Helicobacter pylori; bowel cleansing; carbon dioxide suctioning; mupirocin-resistant Staphylococcus aureus - Evidence For Practice - Author Abstract

AORN Journal,  Oct, 2003  by George Allen

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Helicobacter pylori transmission via contaminated endoscopes

Endoscopy April 2003

Gastric and duodenal peptic ulcers are significant health care problems that cause pain and suffering for millions of people. Most peptic ulcers are caused by an infection from the bacterium, Helicobacter pylori (H. pylori). This prospective study was undertaken to determine if endoscopes serve as a reservoir for H. pylori and if the current cleaning and disinfection procedure for endoscopes completely removes the risk for transmission of this bacterium. (1) During a six-month period, 400 patients undergoing routine upper gastrointestinal endoscopy were assessed for H. pylori. Additionally, the endoscopes used on these patients were cultured before and after manual cleaning and disinfection.

Findings. One hundred twenty-eight (32%) of the 400 patients tested positive for H. pylori. Fifty four (42%) of the rinsing-sample cultures obtained from endoscopes used on the patients with H. pylori were found to be contaminated with H. pylori before manual cleaning and disinfection. One (1.9%) of the 54 contaminated samples grew H. pylori after cleaning and disinfection had been completed.

Clinical implications. This study revealed that endoscopes can become contaminated during procedures on patients with H. pylori and then can serve as reservoirs for the bacteria. Manual cleaning and disinfection using current methods (ie, cleaning with a brush and high level disinfection with a 2% glutaraldehyde solution) cannot completely remove the risk of H. pylori transmission. Perioperative nurses should periodically reassess the efficacy of their manual cleaning and disinfection procedures and consider using automatic endoscope reprocessors.

Safety and efficacy of bowel lavage solutions

Endoscopy April 2003

The usefulness of colonoscopy for the detection and diagnosis of colonic disorders relies heavily on the effectiveness of preoperative bowel cleansing. This randomized, prospective study was undertaken to compare the effectiveness, safety, and tolerability of three commonly used bowel lavage solutions--a standard polyethylene glycol electrolyte solution (PEG-ELS1), a sulphate-free polyethylene glycol electrolyte solution (PEG-ELS2), and a sodium phosphate preparation (NaP). (2) One hundred seventy-three patients undergoing elective colonoscopy were assigned randomly to one of the three preoperative bowel cleansing regimens (PEG-ELS1, n = 59; PEG-ELS2, n = 54; NaP, n = 60). The quality of bowel cleansing for each bowel segment was scored by endoscopists using a five-level rating scale ranging from one (ie, very good) to five (ie, very poor). Before the procedure, the patients scored their overall satisfaction with the bowel preparation on a visual analogue scale ranging from zero (ie, excellent) to 10 (ie, very poor). Safety and tolerability were evaluated by means of clinical laboratory tests. Descriptive statistics were used to analyze differences between the three regimens.

Findings. The cleaning efficiency of PEG-ELS1 was high and consistent across all segments of the colon, with 91.5% of the scores rated as "good" by endoscopists. This formulation was found to be significantly superior to the other formulations in relation to the "worst cleansing" score (P [less than or equal to] 0.003). There was no significant difference for patient satisfaction among the three treatment groups (PEG-ELS1 5.8 [+ or -] 2.0, PEG-ELS2 6.4 [+ or -] 1.6, NaP 6.2 [+ or -] 2.4, P = 0.19).

Clinical implications. Preoperative bowel cleansing with PEG-ELS1 was well tolerated by patients and found to be the most efficient of the three preparations. Perioperative nurses should be aware that PEG-ELS1 may become the preferred method for bowel cleansing before colonoscopy and be prepared to educate and instruct patients in its use.

Aspiration of expired air during cataract surgery

Eye January 2003

Surgical draping of a patient's face during cataract surgery causes the patient to rebreathe carbon dioxide (C[O.sub.2]) from expired air, predisposing the patient to hypoxia. The objective of this randomized study was to investigate the effect on peripheral oxygen saturation (Sp[O.sub.2]) and end tidal carbon dioxide (EtC[O.sub.2]) of aspirating expired air through a suction system. (3) One hundred fifty-five patients scheduled for cataract surgery were assigned randomly to either a control group or a treatment group. Patients in the control group (n = 77) received only oxygen insufflation. Patients in the treatment group (n = 78) received oxygen insufflation, and expired air under the drapes was aspirated with a Y-piece suction system. Heart rate, Sp[O.sub.2] and EtC[O.sub.2] were measured at baseline, block, and 10-minutes intervals (ie, 10, 20, 30, 40, 50, and 60 minutes) after the start of the procedure. Unpaired t test and analysis of variance were used to analyze differences between the groups.

Findings. Baseline Sp[O.sub.2] and EtC[O.sub.2] were similar in both groups. Nine patients in the control group developed hypoxia. Severe reduction of Sp[O.sub.2] and increase of EtC[O.sub.2] also were observed in this group. Peripheral oxygen saturation was significantly higher in the treatment group at 30, 40, 50, and 60 minutes after the start of surgery (P [less than or equal to] 0.05). Similarly, EtC[O.sub.2] levels for the treatment group did not increase and were significantly lower than those of the control group (P [less than or equal to] 0.05).