Current Issues: Current Trends in Gastroenterology: To Reuse or Not

Deb A. Huber MSN, RN, ARNP, CGRN

Gastroenterology Nursing
As I was reviewing the Society of Gastroenterology Nurses and Associates (SGNA)
discussion forum, I came across several discussions of reusable items versus
disposable items. Several different items were mentioned in the forum, ranging
from disposable versus reusable biopsy forceps to single-use items, to items not
labeled as single use but for which there were questions regarding whether they
should be reused or not. These are frustrating times for many endoscopy units.
Cutting costs seems to be an important element to all. Managers are asked to do
this by doing more procedures with fewer staff positions. Equipment and repair
costs seem to continue to mount. We all try to cut corners but still provide safe and
quality care to our patients. I would like to review a few of the topics from the forum
in this column.
Initial Cost
There is always a debate about disposable versus reusable biopsy forceps. Initial
costs need to be considered. How many times can a forceps be used before it is no
longer sharp or badly bent? Do you have certain physicians who are notorious for
forcing forceps down scopes and potentially damaging the forceps or the scope? Do
you think many of your scope repairs are secondary to channel damage from bad
forceps? Are there concerns regarding cleaning and disinfection? Is your staff large
enough or knowledgeable enough to properly clean and maintain these
accessories? There seems to be a lot of questions, but who has the answers for your
situation?
Reimbursement Issues
When there is an endoscopy procedure performed, many pieces of equipment are
used. Each comes with a price tag and a concern for safety and reliability. Does the
patient pay for each item individually, or are these combined as an endoscopy unit
fee? Some of the items in the discussion forum discussed tubing, such as nasal
cannula extension tubing and suction tubing. Other items included such things as
suction canisters or liners. I'm aware the discussion forum does not reflect an equal
representation of all members; however, on these topics, the numbers of members
on both sides seemed fairly equal in responses regard discarding or reusing.
Potential for Infection
The respondents often noted no problems with infections. However, keep in mind
that once those patients (primarily the outpatients) are discharged from your unit,

how do you know what infections they acquire unless it can be directly traced back
to you (not an easy process)? It is thought that because suction tubing is pulling
potentially infected organisms away from the patient to the canister, such tubing
cannot infect another. With the same theory, the oxygen cannula is propelling fresh
oxygen through the cannula toward the infected patient. Is it possible for
microorganisms to pass through the extension tubing?
What are the thoughts about the suction canister? Can microorganisms get out of a
canister or not? Many argue that it simply looks bad and have offered suggestions
to camouflage it. Again, has the patient paid for this article, or is it a unit charge?
What if you must "fish for polyps" after polypectomy and unsuccessful retrieval? Do
you assume all pieces of tissue belong to the current patient who is in the room or is
there a possibility some tissue may belong to another?
Single-Use Items
What about items labeled "single use"? According to the SGNA position statement
regarding reprocessing of endoscopic accessories (adopted May 2002), critical items
labeled for single use should not be reprocessed or reused. However, there are
many practitioners who are reusing these items. Some will clean and maintain them
themselves, whereas others will send them to a third party reprocessing company.
How do you decide when it is no longer safe to use these items? How do you
validate the cleaning process because there are no manufacturer recommendations
for cleaning these items? Who has paid for the cost of the forceps? Is it initially
incurred by the first person to use the piece of equipment, with the next patients
not incurring a charge; or is each subsequent patient receiving a full charge? Or is
the cost divided among the number of patients expected to use it?
Need for Evidence
I am not trying to convey a right or wrong answer to these questions. As I review
the discussion forum, I realize there are many unanswered questions plaguing our
profession with regard to these topics. As Cuba Gooding Jr. said to Tom Cruise in the
film Jerry McGuire, "Show me the money," I say to you, "Show me the research."
SGNA is striving to be a forerunner in gastrointestinal nursing by using evidencebased practice. SGNA continues to support research, so please consider some of
these topics as a basis for a research project, especially if these problems are
affecting your practice setting. I really appreciate the people in the discussion forum
who identify themselves and often their working setting. It's harder to ask questions
or refute claims that are made by someone listed as anonymous.
When something goes wrong, the courts look at the current standards of practice to
compare your practice to a similar practice to help determine wrongdoing. It is up to
you to keep abreast of current changes and ideas in the field and studies being
undertaken. If there is a question, try to validate your information and not simply
take the word of another. You may have asked your child in the past when he has

done something wrong, "Why did you do that?" When he said to you, "Tommy did
it," does that make it right for your child? Probably not, unless Tommy is a known
expert in that area!!

Reaction:
As I reviewed the discussion forum on these topics, I was filled with more questions
than answers. The most frequent concerns regarding these topics included cost
containment (including staff to clean and reprocess equipment), infection control,
safety, and convenience.
Ask yourself: "When it is time for my endoscopy procedure, do I feel good about the
way these things are handled in the unit I am going to use?" When you get your bill
for those services, are you going to be upset by the charges that your insurance
(with your mounting premiums) had to pay, or will you feel it is money well spent?
The answers to these questions are important for you and your patients.