IBS Flashcards

1
Q

What is IBS?

A

Is a functional gastrointestinal disorder involving disturbance in bowel function affecting the sensorimotor function of the gut.

A syndrome with a diagnosis made of cluster of x in the absence of structural abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is fecal calproctectin?

A

A non- invasive market of mucosal inflammation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment decision made on disease is based on what?

A

Severity and and location rather than strictly by diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diagnosis for IBD are..

A
Patient history
Various tests including blood tests. Stool tests (esp fecal calprotectin), 
Endoscopy
Biopsies
Imaging studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In suspected IBD tests should aimed at what?

A

Differentiating IBD from infectious gastrointeritis and coeliac dse.

Ix also helps in defining dse activity and severity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lab test Ix should include blood and stool to rule out what?

A

Other causes of diarrhea and inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Blood tests are not specific for IBD but may be done to detect and evaluate what?

A

Severity of inflammation
Anemia
Vitamin or mineral deficiency associated with IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

FBC can reveal what?

A

Anemia - low mean corpuscular volume (MCV)

High MCV suggesting B12 or folate deficiency or seen in patients on immunomodulators such as thioprines

Normal MCV with high red cell distribution width (RDW) indicating iron and folate def or folate and vit B 12

WCC elevation - evidence of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Low Albumin

A

Inflammation and malnutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Raise creatinine and urea

A

Evidence of dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Electrolyte disturbances

A

Low magnesium, selenium, potassium, zinc

Rrlated to poor diet and long standing diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Low ferritin

A

Iron def < 100 microgram

Elevated serum ferritin can be a marker of inflammationesp in liver rrlated inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Non-celiac features includes

A

Fistulas
Perianal dse
Bloody stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fecal calprotectin is widely used neutrophil derived protien biomarker in Australia.

Highly sensitive, non invasive marker of intestinal inflammation therefore is useful in the ff settings.

What are they?

A

Differentiating people with or without lower gut inflammation bet people with IBS and IBD

Monitoring people on therapy to check disease activity or response to tx

Assess mucosal heal is achieved where colonoscopy is not practicable due to cost, access, patient comorbidities and Pt’s refusal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stool testing with suspected IBD is valuable tool to determine enteric infections such as what?

A

Clostridium difficile (common in elderly, immunocompromised and on antibiotic therapy)

Tx of IBD w/ immunosuppression without addressing infectious pathogens can be dangerous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

FOBT testing can reveal what?

A

Traces of blood that cannot be seen with the naked eye

A screening tests for colorectal ca and should not be used as a diagnosis for IBD

Other stool culture for patients who travelled abroad to check infectious diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Endoscopy and colonoscopy with histology and radiology are used for what?

A

Diagnosis of IBD to assess it’s extent and severity

To prevent young Pt’s from unnecessary exposure to radiation by using MRI over CT if possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

First line procedure to establish diagnosis and extent of IBD

A

Colonoscopy with ileoscopy with multiple biopsy specimens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Endoscopy is used for

A

Visual exam of the the entire lining of large intestine

Examine ulcers, inflammation, bleeding, stenosis
Multiple biopsies from the colon to TI
Lack of response to tx
Assess CMV infections - testing on biopsies, PCR. Pt’s on chronic use of immunosuppressants or w/ C diff infection appearances suggests pseudomembranes

Colonoscopy for dysplasia surveillance

Upper GI endoscopy is ised for upper GI sx such as nausea, vomitting, epi pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Capsule endoscopy is used for what?

A

To assess presence, extent and severity of small bowel involvement in Crohn’s dse

Stricturing Crohn’s dse is a contraindication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Plain abdo xray is used for?

A

Wether colitis is present and its extent in some cases of UC

Exclude toxic megacolon with acute severe colitis

Give impression of mass on RIF or show dilatation or obstructions on CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Barium double contrast enema
Is rarely used and is replaced by colonoscopy.

When is it helphlful?

A

In rare circumstances when colonoscopy is incomplete or to delineate the lenght of a colonic stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is USS and MRI used?

A

To determine the extent and severity of the disease to assess for perforating complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Intestinal USS permits a real time assessment of disease activity including what are they??

A

Quantifying inflammatory burden that assist in determining the inflammatory and fibrotic components of a stricture

Determine sx are due to active diseases or due to functional issues such as faecal loading.

It is non- invasive, don in an unprepped bowel

Relatively safe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Dual emission Xray absorptiometry
To assess bone mineral density
26
CXR
Exclude TB | Look for free air under fiaphragm in case of perforation
27
Referral to specialist should not be delayed for high risk patients due to poor outcome and prevent avoidable bowel resection Who are those people at risk?
``` Weight loss >5 kg at presentation Poor appetite, < oral intake Unable to manage usual activities Need steriods at ist presentation Hospital admission at 1st present Long term reliance on opioids for chronic pain Mood disorder on antidepressants ```
28
Treatment decisions on IBD have been based on a step up approach. What are those
At diagnosis, mild anti inflammatory therapy if these tx fail, Immunomodulating agents are offered. If dse persist Biologic agents are added If all of these measures fail, surgery is the last resort
29
6 main categories treatment to control inflammation to allow GIT opportunity to heal
Aminosalicylates (5 ASA) Corticosteriods Immunomodulators (azathioprine, 6MP, methotrexate) Biologic agents (infliximab, adalimumab, vedolizumab, ustekinumab) Antibiotics ( metronidazole, ciproflixacin,) Exclusive enteral nutrition
30
Mesalazine 5 ASA is the first line tx and is also used to treat mild to moderate sx of active colonic IBD. Is more useful to treat UC than CD True or false
True
31
How do 5 ASA works?
Main use for long term maintenance of remission Act topically on the colonic mucosa to suppress production of pro inflammatiry mediators and control inflammation Effective in colonic dse than in small bowel Can be given orally or rectally Topical therapy act on the mucosal level
32
What are the 5 ASA preparation in Australia?
Sulfasalazine Olsalazine Balsalazide Other mesalazine preparations
33
Those available for rectal use include
Mesalazine enemas )liquid or foam) Suppositories
34
Patients must be treated first with sulfasalazine unless allergic to sulfur containing meds True or false
True Patients will be offered mesalamine containing 5 ASA which do not have sulfamoity
35
Combination of oral steriods and 5 ASA may be used in more severe cases True or false
True A combination of topical and oral 5 ASA bring Pt’s into remission more quickly that oral tx alone
36
When is corticosteroids use for?
Are used for moderate to severe active IBD Use for Pt’s who are not responding to 5ASA tx Prednisone is considered Not effective for maintenance therapy Expect signs of improvement in 3-5 days Hospital admission is necessary if not responding to steriods
37
Steriods shoulds be given with what medications?
Immunomodulators such as azathioprine, 6 MP
38
Corticosteriods side effects includes
``` Weight gain Susceptibility to infections Acne Facial hair Hypertension Glucose intolerance Diabetes Sleep and mood disturbances Dyspepsia Prolonged use >12wks include cataracts, Osteoporosis and myopathy ```
39
Budesonide (oral steriods) are used for what?
Mild ileal or ileocolonic Crohn’s dse Matrix encased budesonide (cortiment) for mild to moderate colitis
40
What is the standard of care for the maintenance of remission in both CD and UC?
Long term maintenance therapy
41
What is immunomodulators?
Drugs that modulate or suppress the immune system ( esp azathioprine, 6MP and methotrexate) Prevent or reduce corticosteriods dependence in IBD ``` Slow onset of action not ideal for induction of remission (2-3/12 for optimal response) 6 MO (8-12/52 full dose efficacy) Methotrexate (commence s/c weekly dosing min 6/52 full dose efficacy) ```
42
In IBD, what are the first line immunomodulating therapy?
Thiopurines (6MP or azathiprine)
43
When is immunimodulator started?
Disease assessed endoscopically is clinically severe at onset Steroid dependence Second course of steriods for a relapse is needed Patients avoiding steroids due to obesity, osteoporosis, diabetes steroid induce menta illness
44
Cycloporins or tacrolimis
Reserved for rescue therapy when there is a severe episode and not responding to high dose IV steroids in hospital Used as a last resort and prior to colorectal surgical consultation is recommended Surgery is the next step mgt
45
Twhat is the aim for immunomodulator therapy?
To achieve and maintain steroid free remission and heal the mucosa
46
Immunomodulators side effects
Vomitting Diarrhea Associated complications include pancreatitis (thiopurines), hepatitis, reduced wbc count, increased risk of onfection.
47
Biologic treatments is used for what?
Patients with moderate to severe IBD where standard medical tx has been insufficiently effective.
48
What are the 2 anti tumour necrosis factor (TNF) antibidies available on PBS tx for IBD
Infliximab(Remicade) Adalimumab (Humira) Both are effective in patients with UC and CD.
49
Infliximab is used in hospitalized pations with UC with severe acute colitis and fail to respond adequately to IV cortecosteroids Itolerance to and inefficacy from aminosalicylates, thiopurines and a course of cortecosteroids. True or false
True
50
Adalimimab is used for what?
Chronically active moderate to severe UC
51
How is infliximab and adalimumab given?
Infliximab is IV infusions Adalimumab is S/C These agents blocks immune syatem’s production of TNF, a pro inflammatory cutokine implicated in IBD.
52
Where is Vedolizumab used?
Approved by PBS for both induction and maintenance therapy for moderate to severe CD and UC
53
Ustekinumab is used for what
For the management of plaque paoriasis for those who developed psoriatic dse while on anti TNF therapy
54
Biologic therapy shown highly effective as first line for the tx of IBD True or false
True
55
Biologics adverse effects
``` Infection Malignancy Immunoganicity Infusion reaction Opportunistic infections Reactivation of viral infections Reactivation of or primary infection with tuberculosis Psorias and other paradoxical immune related disorders Worsening of congestive heart failure Demyelinating disorders Malignancy and lymphoma ```
56
What is Exclusive Enteral Nutrition?
Administratiin of a liquid nutrition formula to meet all nutritional requirements, replacing normal diet either orally or nasoenteric tine.
57
When is antibiotics (metronidazole, ciprofloxacin, rifaximin) used?
Effective for the tx of CD complications (perianal dse, fistulas, inflammatory mass, bacterial overgrowth in setting of strictures) It is used for the tx of pouchitis in UC following proctocolectomy.
58
What antibiotic has an increased risk of C. Difficile infection?
Broad spectrum antibiitic especially fluoroquinolones such as ciprofloxacin
59
When is surgey indicated?
When sx no longer controlled and mechanical complications such as strictures, obstructions, perforations, abscess or refractory bleeding. Resection is not a cure typically will recur post surgery therefore recommend to detect recurrence early is post op surveillance Metronidazole recommend for 12 wks, thiopurine therapy for those at risk and ideally where available an anti TNF agent for thise at highest recurrent risk Colonoscopy at 6-12 mos to see if step up in theraphy is warranted to intervene early before the 2 nd resection.
60
What is TNF?
TNF inhibitors are antibodies made in a lab from human or animal tissue. (Your body makes antibodies to fight off infections.) Once they're put into your blood, they cause a reaction in your immune system that blocks inflammation. Your immune system makes a substance called tumor necrosis factor (TNF). Usually, your body keeps your TNF levels steady. But if you have an autoimmune disease like RA, something goes wrong. You start making too much TNF, and that leads to inflammation.
61
What is IBD?
It is thought to atise from disregulation bet the immune system, host genetics and the complex ecology of the gut.
62
What is microbiome?
The gut is thought to harbour trillions of bacteria. Alterations and reduced diversity of microbiome in Pt’s with IBD is DYSBIOSIS
63
What is the management for recurrent C.Diff?
FMT (faecal microbiota transplantation)
64
What are the goals for IBD therapy?
Symptoms control and mucosal healing Assessed either endoscopically or non- invasively with fecal calprotectin and or intestinal ultrasound A lifelong dse like IBD requires therapeutic drug monitoring for anti TNF and thiopurines in therapies particular.
65
6 TGN levels above 235 pmol x 10 RBC have been associated with increased likelihood of clinical remission. However, if it exceeds 5,700 pmolx10RBC it can be associated with what?
Hepatotoxicity. Therefore, when using with therapeutic 6 TGN while avoiding higher 6 MMP levels where possible
66
How does Anti TNF and Thiopurines work?
Inactive prodrugs that are metabolised to produce the active nucleotide metabolites 6 thioguanine nucleotides (6TGN) and also 6 methylmercaptopurine (6mmp) which do not confer efficacy.
67
Maintenance care for established IBD patients not on immunosuppression, what monitoring should be done?
Annual FBE Biochemistry along with checking weight and asking about general health If symptomatic preceeding year tx is indicated and prompt fecal calprotectin for active dse If Pt’s on steroids or had a low bone density, bone monitoring density should be considered All pt’s should have at least an annual r/v
68
Recommendation for patients with UC extending proximal to the sigmoid colon or patients with Crohn’s colitis affecting more than one third of the colon and with one or more ff risks factors: ``` Active dse PSC Fhx of CRC in 1st deg relative < 50 y/o Colonic strictures, multiple inflammatory polyps shortened colon Previous dysplasia ```
Annual colonoscopy surveillance
69
Recommendation for surveillance for patients with: Inactive colitis extending prox to sigmoid colon without risks factors from annual surveillance category Patient’s with crohn’s colitis affecting more than 1/3 of the colon without other risk factors IBD patients with family hx of CRC in a 1st deg relative > 50 y/o
3 yearly colonoscopies
70
Recommendation for patients with prev colonoscopies were histology were normal.
5 yearly colonoscopies
71
ECCo guidelines for surveillance should take into acct the what?
Risk for dysplasia to progress to CRC between 2 surveillance interventions. Disease extent should be taken from most extensively histologically confirmed inflammation from all prev colonoscopies
72
What should be screened for patients with known significant small intestinal Crohn’s dse and how often it should be done?
A yearly screen for malabsorption in cluding iron studies, vitaminD, B12 and folate to avoid complications from malnutrition.
73
Strategies in managing IBD
Maintaining remission, anticipating problems and thereby preventing complications
74
Recommendation for surveillance for cancer risk 8 years after the onset of extensive colitis should be?
2-3 years colonoscopy surveillance with biopsies for dysplasia.
75
What to assess in patients on long term steroid use and weight loss?
DXA dual energy xray absorptiometry to assess bone mineral density
76
What to check on patients on immune modifiers
Regular weekly or forthnightly blood tests (EUC, FBC, LFTs) while adjusting the dose and regular 3 monthly monitoring while patient on stable therapy.
77
If patients are not in remission, | What to do?
Prompt referral to specialist- routine bloods and fecal calprotectin yearly useful tool for annual assessment
78
What is the common complications of IBD?
Anemia is caused by iron def and also by chronic inflammation
79
Ehat is the most common nutritional problem in IBD?
Iron def that leads to unexplained fatigue/lethargy
80
Ehat other factors in IBD patients that leads to development of anemia?
Blood loss Inadequate nutrient intake or absorption Inflammation on the bone marrow and iron handling/transport.
81
What is the induction therapy in Crohn’s dse among children?
Exclusive enteral nutritional therapy Avoidance of prolonged use of steroids given the direct impact on growth and pubertal development
82
6 monthly height and weight in patients with IBD is recommended among children. True or false
True
83
Gast, colon, entero, and radial eus can be used to how many hours?
72 hrs after last processing provided recent microbiological surveillance cultures have been negative.
84
EUS, DUO and Bronchoscope can be used up to how many hrs?
12 hours after last reprocessing
85
Rmergency endoscopes eg intibating bronchoscopes that are not sterile and wrapped should be reprocessed how many hours?
72 hes even if not used.this is to ensure that in a time critical emergency they are ready to use.
86
Endoscopes that are stored horizontally there should be alarm monitored continuous air flow through each channel True or false
True Storage cupboards ahould be tall enough to allow endoscopes to hang without touching the floor and are well ventilated
87
Duo, liear, bronchoscopes and AFER should be tested how often?
Monthly for microbial growth
88
All other endoscopes and those stored in a wrapped state should be tested how often?
Three monthly for microbial growth.
89
Water supply filtered to 0.2 microns for manual rinsing should be tested how often?
3 monthly or | Monthly if the water is not filtered.
90
What is ISO 15883?
AFER design and principles has been updated
91
A number of chemical germicides are capable of achieving sterilization if used for prolonged periods for eg aldehydebased products a contact time exceeding 3 hours may be required True or false?
True
92
Disinfection is not sterilization what is it?
It involves of removing or killing the vast majority but not all microorganisms. High disinfection is considered adequate for reprocessing of endoscopes because it removes or kill microorganisms regarded likely to cause disease.
93
High level disinfection processes need to kill all forms of bacteria(gram+ and gram-ve), viruses inc HIV and resitant viruses like polio, fungi (candida), protozoa(giardia) Hig level chemical alone can kill the more reistant form of bacterial spores and cyst only with prolonged contact time usually 3 hours Heat alone is alo effective disinfectant for eg temp 70 deg for 100 min are used for pasturisation True or false
True
94
What are the factors that warrants the disfrctant to kill all microorganisms?
Adequate removal of biological material through pre-cleaning. Initial number of microorganisms present- a reduction of microorganisms can be achieved by scrupulous cleaning alone. Temperature Recommended temperature is provided on the disinfectant product label glutaraldehyde 25-35 deg, OPA 20-25 deg Concentration Chemical concentration should be checked using test strips Contact time Minimal time required for biocidal activity based on manufacturers instructions and based on adequately cleaned beforehand Other factors Disinfectant ph and relative resistance of the microorganism involved
95
What are the practical barriers to chemical sterilization?
``` Staff errors Mechanical endoscope defects Design flaws in AFER Potential for inadequate cleaning Contaminated rinse water ```
96
When is bronchoscopes used?
Are feequently used to take samples (BAL) for diagnosis of lung conditions inc culture for bacteria, mycobacteria and fungi.
97
What is pseudo outbreaks?
Repeated positive results for the same microorganisms from BAL fluid from different patients
98
Bacteria (salmonella)
Most commonly transmitted by endoscopy.
99
Mycobacterium tuberbulosis
Relatively resistant to most chemical agents including aldehydes Non tuberculosis (atypical) mycobacteria are even more resistant to glutaraldehyde.
100
Cdiff spores are more susceptible to a variety of chemical disinfectants than test spores Exposure to 10 minutes to 2 percent glutaraldehyde has been shown to inactivate Cdiff spores. True or false
True
101
What bacterial species are extremely difficult to remove from the plumbing, AFER and damaged endoscope channels?
Pseudomonas aeruginosa Is a common hospital oathogen and endoscope and accessories contamination(most likely acquired from the hospital than from prev patients)
102
No agent can be effective against microorganisms it cannot reach. True or false
True. Therefore inadequate cleaning can compromise even prolonged contact time in excess of 60 minutes is unlikely to kill pathogenic microorganisms present on or in the endoscope. Inadequate cleaning caused disinfection process failed.
103
What is the most important process of endoscope decontamination?
Scrupulous manual cleaning prior to disinfection.
104
What is meant by manual cleaning?
Refers to physical tasks performed by hand of removing biological material from the scope with appropriate brush, cloths, detergents and water.
105
Lightguide plug
Connects into light source. The air/water and suction channels have ports in light guide plug. The terminals of it is not waterproof and must be covered with soaking cap supplied prior to cleaning. Periodical checks should be made to ascertain continuing water tightness of these caps.
106
Umbilical cable/universal cord
Connects the light guide plug to the body of the scope.
107
Control head
Contains angulation control handles which allows the operator to flex the instrument, suction and air/water valves for control of air and water flow from the distal too.
108
Insertion tube
Enters the patient’s body and is grossly contaminated during the procedure. The distal tip houses the microchip in video scopes, openings for suctions, air/water and jet washing channels and the lens covering the flexible fibre optic light guides. Bending section is adjacent to insertion tube. Covering is made up of soft flexible material that is Vulnerable to damage
109
Cables allow the tip of scope to flex. A negative leakage test does not exclude damage to internal scooe structures. True or false
True
110
What equipment are useful to clean grooved control handles and to brush the distal tip and biopsy ports?
Soft toothbrushes
111
What does enzymes do?
Digest biological material enhancing removal by brushing and flushing These products reduce microorganisms load by up to 3 folds.
112
Enzymatic detergents should used at the correct temperature and concentration. Optimim efficacy when products are used in warm water 35 deg True or false
True Conversely, use of hot water >60 deg denature protiens and inactivate enzymes
113
Many bacteria exists in a planktonic state (free suspension). What do you call this bacteria?
Biofilm is formed when bacteria adhere to a surface and secrete large amount of polysaccharides to form a protective mattix or film around themselves. Pseudomonas species, legionella and atypical mycobacteria have the ability to exist either in a planktonic state or to form biofilms. Biofilms protect the bacteria against brushing, fluid flow and chemical (disinfectant) making microorganisms more difficult to remove.
114
Biofilms developed in scopes and AFER not detectable by the surveillance culture should be sampled for microbiological surveillance how many hours after disinfection?
12 hrs. As bacteria from superficial layers have been destroyed but within the deeper layers have not.
115
The final rinse for bronchoscope and duo should be bacteria free and other endoscope should also be of high wuality and free of bacterialnown to cause invadive clinical dse including pseudomonas species. The water used after manual cleaning and before disinfection does not need to be bacteria free True or false
True
116
The filterbanks often in a 3-4 stage filter size arrangement from 10 micron to 0.2 micron absolute final filter. Where should filter banks be placed?
At the beginning of water delivery and an access point immediately prior to the entry into the AFER.
117
Disinfectant for use in scooes reprocessing are regulated by who?
TGA Peracetic acid are used in machine systems in Australia and New Zealand
118
The recommended contact time will differ if the disinfectant temperature and concentration is higher. At room temp 20deg how many minutes is the soaking time?
10-20 minutes for glutaraldehyde and OPA in manual systems are usual.
119
Before leak testing performed what needs to be done to assist in detectingminor leaks arising from cracks in a channel.
Removal of buttons.
120
Flexing distal tip whilst instrument is pressured will assist in detecting leaks from where?
A rubber of the bending section. Function of angulation cables should be checked. Check lens and outer sheath for signs of cracking or damage
121
As per AS 4187, what is the minimum air exchanges ler hr is required in processing area?
10
122
Manual cleaning steps following a procedure.
Pre-cleaning Leak testing Cleaning- buttons are clean in ultrasonic cleaner Rinsing AFER Dry Store
123
TGA advised reprocessing of scopes in the new cleaner disinfector AFER mist be commenced within 1 hour of the procedure. Scopes should never be left soaking for long periods eg overnight. True or false
True
124
AFER used as a complete reprocessing machine which performs what?
Leak testing, cleaning, disinfection, alcohol perfusion and drying. Time after use is critical and must not exceed an hour
125
Extended storage is only permitted if microbiological results had shown negative. How long for to store?
Within 12 mos
126
How often emergency scopes should be routinely reprocessed?
72 hrs to ensure they are ready to be used anytime
127
If recent cultures have been positive or inadequate storage facilities not available, endoscope should be disinfected if storage time has been longer than 12 hrs True or false
True
128
Microbiological surveillance for loan scope should be done within how many hrs?
72 hrs of the receipt of scope
129
Chemical indicator
Demonstrates that scopes have been subjected to sterilisation process
130
Surveillance culture of AFER amd scopes as a quality control measure has been recommended by who?
GESA & GENCA since 1995 and endoscopes surveillance by New Zealand expert Committee in 2002
131
What is quality control marker used in endoscopes and AFER?
Surveillance culture to check the adequacy and completeness of cleaning and disinfection process and structural integrity of the scope.
132
How often surveillance culture for AFER, duo, linear and bronchoscopes be done?
4 week or every month All other scopes incl radial should be done every 3 mos
133
Endoscope that have been reprocessed through a sterilisation cycle and stored in a wrapped state shoul be monitored every how often?
3 mos
134
Water used for manual rinsing of endoscopes should be monitored every month If filter banks not in use How often if water is filtered to 0.2 microns?
Every 3 months
135
Endoscopes on loan to be tested within when?
73 hrs of receipt of the instrument
136
Microbiological testing should be done after usual processing and following storage of up to 12 hours to allow detection of microorganism arising from a biofilms True or false
True