevent infections. The experience gained from the clinical audits will provide an opportunity to further develop the checklist, to describe good practices and to produce a definitive methodological guide to assist in completing the checklist.

The clinical audit is an effective tool for testing infection control regimes. Domestic healthcare providers should be encouraged to develop and implement quality systems and to make clinical audit testing an integral part of their quality improvement activities.