Scholarship & Research
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Item Improving small bowel visualization during Video Capsule Endoscopy (VCE): quality improvement initiative(Montana State University - Bozeman, College of Nursing, 2024) Foster, Nicole Marie; Chairperson, Graduate Committee: Molly Secor; This is a manuscript style paper that includes co-authored chapters.Background: This practice improvement project addresses the clinical challenge of suboptimal small bowel visualization during Video Capsule Endoscopy (VCE) procedures, focusing on its local manifestation at a gastroenterology clinic in urban Indiana and proposing interventions (Deding et al., 2023a). Previous studies support the use of polyethylene glycol (PEG) solutions and staff education to improve small bowel visualization, highlighting the importance of standardized protocols and continuous training (Klein et al., 2016; Deding et al., 2022a). Problem: The clinical problem stems from inconsistent bowel preparations and prolonged capsule excretion times, potentially leading to delayed diagnoses and compromised patient care (Deding et al., 2023a). Through a comprehensive literature review and the application of the Johns Hopkins Model as a conceptual framework (Moen et al., 2022a; Bjoersum-Meyer et al., 2021). The aim was to enhance small bowel visualization during VCE procedures by implementing evidence-based strategies. Methods: Methods involved assessing the context, implementing interventions, measuring outcomes, and analyzing data. Results indicated improvements in bowel preparation quality and capsule excretion times following intervention implementation (Deding et al., 2023a). Results: Key findings suggest that standardized protocols and continuous staff education are essential for achieving optimal small bowel visualization during VCE procedures (Bjoersum-Meyer et al., 2021). Conclusions: The Johns Hopkins Model guided the development, implementation, and evaluation of interventions, emphasizing systematic quality improvement processes (Moen et al., 2022a). The project's goal was to improve the quality of small bowel visualization through staff education, protocol adjustments, and process standardization at the gastroenterology clinic in urban Indiana.Item Certification of reprocessing standardization: preventing endoscopy associated infections(Montana State University - Bozeman, College of Nursing, 2023) Ranck, Aaron Thomas; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Between 2012-2015, 25 outbreaks were linked to contaminated duodenoscopes worldwide due to human error or negligence during reprocessing. A standardized education and training reprocessing program is necessary to address nationally increasing Endoscopy Associated Infections (EAIs). Problem: A Montana endoscopy unit committed to adopting national standards. An unmet objective was the certification of endoscopy reprocessing (CER) requirement. This pilot project sted in developing a mandatory CER protocol to optimize infection control. Methods: A Plan-Do-Study-Act (PDSA) quality improvement method was employed, with pre- and post-intervention design to evaluate infection incidence and risk. This involved patient chart review and duodenoscope reprocessing log review. An aggregate comparison was made between a CER participant and eight non-CER technicians. To inform future program development, a survey was conducted to collect data on CER participant motivation, preparation, and perception of recommended educational materials. Intervention: A pilot study involving a single participant attempting to obtain nationally recognized CER was conducted. The facility manager shared the facility's intention of mandatory certification and via endoscope technician meeting, including incentives. Created certification-benefit video presentation and exam preparation materials were provided one month before the exam. Results: Zero infections occurred during pre- and post-intervention. Pre-intervention, the average infection risk scores per endoscope reprocessing were 12.2 relative light units (RLUs) for the unit and 11.1 RLUs for the CER participant. Post-intervention phase, these numbers were 15.7 RLUs by non-CER technicians and 2.8 RLUs by the CER participant. Conclusion: This study highlights the effectiveness of mandatory CER in reducing the risk of patient infections. Maintaining infection prevention and control in endoscopy procedures requires ongoing education, training, and motivation. Informing employees of the benefits of standardization may improve motivation.Item Severe Acute Respiratory Syndrome Coronavirus 2 Is Detected in the Gastrointestinal Tract of Asymptomatic Endoscopy Patients but Is Unlikely to Pose a Significant Risk to Healthcare Personnel(Elsevier, 2022-06) Cherne, Michelle D.; Gentry, Andrew B.; Nemudraia, Anna; Nemudryi, Artem; Hedges, Jodi F.; Walk, Heather; Blackwell, Karlin; Snyder, Deann T.; Jerome, Maria; Madden, Wyatt; Hashimi, Marziah; Sebrell, T. Andrew; King, David B.; Plowright, Raina K.; Jutila, Mark A.; Wiedenheft, Blake; Bimczok, DianeBackground and aims. Recent evidence suggests that the gut is an additional target for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection. However, whether SARS-CoV-2 spreads via gastrointestinal secretions remains unclear. To determine the prevalence of gastrointestinal SARS-CoV-2 infection in asymptomatic subjects, we analyzed gastrointestinal biopsy and liquid samples from endoscopy patients for the presence of SARS-CoV-2. Methods. We enrolled 100 endoscopic patients without known SARS-CoV-2 infection (cohort A) and 12 patients with a previous COVID-19 diagnosis (cohort B) in a cohort study performed at a regional hospital. Gastrointestinal biopsies and fluids were screened for SARS-CoV-2 by polymerase chain reaction (PCR), immunohistochemistry, and virus isolation assay, and the stability of SARS CoV-2 in gastrointestinal liquids in vitro was analyzed. Results. SARS-CoV-2 ribonucleic acid was detected by PCR in the colonic tissue of 1/100 patients in cohort A. In cohort B, 3 colonic liquid samples tested positive for SARS-CoV-2 by PCR and viral nucleocapsid protein was detected in the epithelium of the respective biopsy samples. However, no infectious virions were recovered from any samples. In vitro exposure of SARS-CoV-2 to colonic liquid led to a 4-log-fold reduction of infectious SARS-CoV-2 within 1 hour (P ≤ .05). Conclusion. Overall, the persistent detection of SARS-CoV-2 in endoscopy samples after resolution of COVID-19 points to the gut as a long term reservoir for SARS-CoV-2. Since no infectious virions were recovered and SARS-CoV-2 was rapidly inactivated in the presence of colon liquids, it is unlikely that performing endoscopic procedures is associated with a significant infection risk due to undiagnosed asymptomatic or persistent gastrointestinal SARS-CoV-2 infections.