Infection Prevention, Safety, and Equipment
Standard precautions and reprocessing
Standard precautions apply to every patient regardless of diagnosis. Endoscope reprocessing is a strict multistep sequence, and questions test whether you know the order: bedside pre-cleaning (wipe the insertion tube and flush channels immediately after use so bioburden does not dry), leak testing, manual cleaning with brushes and enzymatic detergent, rinsing, high-level disinfection or sterilization per manufacturer instructions, rinse with filtered water, alcohol flush with forced-air drying, then vertical storage. Duodenoscopes deserve special attention because of CRE outbreaks linked to the elevator mechanism; some facilities use supplemental sterilization.
Safety hazards in the GI lab
Electrosurgical and argon plasma units create fire risk when alcohol-based preps or oxygen-enriched environments are present: allow preps to dry fully, use the lowest effective oxygen concentration, and keep ignition sources away. Grounding pads must sit on clean, dry, hairless skin with good contact. Also monitor fall risk in recovery, specimen labeling with two identifiers, sharps safety, and exposure to glutaraldehyde or formaldehyde.
Traps
Common wrong answers: storing scopes coiled in a case, skipping the leak test, using alcohol-based skin prep immediately before cautery, or assuming a scope needs only disinfection between "dirty" cases. PPE is not optional for a "quick" procedure.
Worked example
A patient's back is prepped with alcohol-based chlorhexidine and the endoscopist requests snare cautery. Correct action: allow the prep to dry completely, remove pooled solution and soaked drapes, keep oxygen at the lowest feasible level, and confirm the return electrode is well adhered before activation.
Rule of thumb
Clean first, disinfect second - no disinfectant works through visible soil.