Accreditation program for gastrointestinal endoscopes reprocessing in Italy: An on-site survey

Abstract Background and study aims Endoscope reprocessing has been associated with a variable failure rate. Our aim was to present an overview on current practices for reprocessing in Italian facilities and discuss the principle critical points. Methods In 2014 the Italian Society for Digestive Diseases implemented an accreditation program in collaboration with an independent organization for certification and with the Italian Association for Endoscopy Technical Operators. During a 1-day site visit of the endoscopy center, two endoscopists, one nurse, and the representative of the certification body evaluated the endoscope reprocessing. Results As of July 1, 2020, 28 endoscopy centers had been accredited. Ten centers are completing the measures to correct deficiencies found at the visit. Three centers withdrew from the program. The accreditation program has found variations between the various centers, confirming the poor compliance with guidelines. Major deviations from the standards, established by the model before the site visit according to national and international guidelines, concerned instrument cleaning (44.7 % of the centers), instrument storage (23.7 %), and microbiological tests (31.6 %). Conclusions Our overview demonstrated the lack of many reprocessing phases, which are important to prevent endoscopy-associated infections. Accreditation can achieve a transformation in quality and safety of reprocessing with the Italian centrally-led approach.

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The Italian Society for Digestive Endoscopy (SIED) accreditation and quality improving project based on international standards

Endoscopy International Open ◽

10.1055/a-1096-0219 ◽

2020 ◽

Vol 08 (03) ◽

pp. E338-E345 ◽

Cited By ~ 2

Author(s):

Giancarlo Spinzi ◽

Angelo Milano ◽

Piero Brosolo ◽

Paola Da Massa Carrara ◽

Maurizio Labardi ◽

...

Keyword(s):

Quality Indicators ◽

Italian Society ◽

International Standards ◽

Site Visit ◽

Digestive Endoscopy ◽

Adenoma Detection ◽

Significant Difference ◽

Certification Body ◽

Important Quality ◽

Incomplete Sampling

Abstract Background and study aims Accreditation of endoscopy services, using valid quality indicators, may address failures to comply with quality standards between endoscopy services. The aim of this work was to present the Italian Society for Digestive Endoscopy (SIED) accreditation model and its effectiveness. Methods A team of eight endoscopists identified quality indicators derived from international guidelines and assessed them in each center voluntarily requesting accreditation. During a 1-day site visit, two expert endoscopists, the representative of the independent and international administrative certification body and a professional nurse evaluated the endoscopy center, by direct observation of the endoscopy team and examination of the medical records Results In all centers we noted shortcomings in instrument reprocessing. In 30 of 40 centers (75 %) the information in the nursing charts was incomplete. Sampling for Helicobacter pylori had not been done in 12 of 40 centers (30 %). In six of 40 centers (15 %) the adenoma detection rate for each endoscopist had not been evaluated. Post-polypectomy intervals were inappropriate in 12 of 40 centers (30 %). We noted a statistically significant difference (P < 0.001) between the answers to the SIED checklist of indicators submitted to the inspection team for accreditation before the site visit and the situation found for colonoscopy on site. As of June 30, 2018, 18 endoscopy centers had been accredited and 10 centers had not yet being accredited because they had not completed the measures to correct points raised at the visits. Conclusions Numerous Italian endoscopy centers fail to meet important quality indicators. Our accreditation program can provide means for detecting these problems and correcting them by implementing SIED standards.

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The relationship of the scleractinian corals to the rugose corals

Paleobiology ◽

10.1017/s0094837300025707 ◽

1980 ◽

Vol 6 (02) ◽

pp. 146-160 ◽

Cited By ~ 29

Author(s):

William A. Oliver

Keyword(s):

Critical Points ◽

Scleractinian Corals ◽

Convincing Evidence ◽

Early Triassic ◽

Rugose Corals ◽

History Of ◽

The Subject ◽

Relationship Of ◽

The Relationship ◽

Biologic Factors

The Mesozoic-Cenozoic coral Order Scleractinia has been suggested to have originated or evolved (1) by direct descent from the Paleozoic Order Rugosa or (2) by the development of a skeleton in members of one of the anemone groups that probably have existed throughout Phanerozoic time. In spite of much work on the subject, advocates of the direct descent hypothesis have failed to find convincing evidence of this relationship. Critical points are:(1) Rugosan septal insertion is serial; Scleractinian insertion is cyclic; no intermediate stages have been demonstrated. Apparent intermediates are Scleractinia having bilateral cyclic insertion or teratological Rugosa.(2) There is convincing evidence that the skeletons of many Rugosa were calcitic and none are known to be or to have been aragonitic. In contrast, the skeletons of all living Scleractinia are aragonitic and there is evidence that fossil Scleractinia were aragonitic also. The mineralogic difference is almost certainly due to intrinsic biologic factors.(3) No early Triassic corals of either group are known. This fact is not compelling (by itself) but is important in connection with points 1 and 2, because, given direct descent, both changes took place during this only stage in the history of the two groups in which there are no known corals.

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High-Resolution, Low-Voltage SEM of Cell Wall Regeneration of Yeast Shizosaccharomyces Pombe Protoplasts

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100103127 ◽

1988 ◽

Vol 46 ◽

pp. 208-211

Author(s):

M. Osumi ◽

N. Yamada ◽

T. Nagatani

Keyword(s):

Electron Microscope ◽

Scanning Electron Microscope ◽

Low Voltage ◽

Cell Wall Regeneration ◽

The Past ◽

The Poor ◽

Probe Size ◽

Beam Damage ◽

Biological Field ◽

Scanning Electron

Even though many early workers had suggested the use of lower voltages to increase topographic contrast and to reduce specimen charging and beam damage, we did not usually operate in the conventional scanning electron microscope at low voltage because of the poor resolution, especially of bioligical specimens. However, the development of the “in-lens” field emission scanning electron microscope (FESEM) has led to marked inprovement in resolution, especially in the range of 1-5 kV, within the past year. The probe size has been cumulated to be 0.7nm in diameter at 30kV and about 3nm at 1kV. We have been trying to develop techniques to use this in-lens FESEM at low voltage (LVSEM) for direct observation of totally uncoated biological specimens and have developed the LVSEM method for the biological field.

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Artefacts in the x-ray microanalysis of frozen-hydrated biological samples

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100127724 ◽

1987 ◽

Vol 45 ◽

pp. 658-659

Author(s):

Patrick Echlin

Keyword(s):

Electron Scattering ◽

Biological Samples ◽

Fracture Face ◽

Detailed Structure ◽

X Ray ◽

Morphological Appearance ◽

The Poor ◽

Freeze Dried

A number of papers have appeared recently which purport to have carried out x-ray microanalysis on fully frozen hydrated samples. It is important to establish reliable criteria to be certain that a sample is in a fully hydrated state. The morphological appearance of the sample is an obvious parameter because fully hydrated samples lack the detailed structure seen in their freeze dried counterparts. The electron scattering by ice within a frozen-hydrated section and from the surface of a frozen-hydrated fracture face obscures cellular detail. (Fig. 1G and 1H.) However, the morphological appearance alone can be quite deceptive for as Figures 1E and 1F show, parts of frozen-dried samples may also have the poor morphology normally associated with fully hydrated samples. It is only when one examines the x-ray spectra that an assurance can be given that the sample is fully hydrated.

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Influence of the Acoustic Reflex on Vowel Recognition

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.2903.420 ◽

1986 ◽

Vol 29 (3) ◽

pp. 420-424 ◽

Cited By ~ 4

Author(s):

Michael Dorman ◽

Ingrid Cedar ◽

Maureen Hannley ◽

Marjorie Leek ◽

Julie Mapes Lindholm

Keyword(s):

Auditory System ◽

Sound Pressure ◽

Dynamic Range ◽

Recognition Accuracy ◽

Pressure Level ◽

Acoustic Reflex ◽

The Poor ◽

Stapedial Reflex ◽

Vowel Recognition ◽

High Sound

Computer synthesized vowels of 50- and 300-ms duration were presented to normal-hearing listeners at a moderate and high sound pressure level (SPL). Presentation at the high SPL resulted in poor recognition accuracy for vowels of a duration (50 ms) shorter than the latency of the acoustic stapedial reflex. Presentation level had no effect on recognition accuracy for vowels of sufficient duration (300 ms) to elicit the reflex. The poor recognition accuracy for the brief, high intensity vowels was significantly improved when the reflex was preactivated. These results demonstrate the importance of the acoustic reflex in extending the dynamic range of the auditory system for speech recognition.

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