ASGE Repetitive Use Syndrome Survey

REPORT TO THE SGNA BOARD OF DIRECTORSFebruary 2000

FROM: Paulette Smith, RN, BSN, CGRN X___ Action Secretary

SUBJECT: December1999 Board Meeting Minutes. RECOMMENDATION: That the SGNA Board of Directors accept the minutes from the December BOD meeting via teleconference.

Relevant Strategic Goal/Objective: none

Action: ____ Approved ____ Deferred ____ Rejected

____ Refer back to Committee ____ Amend and Adopt

SGNA Board of Directors MeetingDecember 7, 1999Via Teleconference

Voting ParticipantsKaren Laing, RN CGRN, PresidentNancy Schlossberg, BSN RN CGRN, President ElectDonna Reeves, LPN CGN, TreasurerPaulette Smith, BS RN CGRN, SecretaryMarilyn Schaffner, MSN RN CGRN, Immediate Past PresidentTheresa Morse, BSN RN CGRN, Director of EducationMargaret Coffey, BSN RN CGRN, Director of PracticeCarol Stevens, BSN RN, Director of ProgramVirginia Walter, MS RN CGRN, Director of Communications & CollaborationCathy Dykes, MS RN CGRN, Speaker of the House of DelegatesMaureen Wright, RN CGRN, Director of Government

Non-Voting Participants/Guests:Cathleen Ferarro, CBGNA PresidentMary Beth Hepp, Interim Executive DirectorKathleen Domkowski, MS RN C, Director of Nursing EducationHeather Bagby, Operations ManagerAllison Cline, Member Services CoordinatorKathy Wright, MS RN CGRN, GNJ Editor

1) Roll Call/Agenda

Call to Order/Roll CallSGNA President Karen Laing, RN CGRN, called the meeting to order at 6:05 p.m. on Tuesday, December 7, 1999. Secretary Paulette Smith, BS RN CGRN, called the roll of voting and non-voting members.

2) Approval of Minutes

February 2000 – SGNABoard Book 1

>>APPROVED the minutes from the October 14-17, 1999 Board of Directors Meeting with the following additions/corrections: Maureen Wright was added to voting participants Kathy Wright and Nancy Shields were added to non-voting participants Under the heading “Membership Retention and Recruitment Plan” paragraph 2, sentence 2, remove the word

“plan.” Under the heading “Foreign Affairs” paragraph 3, sentence 1, edit the word development to read develop Under the heading “Foreign Affairs” paragraph 4, sentence 1, edit the word development to read develop

3) Approve Agenda Ms. Smith recommended that the meeting agenda be approved.

>>APPROVED the December Board meeting Action agenda with the following changes: Consent report Policy D-4 moved to the Action agenda SIG Needs Assessment Survey Information report moved to Action agenda

4) Action Agenda

2000 BudgetTreasurer Donna Reeves, LPN CGN, recommended that the 2000 budget be approved pending final contract approval by legal counsel and auditors report.

Director Theresa Morse, BSN RN CGRN, noted that the education committee may not meet in 2000; therefore, the estimated $10k in meeting expenses may be saved. Ms. Smith noted that secretary travel might be another area for potential savings. It was also explained that the increase in honorarium was accounted for in the proposed 2000 budget.

>>APPROVED the 2000 budget pending final contract approval by legal counsel and auditors report.

ASGE Repetitive Use Syndrome SurveyMs. Smith recommended that the SGNA BOD approve participation with ASGE in the formation of a survey regarding repetitive use syndromes by Gastroenterologists and GI Nurses and Associates.

Ms. Smith reiterated that there is no financial commitment at this time. Director Virginia Walter, MS RN CGRN, expressed concern regarding publishing rights. Ms. Smith acknowledged her concern, but noted that it is too early in the process to negotiate. Ms. Laing expressed support.

>>APPROVED that the SGNA BOD participate with ASGE in the formation of a survey regarding repetitive use syndromes by Gastroenterologists and GI Nurses and Associates

Endorsement of the Academy of Medical-Surgical Nurses (AMSN) position statementsPresident Elect Nancy Schlossberg, BSN RN CGRN, recommended that the SGNA BOD vote to endorse the Academy of Medical-Surgical Nurses (AMSN) position statements: Unlicensed Assistive Personnel (UAP) Political Awareness of the Registered Nurse General Health & Wellness Identification of the Registered Nurse in the Workplace Code of Conduct/Ethics

It was noted that these position statements come from NOLF/NFSNO.

>>APPROVED that the SGNA BOD endorse the Academy of Medical-Surgical Nurses (AMSN) position statements:


Unlicensed Assistive Personnel (UAP) Political Awareness of the Registered Nurse General Health & Wellness Identification of the Registered Nurse in the Workplace Code of Conduct/Ethics

Nurse in Washington InternshipMs. Schlossberg recommended that the SGNA BOD fund $1500 for the President-elect to attend the Nurse in Washington Internship (NIWI) program on a yearly basis, with initial funds to come from the 2000 Strategic Plan budget.

It was noted that Ms. Schlossberg and Ms. Laing feel this is a good opportunity because other NOLF/NFSNO organizations have raved about it. Immediate Past President, Marilyn Schaffner, MS RN CGRN, expressed the need to capture a detailed report regarding knowledge gained to the BOD. Ms. Schlossberg explained that there are scholarships available.

>>APPROVED that the SGNA BOD fund $1500 for the President-elect to attend the Nurse in Washington Internship (NIWI) program on a yearly basis, with initial funds to come from the 2000 Strategic Plan budget.

Provide SGNA Materials to Vendors ElectronicallyMs. Schlossberg recommended that the SGNA provide Frank Bass with an electronic copy of SGNA’s Standards for Infection Control and Reprocessing of Flexible Gastrointestinal Endoscopes, under a written agreement that is for view-only purposes on his laptop not to be printed or reproduced.

Interim Executive Director, Mary Beth Hepp, noted that legal counsel has reviewed this recommendation and believes permission can be granted provided a person who wants this type of information in this manner signs a written agreement.

>>APPROVED that the SGNA provide Frank Bass with an electronic copy of SGNA’s Standards for Infection Control and Reprocessing of Flexible Gastrointestinal Endoscopes, under a written agreement that is for view-only purposes on his laptop not to be printed or reproduced.

Teleconference on sclerotherapy for the treatment of esophageal varicesMs. Schlossberg recommended that the SGNA Board of Directors approve assisting McCarthy Medical Marketing in developing a teleconference on sclerotherapy for the treatment of esophageal varices by recommending members experienced in this topic as potential faculty, and to participate in program planning.

Director of Nursing Education, Kathleen Domkowski, MS RN C, explained that McCarthy Medical Marketing is working with a vendor that is looking for content experts to help them. It was explained that SGNA would be acting as a referral service.

Ms. Hepp noted that the staff would develop a procedure and bring it to the board. Ms. Smith recommended that the staff put the call out on the web page, if we don’t get the responses needed we would know then if we have the capability to provide experts.

>>APPROVED assisting McCarthy Medical Marketing in developing a teleconference on sclerotherapy for the treatment of esophageal varices by recommending members experienced in this topic as potential faculty, and to participate in program planning.

Palliative CareMs. Schlossberg recommended that the SGNA Board of Directors vote to join 31 other Specialty Nursing Organizations in support of the position Statement on Palliative Care.

Ms. Laing noted that this came from the NOLF/NFSNO meeting.


>>APPROVED that the SGNA Board of Directors joins 31 other Specialty Nursing Organizations in support of the position Statement on Palliative Care.

Nursing ShortageMs. Schlossberg recommended that the SGNA Board of Directors vote to support the “Nurses for a Healthier Tomorrow” coalition.

Ms. Schlossberg explained that this is a global message that will provide good public relations in specialty nursing. This came from the NOLF/NFSNO meeting. Ms. Walter noted that this is a good initiative to share with the regionals. Ms. Reeves explained that we do not have funds to allocate at this time. Ms. Schaffner stated that if members and/or regionals want to donate, they might do so via the SGNA Foundation.

>>APPROVED that the SGNA Board of Directors support the“ Nurses for a Healthier Tomorrow” coalition.

Multi-State Compact for Nursing LicensureMs. Schlossberg recommended that the SGNA Board of Directors vote to support the American Academy of Ambulatory Care (AAACN) position statement of Multi-State Nursing Licensure.

>>APPROVED that the SGNA Board of Directors support the American Academy of Ambulatory Care (AAACN) position statement of Multi-State Nursing Licensure.

Policy A-9Ms. Smith recommended that policy A-9 “Termination of Membership” be approved.

It was noted that this has had legal review.

>>APPROVED policy A-9.

Deletion of Policies A-6 and A-8Ms. Smith recommended that policies A-6 & A-8 be deleted.

It was noted that both of these policies are addressed in detail via bylaws Articles V and XXIV.

>>APPROVED that policies A-6 and A-8 be deleted.

Policy D-4Ms. Smith recommended that the board approve revisions made to Policy D-4.

It was noted that 5.3 should be deleted as well. The numeral 5 will be added under the heading Per Diem Expenses.

>>APPROVED the revisions made to Policy D-4.

Endoscope Reprocessing Wall ChartMs. Schlossberg recommended that the SGNA BOD approve the recommended revisions to the wall chart “the steps necessary to thoroughly clean and high level disinfect immersible GI Flexible Endoscopes.”

It was noted that ASP currently sponsors the wall chart. It was recommend that the revision be laminated.

>>APPROVED the recommended revisions to the wall chart “the steps necessary to thoroughly clean and high level disinfect immersible GI Flexible Endoscopes.”


Performance of Flexible Sigmoidoscopy by Registered Nurses for the Purposes of ColorectalCancer Screening

(Guideline)Ms. Schlossberg recommended that the SGNA BOD approve the recommended revisions to the guideline performance of flexible sigmoidoscopy by registered nurses for the purposes of colorectal cancer screening.

A lengthy discussion occurred regarding supporting certification. The overall sentiment was that we have sidestepped the issue of certification and think it is time the SGNA BOD support the certification board. It was further noted that this is a recommendation, not the law.

>>REJECTED that the SGNA BOD approve the recommended revisions to the guideline performance of flexible sigmoidoscopy by registered nurses for the purposes of colorectal cancer screening.

Ms. Schlossberg recommended that the SGNA BOD approve the recommended revisions to the guideline performance of flexible sigmoidoscopy by registered nurses for the purposes of colorectal cancer screening with the following addition: SGNA recommends that the procedure be performed by a registered nurse who holds current certification as a

CGRN.

>>APPROVED the recommended revisions to the guideline performance of flexible sigmoidoscopy by registered nurses for the purposes of colorectal cancer screening with the following addition: SGNA recommends that the procedure be performed by a registered nurse who holds current certification as a

CGRN.

ONS MeetingMs. Schlossberg recommended that the SGNA BOD send one staff member and one volunteer to attend the ONS meeting, and the Board should determine which volunteer would attend.

>>APPROVED SGNA will send one staff member and one volunteer to attend the ONS meeting.

SIG Needs Assessment SurveyDirector Margaret Coffey, BSN RN CGRN, recommended that the SIG Needs Assessment Survey be withdrawn from the Action agenda.

>>WITHDRAWN to review the SIG Needs Assessment Survey.

5) OtherMs. Reeves reminded that BOD to submit any outstanding expense reports from fiscal year 1999.

Ms. Schlossberg announced that the President passed into law that March will be Colon Cancer Awareness Month. It was also announced that SGNA may use the Caring Star.

There being no further business, the meeting was adjourned at 7:46 p.m.



FROM: Margaret Coffey X__ Action Chair of SIG Task Force

SUBJECT: Special Interest Group Task Force

RECOMMENDATION(S):1) Recommend that the chairperson of each SIG be invited to the leadership conference in the year 2000 , to develop a leadership track for each Sig to follow2)Recommend that a Web page be developed for each SIG (linked off SGNA.ORG)3)Recommend that SGNA not support future Hepatology SIG Meetings with AASLD4) Recommend that the Special Interest Task force be disbanded

Relevant Strategic Goal/Objective: Goal 3, SGNA will be a relevant organization through successful use of Internet resources in order to communicate with the Gastroenterology and Endoscopy community. Objective 3.1b Identify and within financial boundaries and with BOD approval, update any new internet technology on the SGNA Web site.

Justification: The SIG survey showed the most important benefit for SIG members are: newsletters, networking and education. 1) The task force realized that many of the Sig was struggling to survive and felt that a leadership track would offer new benefit to the SIG leaders and assist them to become future leaders in SGNA.2) Many of the SIG members expressed the desire for a Web page for their newsletter3) Hepatology SIG has a membership of 128, only 49 attended the 1999 HEP SIG conference. SIG survey showed that the majority of the members were not interested in meeting more than one a year at the annual course4) SIG task force has completed its assignment

Time Frame/Target Date for Completion: Leadership meeting, fall of 2000; SIG WEB page, August 2000; Hepatology Meeting , Immediately. SIG task force be disbanded immediately.

Financial Impact: Budget projection for the SIG leadership course are for 17 SIG chairs and 4 SIG coordinators:Airfare: 21 @ 360 = $7560 Hotel 21 @ $75 ( 2/room) = 1575Per Diem 2 1 @ 100 (assumes 2 days @ $50 ) = 2100Materials: 21 @ $30 = 630 TOTAL $11865

Staff Impact: Can be absorbed by current staff

Relation to Strategic Plan: Goal 2. These actions will provide current and expanded educational opportunities to SGNA members and customers by maintaining and enhancing delivery mechanisms. Goal 3. SGNA will be relevant organization through successful use of Internet resources in order to communicate with the Gastroenterology and Endoscopy community.





FROM: Nancy Shields, President, SGNA Foundation X__ Action

SUBJECT: Don Wilson Memorial Scholarship

RECOMMENDATION(S): That the SGNA establish an educational scholarship in Don Wilson’s name. SGNA would make an initial contribution of $1,000 to establish the fund, but contributions would be accepted from other sources as well, including SGNA members, physicians, Wilson-Cook Medical Inc. and their international affiliates. SGNA would contribute $1,000 annually to the fund. Criteria for disbursement are based upon areas of interest in Don’s professional life.Criteria for disbursement would include some or all of the following:1. Fund SGNA members to international educational meetings2. Fund international GI nurses to attend SGNA educational meetings3. Fund nurses to attend specialty procedure courses, ie: ERCP sponsored by other organizations or in other

countries.4. Fund research projects for nurses involved in innovative procedures or techniques5. Fund certification scholarships for SGNA members in the U.S. and for international nurses who may wish to

take the U.S. certification exam

After the Scholarship Fund has been established, a letter from the SGNA Foundation President and SGNA President will notify Wilson-Cook Medical Inc. and Mrs. Minda Wilson that the fund has been established in Don’s name.

Relevant Strategic Goal/Objective: Goal 2.2, Objective 2.1, 2.4

Justification: Establishment of this scholarship fund serves as a public declaration to honor Don’s contribution to the field of professional gastroenterology/endoscopy nursing both within the U.S. and around the world.

Time Frame/Target Date for Completion: Initial contribution to be made as soon as possible so at least one scholarship can be awarded in May 2000. Announce scholarship creation in SGNA newsletter immediately prior to Annual Meeting.

Financial Impact: Annual SGNA contribution of $1,000.

Staff Impact: No additional impact.

Relation to Strategic Plan: Public identity with the pursuit of excellence in our professional field and SGNA’s acknowledgement that the contributions of others have helped to shape our success as individual practitioners as well as enhanced the success of the professional society.





FROM: Budget and Finance Committee x Action Members: Donna Reeves, Chair Marilyn Schaffner, Karen Laing, Nancy Schlossberg, Margaret Coffey, Theresa Morse, Heather Bagby, Mary Beth Hepp SUBJECT: Budget and Finance Report

RECOMMENDATION: That the 1999 Audited Surplus funds be designated to the Permanent Fund, deposited at Merrill Lynch.

Relevant Strategic Goal/Objective: Goal 6, Fiscal Resources: SGNA will maintain a well-managed, dynamic and financially stable organization responsive to members needs.

Justification: The approved Investment Policy D-2, states that the SGNA will allocate 1% of its annual revenue to the Permanent Fund. This 1% is budgeted in the Operating Budget. Ideally, the Society should have up to 50% of its annual operating budget in the Permanent Fund. We recommend the audited 1999 surplus over the 1% be deposited in the Merrill Lynch SGNA Permanent Fund.

Financial Impact: The Permanent Fund is at $737,832 with our goal of 50% of the Operating Budget ($2,602,439) $1,201,219.

Staff Impact: None



FROM: Mary Beth Hepp, Executive Director X__ Action

SUBJECT: SGNA 2000 Organizational Priorities

RECOMMENDATION(S): That the SGNA Board of Directors approve the 2000 Organizational Priorities.

Relevant Strategic Goal/Objective: The Organizational Priorities focus on assisting the SGNA to meet all Strategic Plan goals:-Coordinated fund-raising efforts.-Provide current and expanded educational opportunities to SGNA members and customers by maintaining and enhancing delivery mechanisms.-SGNA will be a relevant organization through successful use of Internet resources in order to communicate with the Gastroenterology and Endoscopy community.-Enhance SGNA’s ability to increase scientific research and the number of scientist’s within our speciality.-SGNA is positioned as the expert provider of information and data on practice issues within our specialty, and identifies bridges between the scientific community and the practicing GI nurse.

Justification: The Organizational Priorities provides guidance to the SGNA staff and an evaluation tool to the Board of Directors in order to evaluate Smith, Bucklin and Associates.

Time Frame/Target Date for Completion: January – December 2000.

Financial Impact: As determined each year by the SGNA and SBA annual contract.

Staff Impact: The Organizational Priorities great affects staff because it outlines what they are to accomplish each year in working with the SGNA.

Relation to Strategic Plan: See above.




2000 ORGANIZATIONAL PRIORITIES

Priority A: Membership Growth and Stability

Continue to recruit and retain members based upon staff-developed, Board-approved recruitment and retention plan. In 2000, increased emphasis should be placed on membership retention, particularly those individuals joining via the 18-month and 2-year renewal options as well as those taking advantage of the incentives for large group

Outcomes:

Rate contribution to progress or success for each item by placing corresponding number in parentheses on left-hand margin:

1 = Exceeded goal2 = Met goal3 = Partially met goal4 = Did not meet goal

( ) 1. Continue the SGNA Share-the-Wealth member-get-a-member campaign with a goal of 300 new members by campaign’s end—March 2000.

( ) 2. Launch and complete the 2000 dues renewal initiatives by May 15, 2000, with a minimum goal of 80 percent retention based on 1999 year-end membership.

( ) 3. Implement the 18 month and 24 month, and on-line dues renewal options; evaluate the progress and implications of offering these options and report to BOD in Summer Board Meeting.

( ) 4. Implement the incentive renewal program for large numbers of memberships; evaluate the progress and implications of offering these incentives and report to BOD in Summer Board meeting.

( ) 5. Determine a realistic annual retention rate for SGNA through ongoing data collection and analysis; report to BOD at the Fall 2000 BOD meeting.

Priority B: Finances

Work with the SGNA Board of Directors to develop and maintain a 1999 – 2000 balanced operating budget and to effectively manage the Strategic Plan Fund.

Outcomes:

Rate contribution to the progress or success for each item by placing corresponding number in parentheses on left-hand margin:



( ) 1. Continue to work on increasing non-dues revenue through increased product and publication sales, Annual Course registrations, and securing increased sponsorship dollars.

( ) 2. Maintain high quality financial reporting, standardization of financial processes, and budget planning. Sustain a consistent level of communication with the SGNA Treasurer and Board of Directors on the Society’s financial status, such communication to include providing the Treasurer and President a monthly written analysis of the SGNA financial statements.

( ) 3. Ensure through SGNA staff and Board cooperation that operational expenses are within budget and budget overages are anticipated.

( ) 4. Work to maintain/increase the SGNA bottom line through effective management of financial resources. Goal: Increase the 2000 year-end net by 3-5%.

Priority C: Governance

Ensure that governing tools are in place to effectively guide the Society.

Outcomes:



( ) 1. Publish an SGNA Policy Manual by March 2000.

( ) 2. Maintain manual via sgna.org Board Members only web page.

( ) 3. Implement Board Members Only page on the SGNA Website by May 2000. Use this site for Board communications and preparation for Board meetings. Evaluate use and report to BOD at Winter Board meeting.

( ) 4. Increase and enhance electronic communications between Board of Directors,


SGNA staff, and SGNA members; continue e-mailing BOD books and electronic voting when needed. Provide SGNA E-Scope monthly to all SGNA members with e-mail addresses.

Priority D: Leadership

Work with the SGNA Board of Directors in their ongoing efforts to recruit and develop leaders. Work with the SGNA President and President-Elect on ways to provide greater leadership development and discussion of global issues important to the future of the gastroenterology nursing specialty.

Outcomes:

Rate contribution to progress or success of each item by placing corresponding number in parentheses on left-hand margin:

1=Exceeded goal2=Met goal3=Partially met goal4=Did not meet goal

( ) 1. Work with SGNA President-Elect on continued improvement and enhancement of

the Board/Committee Chair Orientation held in conjunction with the Winter 2000

Board meeting.

( ) 2. Continue to offer a Regional Presidents Leadership Conference in conjunction with the Fall 2000 SGNA Board meeting.

( ) 3. As needed, bring outside speakers to address the Board on environmental issues and member expectations in order to expand the Board’s information base on which it draws to make decisions.

( ) 4. Continue the work of the Unified Partnership Task Force in the joint fundraising project; evaluate and report results of the project at the Fall 2000 Board meeting.

( ) 5. Continue the work of the Unified Partnership Task Force in the joint –800 number

project; evaluate and report results of the project at the Fall 2000 Board meeting.

( ) 6. Support the SIGs via 2 bi-annual newsletter publications and distribution as well as staff support to all annual SIG meetings at the Annual Course. Provide support to any Board of Directors approved SIG meetings outside the Annual Course.


Follow the recommendations of the SIG Task Force and/or SIG liasion in working

with SIG activities

Priority E: Performance and Quality of Staff Services

Ensure that members perceive SGNA as an effective and efficient organization as measured by functional objectives.

Outcomes:



( ) 1. Consistently deliver top-quality, contracted services in an accurate and timely manner. Member feedback mechanisms including postcards and regional

presidents survey will be used as part of the evaluation process.

( ) 2. Continue to enhance staff “friendliness” at all levels of the organization. Staff to work at continuing to anticipate members needs and identifying trends;

acting as a resource and providing guidance/direction to members.

( ) 3. Work with SGNA Board of Directors to increase their level of trust and confidence in the SGNA staff, which will free up the Board to focus on

organizational planning, direction and policy setting, thereby helping the Society to develop to its full potential.

( ) 4. Share with BOD the SGNA Administrative staff Key Responsibilities and provide an overall progress report to the Board of Directors at Fall 2000 Board meeting.

( ) 5. Continue to identify course sites and negotiate hotel arrangements on a “five-year-

out” basis. Work in 2000 should focus on identifying and negotiating the 2005 Annual Course site.

( ) 6.. Clearly communicate to the Board specific timelines for completion of all projects

and status reports on implementation of projects in order to assist them in accurately measuring completion dates.


( ) 7. MARCOM will successfully complete all 2000 budgeted MARCOM projects; specifically adhering to timelines and budget, while providing high quality

work

Priority F: Education

Maximize the abilities and presence of SGNA’s nursing educator in order to identify and develop up-to-date continuing education materials and practice products based on identified member needs, thereby increasing SGNA’s non-dues revenue.

Outcomes:



( ) 1. Work with the Certification Review Task Force to offer at least one SGNA-sponsored certification review course by December 2000.

( ) 2. Revise and publish the SGNA High-Level Disinfection Module working in conjunction with the SGNA Practice Committee by May 2000

( ) 3. Publish the revised SGNA Manual of Gastrointestinal Procedures (4th Ed.) by Jan. 30, 2000.

( ) 4. Conduct the ANCC re-accreditation process with ANCC visit in Spring 2000. Entire process to be completed in 2000.

( ) 5. Videotape plenary sessions at the Annual Course in Anaheim and develop at least two new CE modules in for sale by September, 2000.

( ) 6. Develop at least 5 additional audiotape study modules from popular 1999 and 2000 Annual Course sessions; Have at least 2 audio study modules ready for sale by May 2000 and 3 more by Sept. 2000.

( ) 7. Develop at least 4 videotaped sessions as CE modules available for viewing on the Internet and for sale via the SGNA Website by September, 2000.


( ) 8. Develop with the Journal Editor and Publisher improved strategies for using Gastroenterology Nursing articles for independent study CE Credit. Reportwith specific recommendations and budgetary implications due to SGNA Board by May 2000.

( ) 9. By Dec, 31, 2000, SGNA will help at least 10 regionals conduct programs themselves that specifically focus on increasing hands-on learning at regional meetings.

Priority G: Marketing and Communications

Provide SGNA with quality marketing and communications services.

Outcomes:



( ) 1. Develop and adhere to an annual newsletter publication schedule and budget.

( ) 2. Develop and publish all Annual Course marketing materials in a consistent and high quality manner.

( ) 3. Develop and publish SGNA Membership Directory according to schedule and budget.

( ) 4. Develop and publish SGNA Joint-Sponsorship Opportunities booklet according to schedule and budget.

( ) 5. Continue implementing the comprehensive strategic plan for expanding the information and services available through the SGNA Web site. Services to include; shopping cart, auditorium chats, discussion forums, BOD only page, and on-line learning.

( ) 6. Continue to effectively plan and manage budgets for all other Marketing and Communications-related projects.

Priority H: Alliances


Increase visibility and promote practice through alliances with other nursing organizations, GI physician groups, government, vendors, other health professional groups and the public.

Outcomes:



( ) 1. Continue and enhance the relationship between the SGNA, CBGNA and the Foundation via joint projects, common meetings, and shared information. Conduct monthly conference calls with all three organizations.

( ) 2. Develop relationships with other specialty nursing organizations such as NFSNO members; become a member of a NFSNO Work Group; support other specialty nursing organization missions when possible and appropriate.

( ) 3. Explore opportunities to increase SGNA visibility internationally via vendors, international meetings, and increasing international membership.

( ) 4. Provide staff support as the Board of Directors continue to evaluate alliances with physician groups and governmental alliances.

Priority I: Use of Technology

SGNA will be a relevant organization through successful use of Internet resources in order to communicate with the Gastroenterology and Endoscopy community.

Outcomes:



( ) 1. Increase the number of overall SGNA transactions via E-commerce by 50% from


1999 to 2000.

( ) 2. Increase use of Internet to hold virtual meetings and discussions; in 2000 conduct at least 2 Board discussion forums, 4 Auditorium chats, and increase activity in member discussion forums by 20% over 1999 volume.

( ) 3. Assist our members in the utilization of Internet technology by providing an education program for members who need assistance understanding Internet uses.

( ) 4. Obtain evaluations and recommendations about SGNA Web site features from at least 5% of our Web site visitors.

Priority J: Research

Enhance SGNA’s ability to increase scientific research and the number of scientists within our speciality.

Outcomes:



( ) 1. Support investigators by helping SGNAFER offer grant funding and establishing a New Investigator Award.

( ) 2. Develop and explore a Director of Research role for SGNA by May 2000.

( ) 3. Further the education of SGNA members in research and science via AnnualCourse sessions, assisting in the development of advanced practice scholarships, and posting grant applications.

Priority K: Practice Issues

SGNA is positioned as the expert provider of information and data on practice issues within our specialty, and identifies bridges between the scientific community and the practicing GI nurse.


Outcomes:



( ) 1. By 6.30.00, identify at least 3 practice issues and their clinical outcomes.

( ) 2. By 12.31.00, develop a plan that allows SGNA to provide information and data on

the 3 practice issues identified.

( ) 3. By 12.31.00, develop a plan that allows SGNA to better link the practicing GI community with the scientific GI community


REPORT TO THE SGNA BOARD OF DIRECTORSFeb 2000

FROM: Allison Cline, Member Services Coordinator X__ ActionHeather Bagby, Operations Manager

SUBJECT: Special Interest Group and Regional Society Website Pages

RECOMMENDATION(S): That SGNA approve the development and implementation of pages on www.sgna.org for each individual Special Interest Group and Regional Society.

Relevant Strategic Goal/Objective: 3: SGNA will be a relevant organization through successful use of Internet resources in order to communicate with the Gastroenterology .

Justification: This would allow Special Interest Groups access to group rosters and archived SIG newsletters, and allow for more in-depth and individualized information for both SIGs and Regionals.

Time Frame/Target Date for Completion: July 2000

Financial Impact: Can be absorbed in current staff and web budget.

Staff Impact: Can be absorbed in current staff time.

Relation to Strategic Plan: This will enable members and non-members access to more information about SGNA electronically.





FROM: Mary Beth Hepp X__ ActionExecutive Director

SUBJECT: NFSNO and NOLF Task Force

RECOMMENDATION(S): That SGNA sign the attached letter to the NFSNO and NOLF board of directors formally requesting that a work group / task force be formed to pursue closer collaboration and better alignment of effort between NFSNO and NOLF.

Relevant Strategic Goal/Objective: This recommendation helps SGNA in its work with alliances with other nursing specialty groups as well as Goal 5: SGNA is positioned as the expert provider of information and data on practice issues within our specialty, and identifies bridges between the scientific community and the practicing GI Nurse.

Justification: NFSNO and NOLF participating organizations see too much over-lap with these two organizations, especially when paying fees to belong to both organizations. We need a task force to investigate the purpose of having two separate groups. See attached letter for further justification. Currently SGNA is a NFSNO and NOLF member. SGNA paid both fees in 1999 and budgeted to pay both in 2000. NFSNO fees are $1550 per year and NOLF fees are $450 per year.

Time Frame/Target Date for Completion: Send the letter as soon as possible. Work group to be formed by NFSNO and NOLF and meet by Nov. 2000.

Financial Impact: No financial impact to send the letter. Could lead to improved expenses in fees to NFSNO and NOLF. Although currently SGNA is only paying NFSNO fees.

Staff Impact: Can be absorbed by current staff; need ½ additional full-time employee; will need part-time help for 3 months; etc. Also include total cost.

Relation to Strategic Plan: This helps identify the purpose of each group (NFSNO and NOLF) and therefore helps SGNA determine which group to be a part of (of both) in helping SGNA meet all of its strategic plan goals.



DRAFT April 10, 2023Letter to NOLF and NFSNO boards of directors from the boards of directors of specialty nursing organizations.

Dear NOLF or NFSNO Director,

When the members of the National Federation of Nursing Specialty Organizations (NFSNO) and the Nursing Organizations Leadership Forum (NOLF) met together in Washington, DC in November 1999, they discussed forming a joint task force to pursue closer collaboration and better alignment of effort between NFSNO and NOLF. As a member


of NFSNO [NOLF] since 19__, we are writing to you today, as a followup to this discussion, to formally request that such a working group be formed as soon as possible. Further, we ask that this group be charged with the broader (and more meaningful) task of examining the collective and collaborative needs of the specialty nursing community in general.

It is our observation that both NFSNO and NOLF have, to a greater or lesser degree, moved away from their original purpose and mission, and evolved structures that may no longer serve our shared goals effectively. It is evident to us that both inefficiency and significant overlap exist between and within both groups, with the clear and present danger of working at cross-purposes. We believe that specialty nursing’s needs will be better met through a unified structure – either by melding the two groups or by conceiving and forming an entirely new group.

In terms of composition, we respectfully request that the working group include representation from both the NOLF and NFSNO leadership and that its members include a wide variety of specialty nursing organizations. Also, to help ensure that its recommendations represent the best functional solutions, we ask that the group include nonbiased third party members with no vested interest in the outcome.

We urge the NFSNO and NOLF leaderships to address without delay the feasibility of forming a group that could meet between now and the next joint NFSNO/NOLF meeting in November 2000, and could present some preliminary direction for discussion and further action at that joint meeting. Understanding the importance of this effort, [MY ORG] would consider supporting this group as appropriate, always acknowledging limited financial and volunteer resources.

Now, more than ever, the nursing community must speak with one voice in forming and influencing policy that will affect the delivery of nursing care across all specialties and settings. We believe that specialty nursing must participate fully in this national agenda to improve patient care, while maintaining a vehicle to effectively and efficiently serve the special needs of its members, customers and other constituencies.

We feel strongly that the time is right, and the need urgent, for the formation of a working group that will address the best vehicle for such collaborative and collective work. We appreciate the timely consideration of this request, and we look forward to your response.

With best wishes,

Sincerely,

[Name]2000 President

cc: David HennageExecutive Director, ANA



FROM: Karen Laing RN, CGRN X_ ActionPresident

SUBJECT: Board of Directors Award

RECOMMENDATION: SGNA Board of Directors Give This Award to M. Eileen Widmer CAE

Justification: Eileen led us for three + years. She guided us to and through our first strategic plan and helped us to see the need for our new strategic plan. She helped us to gain financial stability by educating us in the often confusing process of budgeting and encouraged us to settle for nothing less than a balanced budget. Eileen taught us to see the SGNA as a business and served a coach and mentor to several Presidents and President-elects.

Time Frame/Target Date for Completion: May 2000

Financial Impact: Hotel for 2 nights $300.00 Airfare $360.00 Per Diem $150.00 Cost of award TBD

Staff Impact: none

Relation to Strategic Plan:

Action: ____ Approved ____Deferred ____Rejected

____Refer back to Committee ____Amend and Adopt


REPORT TO THE SGNA BOARD OF DIRECTORSFEBRUARY 2000

FROM: Sallie Walker, BA RN CGRN X ActionChair, Practice Committee

SUBJECT: Guideline on the Use of High Level Disinfectants and Sterilants for Reprocessing Of Flexible Gastrointestinal Endoscopes

RECOMMENDATIONS: Practice Committee recommends that the SGNA Board of Directors approve the attached recommended revisions to Guideline on the Use of High Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes.

Because additional compatibility statements are anticipated from a major endoscope manufacturer in the very near future, Practice Committee recommends that should these statements become available prior to publication deadline for this document, that these compatibility statements be incorporated into the guideline.

Relevant Strategic Goal/Objective: Goal 5: SGNA is positioned as the expert provider of information and data on practice issues within our specialty and identifies bridges between the scientific community and the practicing GI nurse.

Justification: Since the adoption of this guideline in February 1999, significant changes have occurred with changes in compatibility statements from a major endoscope manufacturer and with the introduction of a new high level disinfectant, 0.55% ortho-phthalaldehyde. These changes are reflected in the revision of this document. SGNA’s membership needs current information as they make purchasing decisions for endoscopes and the chemicals used to reprocess them.

This guideline is part of SGNA’s Self-Study Module on Reprocessing. Revisions of the other components of this module are also being presented to the Board at this time.

Time Frame: With the Board’s approval the revised guideline can be forwarded to Gastroenterology Nursing for publication in the next available issue. Reprints can be made available for purchase via Headquarters and the web site. The revised guideline will be incorporated into the third edition of SGNA’s Self- Study Module on Reprocessing at the same time as other updates are made.

Financial Impact: This guideline is made available for purchase alone and as part of the Self-Study Module. Both have generated income for SGNA. Because the cost of producing this item is carried as an inventory item on SGNA’s balance sheet, it requires no additional budgeted monies for production. In anticipation of changes to several components of the module, its inventory is down to one copy.

Staff Impact: Can be absorbed by current staff.Action: _____ Approved _____ Deferred _____ Rejected

_____ Refer back to Committee _____ Amend and Adopt

DRAFT

Guideline for the Use of


High-Level Disinfectantsand Sterilants for

Reprocessing of FlexibleGastrointestinal Endoscopes

Society of Gastroenterology Nurses and Associates, Inc.

Disclaimer

This document is based on current published data available at the time of publication. The Society of Gastroenterology Nurses and Associates, Inc. (SGNA) assumes no responsibility for the practices and recommendations of any member or other practitioner, or for the policies and procedures of any practice setting. The nurse and associate function within the limitations of licensure, state nurse practice act and/or institutional policy.

Acknowledgments

Prepared and written by the Society of Gastroenterology Nurses and Associates, Inc. Practice Committee, Chaired by Sallie B. Walker, RN CGRN, and adopted by the Society of Gastroenterology Nurses and Associates, Inc. Board of Directors, February 19992000. Published as a service to members by the Society of Gastroenterology Nurses and Associates, Inc.

Copyright © 19992000, Society of Gastroenterology Nurses and Associates, Inc. Additional reprints are available for purchase from the Society of Gastroenterology Nurses and Associates, Inc. (SGNA) Headquarters. To order, contact SGNA.

Department of Membership ServicesSociety of Gastroenterology Nurses and Associates, Inc.

401 N. Michigan Avenue3620 Swenson Avenue


Chicago, IL 60611-4267St. Charles, IL 60174800/245-SGNA (in Illinois, 312/321-5165)

Email: [email protected] www.SGNA.org

GUIDELINE FOR THE USE OF HIGH LEVEL DISINFECTANTS AND STERILANTS FOR REPROCESSING OF FLEXIBLE GASTROINTESTINAL ENDOSCOPES

PrefaceProfessional associations and regulatory agencies recognize high level disinfection as

the standard of care in reprocessing flexible endoscopes (American Society for Gastrointestinal Endoscopy [ASGE], 1996). Four Five chemicals are currently cleared by the Food and Drug Administration (FDA) as high level disinfectants and/or sterilants with general claims for reprocessing reusable medical devices: glutaraldehyde, 0.2 % peracetic acid, 7.5% hydrogen peroxide, and 0.08% peracetic acid/1% hydrogen peroxide, and 0.55% ortho-phthalaldehyde. This guideline provides information about the properties of these solutions, their safe and effective use and their compatibility with flexible endoscopes.

Definition of TermsEndoscope. In this document, refers only to flexible gastrointestinal endoscopes.High level disinfection (HLD). A process that results in the destruction of all vegetative

bacteria, viruses, fungi, and mycobacteria but not necessarily all bacterial spores. The Spaulding Classification identifies HLD as the standard for medical devices that touch mucous membranes, such as endoscopes (Association of Professionals in Infection Control and Epidemiology [APIC], 1996).

High level disinfectant/sterilant. A chemical germicide which has been cleared by the FDA as capable of destroying all microorganisms, including all bacterial spores, which when used at a shorter exposure time destroys all viruses, vegetative bacteria, fungi, mycobacteria and some, but not all, bacterial spores.

Material Safety Data Sheet (MSDS). A descriptive sheet that accompanies a chemical or chemical mixture, providing the identity of the material; physical hazard, such as flammability; acute and chronic health hazards associated with contact with or exposure to the compound.

Minimum effective concentration (MEC). The lowest concentration of active ingredient necessary to meet the label claim of a reusable high level disinfectant/sterilant.


Mutagen. A substance capable of inducing or accelerating changes in a gene or chromosome.

Sterilant. A chemical germicide which has been cleared by the FDA as capable of destroying all microorganisms, including all bacterial spores.

Sterile. The state of being free from all living organisms.Sterilization. A process that results in the complete elimination or destruction of all

forms of microbial life. The Spaulding Classification identifies sterilization as the standard for medical devices that enter the vascular system or sterile tissue, such as biopsy forceps (APIC, 1996).

Teratogen. An agent that increases the incidence of a congenital malformation.Threshold limit value ceiling (TLV-C). The airborne concentration of a substance that

should not be exceeded during any part of the work experience.Threshold limit value time-weighted average (TLV-TWA). The airborne concentration of

a substance to which all workers may be exposed day after day without experiencing any adverse health effects.

Use-life. Statement by the manufacturer of the maximum number of days a reusable high level disinfectant/sterilant might be effective.

General Principles Common to the Use of All High Level Disinfectants and/or Sterilants

Product SafetyNone of the four five chemicals addressed in this document is listed as a carcinogen. Glutaraldehyde is

neither a mutagen nor a teratogen (Union Carbide, 1995a). The Material Safety Data Sheet (MSDS) for peracetic acid lists information on mutagenicity and teratogenicity as “not available” (STERIS, 1997b). The MSDS for hydrogen peroxide does not address mutagenicity or teratogenicity (Reckitt & Colman, 1997). The MSDS for ortho-phthalaldehyde states the product is not reported to produce mutagenic, embryogenic, teratogenic or reproductive effects in humans.

It is imperative that healthcare workers who use any high level disinfectant and/or sterilant be familiar with and have readily accessible the product/brand-specific MSDS for all chemicals used, follow Occupational Safety and Health Administration (OSHA) guidelines, and keep current with developments in products, protective equipment, and practice.

Manual CleaningMeticulous manual cleaning of all instruments must precede exposure to any high level

disinfectant or sterilant. (Association of Operating Room Nurses [AORN], 1996a; APIC, 1996; ASGE, 1996; Society of Gastroenterology Nurses and Associates, Inc. [SGNA], 1996). Inadequate cleaning of instruments has been one factor cited in transmission of infection by flexible endoscopes (APIC, 1996; Akamatsu, Tabita, Hironga, Kawakami, and Uyeda 1996; Bronowicki, et al., 1997; Spach, Silverstein, and Stamm, 1993). Studies demonstrate that appropriate cleaning reduces the number of microorganisms and organic load by 4 logs or 99.9% (Rutala and Weber, 1995; Chu, McAlister, and Antonoplos, 1998). This significantly reduces the organic and microbial challenge to the high level disinfectant or sterilant. A detailed cleaning protocol for endoscopes is found in SGNA’s Standards for Infection Control and Reprocessing of Flexible Gastrointestinal Endoscopes (1997). Endoscope manufacturers’ guidelines should always be consulted for design features unique to a particular instrument.

Cleaning of endoscopes prior to chemical exposure includes purging the air/water channel, using enzymatic detergent solution for cleaning the exterior of the instrument, and brushing all valves and accessible channels. The endoscope must then be immersed in fresh enzymatic detergent solution, which is flushed through all channels. Some automated reprocessors provide for irrigation of enzymatic solution. If not, this step must be done manually prior to beginning the automated cycle.


Determining Minimum Effective ConcentrationGlutaraldehyde, 7.5% hydrogen peroxide, and 0.08% peracetic acid/1% hydrogen

peroxide and ortho-phthalaldehyde are reusable products. The challenges of microbes and organic matter, dilution by rinse water and age of the chemical solution result in a gradual reduction of the effectiveness of reusable high level disinfectant/sterilants. Reusable high level disinfectant/sterilants must be changed whenever the MEC fails or the use life expires, whichever comes first. The appropriate number of reuses of each of these products must be determined by testing that the solution is at or above its MEC. Use product-specific test strips. MEC should be monitored at least each day of use and more frequently as dictated by the number of endoscopes reprocessed (SGNA, 1997). Maintain a log of test results. [See Appendix A for a sample log.]

Final Rinse/Alcohol PurgeAll high level disinfectants or sterilants used to reprocess flexible endoscopes have the potential to injure

mucous membranes if not thoroughly rinsed from the endoscope. In addition, rinse water may contaminate the endoscope following chemical exposure. Sterile water is ideal for the final rinse but is impractical in most settings. Clean water may be used for the final rinse of the endoscope and its channels, followed by air-drying, a rinse with 70% isopropyl alcohol obtained from a tightly-closed container, and a second air drying of the instrument. Most automated reprocessors incorporate an optional water filtration system. Such systems may reduce the number of tap water contaminants but do not eliminate the need for the air/alcohol/air purge as the final step prior to storage.

Personal Protective EquipmentUse personal protective equipment when reprocessing endoscopes, as exposure to high

level disinfectants, sterilants and/or body fluids may occur. Gowns, gloves and protective eyewear are recommended when handling glutaraldehyde, 0.2% peracetic acid, 7.5% hydrogen peroxide, or 0.08% peracetic acid/1%hydrogen peroxide, or ortho-phthalaldehyde. Gowns should be impervious to fluid, have long sleeves that fit snugly around the wrist, and wrap to cover as much of the body as possible. Dispose of or launder gowns if they become wet or are exposed to contaminated material. Inspect gloves for tears or holes before use. Do not use an imperfect glove or reuse disposable gloves. Gloves should be long enough to extend up the arm to protect the forearm or clothing from splashes or seepage. To avoid cross-contamination, change gloves and wash hands whenever moving from a dirty to clean task or environment. Eye and/or face protection is necessary to protect against all four chemicals. Contact lenses are not sufficient eye protection. A face shield (or safety glasses in combination with a facemask allowing for ventilation) is recommended. Each reprocessing area must contain an eyewash station. The MSDS for each high level disinfectant and sterilant recommends evaluation by a physician in the event of eye exposure. Do not use high filtration masks since they may actually trap vapors.

Material CompatibilityEndoscopes and automated reprocessors are composed of a variety of materials such

as rubbers, plastics and metals that may be affected by ingredients in high level disinfectants or sterilants. Consult manufacturers of endoscopes and reprocessors for results of compatibility studies as part of the process of choosing a product. Incompatibility may result in changes in appearance and function of an endoscope. Use of a high level disinfectant or sterilant for which a manufacturer has not issued a compatibility statement may void the instrument’s warranty. Third-party repair companies may use different materials in replacement components than those of the original equipment manufacturer. If using the services of a third party for repairs, consult them for compatibility and warranty information. See Appendix B for a chart summarizing compatibility listing of endoscope manufacturers.


Susceptibility of Resistant OrganismsOrganisms such as gram negative rods and gram positive bacteria, which are frequent

contaminants of gastrointestinal endoscopes (Chu, McAlister, and Antonoplos, 1998), are susceptible to 2% glutaraldehyde, 0.2% peracetic acid, 7.5% hydrogen peroxide, and 0.08% peracetic acid/1% hydrogen peroxide. Other microorganisms of concern in gastroenterology settings, such as Clostridium difficile, Helicobacter pylori, Hepatitis C virus, Hepatitis B virus, Human immunodeficiency virus (HIV), Vancomycin-resistant enterococcus, Methicillin-resistant Staphylococcus aureus, and multi-drug-resistant tuberculosis are also sensitive to these products (APIC, 1996). It is not necessary to deviate from routine reprocessing protocols when exposure to such organisms is suspected, since to do so would constitute a “double standard” of care (APIC, 1996; Rutala, 1998b).

GlutaraldehydeGlutaraldehyde has been used for more than 30 years in many health care settings for

high level disinfection and cold sterilization. It is the most widely used high-level disinfectant/sterilant for reprocessing gastrointestinal endoscopes. Glutaraldehyde products are marketed under a variety of brand names and are available in a variety of concentrations, with and without surfactants. For reprocessing of endoscopes, a 2% glutaraldehyde solution that does not contain surfactant is recommended (ASGE, 1996).

Glutaraldehyde has excellent biocidal activity, is active in the presence of organic matter and is non-corrosive to metals, rubbers and plastics (APIC, 1996). Glutaraldehyde may be used in manual or automated reprocessing protocols. Olympus, Pentax and Fujinon list glutaraldehyde as compatible with their endoscopes. Glutaraldehyde is compatible with automated reprocessors except STERIS SYSTEM 1.

In 1995 the Society of Gastroenterology Nurses and Associates, Inc. (SGNA), in collaboration with the American Society for Gastrointestinal Endoscopy (ASGE), the American Gastroenterological Association (AGA), the American College of Gastroenterology (ACG), and the Association for Professionals in Infection Control and Epidemiology (APIC) adopted the position, based on scientific data, that after meticulous manual cleaning, high level disinfection is achievable with a 20 minute exposure at 20°C (room temperature) in a 2% glutaraldehyde solution which does not contain surfactant and which tests above its minimum effective concentration (ASGE, 1996). The Association of Operating Room Nurses (AORN, 1996b) concurs. These conditions may not be extended to other glutaraldehyde solutions. This recommendation differs from the label claims on 2% glutaraldehyde stating a 45-minute exposure at 25C for HLD because the current federal labeling regulation assumes no cleaning of the medical device prior to chemical exposure.

Two percent glutaraldehyde solutions range in concentration from 2.4 – 2.6% and have variable maximum use lives. For example, the maximum use life of an alkaline (activated) 2% glutaraldehyde without surfactants is 14 days. The actual use life of any reusable HLD/sterilant must be determined by testing for MEC with product-specific test strips. Labeling regulations require the manufacturer to place the MEC on the container. For example, test strips for 2.4% glutaraldehyde products are constructed to show failure when the concentration drops below 1.5% (Cotrell, Ltd., 1994).

Glutaraldehyde is an irritant and some individuals develop acute sensitivities (Union Carbide, 1995b). These sensitivities may be displayed as itching of the skin with slight redness, to redness and swelling or yellowing of the skin with prolonged exposure, or irritation to eyes and nasal membranes, headache, coughing, sneezing, and asthma-like symptoms. Glutaraldehyde can be absorbed by inhalation, ingestion and through the skin. It has a detectable odor at 0.04 parts per million volume (ppmv) and is irritating to skin and mucous membranes at 0.3 ppmv. Vapors are released whenever solutions are disturbed and the surface tension is broken. Mixing, adding and removing equipment, or disposing of a glutaraldehyde solution can cause a break in the surface tension (Notarianni, 1992).


Whenever the glutaraldehyde solution is not being accessed, it should be covered with a tight-fitting lid.

Provide adequate ventilation in areas where glutaraldehyde is in use. Ventilation systems should be installed by certified heating, ventilation and air conditioning (HVAC) professionals to ensure that the system designed for removal of glutaraldehyde does not interfere with other HVAC systems in the facility (Burkhart, 1991). Adequate ventilation, as described by AAMI (1995) and Burkhart (1991), includes the following:

Room large enough to ensure adequate dilution of vapors. 10 air exchanges per hour to allow volume flow rate of air moving through the room

to be at least 1.0 to 2.0 cubic feet per minute per square foot of floor area (Burton, 1994).

Exhaust located at the source of the discharge of vapors (pulling vapors away from the user’s breathing zone). This can be done by placing the exhaust fan at foot level or on a countertop and venting the vapors to the outside.

Fresh air return entering at ceiling level across the room from the exhaust vents. Routine maintenance and surveillance of the system to ensure continued proper

functioning. Elimination of cross-draft effects. Care should be taken to ensure that the discharge of the vapors is sufficiently

removed from windows, outside air intakes or other such openings to prevent reentry of the discharged air. Air must not be recirculated.

In areas where local exhaust ventilation systems are not in place, use ductless fume ventilation devices that contain filters to absorb glutaraldehyde vapors from the air. These hoods should achieve a face velocity of at least 100 feet per minute with the airflow directed toward the back of the hood, away from the user’s breathing zone (Burkhart, 1991).

In 1998, the American Conference of Governmental Industrial Hygienists (ACGIH) lowered its recommended TLV-C from 0.2ppm to 0.05ppm. Monitor glutaraldehyde vapors if there is reason to believe the TLV-C exceeds the recommendation, if an employee exhibits symptoms of overexposure, or following any corrective action taken to lower vapor levels. Devices are available for area monitoring and for monitoring of an employee’s breathing zone. Follow manufacturer’s directions to ensure that the device is used in a manner that will achieve the most accurate analysis. Monitor at the peak time of exposure, such as when fresh solutions are being mixed and transferred to containers.

Changing latex gloves every 15 minutes during periods of glutaraldehyde exposure or using double gloves provides up to a four-fold increase in permeation time compared with single latex gloves. One hundred percent nitrile rubber or 100% butyl rubber gloves are recommended for the best protection from glutaraldehyde. Neoprene and polyvinyl chloride (PVC) gloves are not recommended as these materials absorb and retain glutaraldehyde (Jordan, 1995).

Glutaraldehyde spills small enough not to cause tearing of the eyes and/or respiratory discomfort can be cleaned up with a mop, sponge or towel. Discard the saturated item in a tightly sealed biohazard bag. Rinse surfaces thoroughly with water. Large spills may require neutralization with sodium bisulfite or 2% dibasic ammonium phosphate. Have one of these chemicals available wherever glutaraldehyde is used. Be familiar with the MSDS recommendations for spill or leak procedures and consult with the institution’s Safety Officer to prepare a plan for handling spills.

In most states, glutaraldehyde solutions that have failed MEC tests can be discarded down the drain and flushed with large amounts of water. Triple-rinse empty containers from freshly activated solutions with water prior to disposal. Consult state and local regulations for possible differences in disposal requirements.

0.2% Peracetic AcidPeracetic acid is part of the family of peryoxygen compounds. The STERIS Corporation has marketed

STERIS 20 Sterilant Concentrate™, a 35% peroxyacetic acid concentrate, for use in the STERIS SYSTEM 1 for 10 years. STERIS SYSTEM 1 is FDA-cleared as a liquid chemical sterilization processor for medical devices. The processor dilutes and mixes this concentrate to its final concentration of 0.2% peracetic acid with a neutral pH, which is sporocidal at 50°C. The processing cycle is approximately 30 minutes and reaches temperatures of 50C-55.5C (122F-131.9F) during exposure time. (STERIS Corporation, 1997a).


The STERIS SYSTEM 1 has become widely used for reprocessing of flexible gastrointestinal endoscopes. Instruments processed with 0.2% peracetic acid must be handled and stored in a sterile manner upon removal from the STERIS SYSTEM 1 in order to be considered sterile at the point of next use.

A concentration of 0.2% peracetic acid is rapidly active against all microorganisms including bacterial spores, and is effective in the presence of organic matter. It is only available in the United States in conjunction with the automated STERIS SYSTEM 1. A chemical indicator for each cycle measures the ionic strength of buffering agents. A biological indicator is available, but may not be suitable for routine monitoring of liquid sterilants. Two criticisms are that the indicator is not able to be placed in the least accessible location of an endoscope, and that liquid sterilants are thought to cause spores to wash off the indicator strip (Rutala, 1998a; Rutala and Weber, in press). Fuselier and Mason (1997) published a study comparing STERIS SYSTEM 1 and manual reprocessing with a 2% glutaraldehyde solution for flexible cystoscopes. They concluded that clinical outcomes were the same.

When handled properly, the peracetic acid used in the STERIS SYSTEM 1 is self-contained, circulated around and through the endoscope via channel connectors, and discarded down the drain. The processor then rinses the instrument with large amounts of filtered water. Unlike other automated reprocessors, STERIS SYSTEM 1 has no capability of circulating enzymatic detergent solutions.

Pentax lists the STERIS SYSTEM 1 as compatible with its endoscopes. Olympus, in a letter to health care practitioners dated October 19, 1998 states,

Steris System I is not currently listed as a compatible product for use in reprocessing Olympus flexible endoscopes. However Olympus is currently engaged in a program to evaluate the compatibility of its flexible endoscopes with the Steris System I. Although Olympus lists as compatible only those products which have completed and passed our testing process, use of an unlisted disinfectant product does not automatically void the Olympus standard warranty. However, Olympus cannot accept the responsibility for damage or functional impairment attributable to the use of unlisted products, just as we cannot be responsible for damage or functional impairment which results for the improper use of a listed product. Such situations are not covered under the terms of our warranty (Goldstine, 1998).

As of the date of this publication, no compatibility data is available from Fujinon.Cartons of the peracetic acid concentrate should be stored upright in a cool, dry area (<86°F). Care

should be taken not to damage the STERIS 20 Concentrate™ sealed container. The concentrate may cause irritation of the nose, throat and lungs, and is corrosive to the eye and skin, potentially causing irreversible eye damage or severe burns. General or local exhaust ventilation systems are adequate. In the event of a spill or leak of the concentrate, increase ventilation and shut off ignition sources. Wearing protective equipment, flush spilled material with large quantities of water (at least 20 times the volume spilled). Consult the STERIS SYSTEM 1 user manual for information to assist in preparing a spill cleanup plan. Once diluted to 0.2%, peracetic acid is not considered a hazardous waste and can be safely discarded down the drain (STERIS Corporation, 1997b).

7.5% Hydrogen PeroxideIn 1998 a 7.5% hydrogen peroxide solution was reintroduced by Reckitt & Colman under the brand

name SPOROX™. This product is a reusable high level disinfectant/sterilant cleared by the FDA for HLD at a contact time of 30 minutes at 20°C (room temperature) when the MEC is validated by SPOROX™ test strips. No mixing or activation is required. Hydrogen peroxide is a rapid oxidizer and has wide biocidal properties. Two studies have favorably compared hydrogen peroxide with alkaline glutaraldehyde (Vesley, Norlien, Nelson, Ott, and Streifel, 1992; Sattar, Taylor, Paquette, and Rabino, 1996).

As with all other high level disinfectants or sterilants, meticulous manual cleaning is required prior to exposure to the high level disinfectant or sterilant. The maximum use-life of 7.5% hydrogen peroxide is 21 days but the actual use-life must be determined by validating that the minimum effective concentration of 6% is present. The 7.5% solution may be used in manual or automated reprocessing protocols. If using an automated reprocessor, check with the manufacturer for specific brand and model compatibility.

Hydrogen peroxide can cause damage to rubbers and plastics and can corrode aluminum, nickel-silver alloy and chrome plated steel (Reckitt & Coleman, Inc., 1998). In a technical bulletin dated October 15, 1999 covering all models of fiberoptic and videoendoscopes, Olympus withdrew its April and November 1998 compatibility statements regarding SPOROX™ (Olympus, 1999). Noting observed damage to insertion tubes in both clinical and laboratory settings, the technical bulletin concludes

At the present time it is not possible to predict if all models of Olympus flexible


endoscopes or all clinical sites using Sporox will experience durability problems. However, the results of current investigations of damage to rhinolaryngoscopes and colonoscopes, and observations of damage to gastroscopes and flexible cystoscopes, form the basis for the current decision not to list Sporox or Sporox II as a compatible sterilant/disinfectant for any Olympus flexible endoscope.Olympus lists SPOROX™ as compatible with 40 series, 140 series and 240 series endoscopes.

Cosmetic changes, including corrosion of the model name and serial number plates, progressive lightening of black anodized metal finishes and peeling of painted portions of the control body, particularly the eyepiece, and light guide connector were observed in 100-, 130-, 200- and 230-series GI videoscopes, 10-, 20- and 30-series fiberscopes and 10-, 20- and 30-series fiberoptic bronchoscopes and 200-series videobronchoscopes. SPOROX™ is not compatible with OSF or OSF-2 sigmoidoscopes. Olympus further notes that flexible endoscopes are not compatible with SPOROX™ at elevated temperatures (Olympus, 1998). Pentax states the compatibility studies for SPOROX™ are still being performed by the parent company in Japan. As of the date of this publication, nNo compatibility data information is available from Fujinon.

Hydrogen peroxide in a 7.5% concentration is a clear colorless liquid with an odor characteristic of peroxide. The TLV-TWA is established by ACGIH at 1ppm. A face shield or protective eyewear is mandatory, since this concentration can cause irreversible eye damage. Due to its corrosive nature it may be harmful or fatal if swallowed. Contact with skin may result in temporary whitening. Latex gloves provide protection (Reckitt & Colman, Inc, 1997).

Hydrogen peroxide solutions that have failed MEC tests can be discarded down the drain and flushed with large amounts of water. Triple-rinse empty containers with water prior to disposal. Consult state and local regulations for possible differences in disposal requirements.

0.08% Peracetic Acid/1% Hydrogen PeroxideAlso introduced as a high level disinfectant/sterilant in 1998 is a 0.08% peracetic acid/1% hydrogen

peroxide formula marketed by Advanced Sterilization Products as CIDEX*PA™. Manufacturer’s data demonstrates that this formula has wide biocidal activity at a 25-minute exposure time. This product is FDA-cleared as a high level disinfectant at 20°C at an immersion time of 25 minutes. No mixing or activation is required. It may be used in manual or automated reprocessing protocols. If using an automated reprocessor, check with the manufacturer for specific brand and model compatibility. As with all other high level disinfectants and sterilants, meticulous manual cleaning is required prior to exposure to the high level disinfectant or sterilant.

CIDEX*PA™ has a maximum use-life of 14 days. Its actual use-life must be determined by testing that the solution remains at or above its minimum effective concentration of 500 ppm. The manufacturer advises using three CIDEX*PA™ test strips each time the MEC is checked.

CIDEX*PA™ is incompatible with iron, copper alloys, and brass but has no affect on polyethylene, polypropylene, Teflon™, polyvinyl chloride, annodized aluminum or stainless steel (Advanced Sterilization Products, 1998a). Pentax states that compatibility testing with CIDEX*PA™ is still being performed by the parent company in Japan. Olympus (1988) has issued a technical bulletin with the following summary statement:

The use of CIDEX*PA™ Solution on Olympus endoscopes will not automatically void your standard Olympus warranty covering original materials and workmanship. However, due to the observed internal corrosion, Olympus does not endorse the use of CIDEX*PA™ on any Olympus endoscope and will not assume any liability for chemical damage to your Olympus endoscopes as a result of its use.

Data from the manufacturer of CIDEX*PA™ on compatibility testing with Olympus and Pentax endoscopes found that the solution had no deleterious affects on plastics, anodized aluminum or stainless steel. Endoscope failures that were noted were deterioration of the seals in the control head allowing fluid invasion and also failure of the bending rubber attributed to device handling (Advanced Sterilization Products, 1998b). Advanced Sterilization Products (1998, June 8) has advised users of CIDEX*PA™ that they

. . . will reimburse the user for repair of any functional damage to flexible endoscopes,


not including accessories, processed exclusively with CIDEX*PA™ solution, when such damage is shown to be caused by CIDEX*PA™ solution in excess of the rate of damage historically experienced and documented by the user with alkaline glutaraldehydes used for high level disinfection.

As of the date of this publication, no compatibility data is available from Fujinon. The solution is a clear colorless liquid with a mild vinegar odor. The TLV-TWA is established by

ACGIH at 1ppm. Environmental toxicity testing has found 0.08% peracetic acid/1% hydrogen peroxide has no known respiratory toxicity, and under normal use conditions special ventilation is not required. It may cause skin irritation. The solution is corrosive to eye tissue; face shield or protective eyewear is mandatory.

Prior to use, the product should be stored in its original container, away from direct sunlight, and in temperature-controlled conditions (15-30° C). Avoid contact with combustible materials. Empty containers of 0.08% peracetic acid/1% hydrogen peroxide should be triple rinsed prior to disposal. Residual solution breaks down into water, oxygen, acetic acid (vinegar) and hydrogen peroxide and can be disposed of down the drain.0.55% Ortho-phthalaldehyde

In late 1999, 0.55% ortho-phthalaldehyde (OPA) was introduced to market as CIDEX® OPA SOLUTION. It is cleared by the FDA as a high level disinfectant at 20C at an immersion time of 12 minutes (Advanced Sterilization Products, 1999). CIDEX® OPA is not intended nor is it cleared for use as a sterilant. No mixing or activation is required. A hospital-based study of ortho-phthalaldehyde found it to be effective in eradicating vegetative bacteria, fungi and parasites from bronchoscopes, gastroscopes and colonoscopes (Alfa and Sitter, 1994). Two studies have assessed its tubercuclocidal properties. One found it to be more rapidly tuberculocidal than glutaraldehyde in the laboratory setting (Gregory, Schaalje, Smart, and Robison, 1999). The other suggests that OPA is effective against glutaraldehyde resistant mycobacteria (Walsh, Maillard, and Russel).

CIDEX® OPA is a reusable product with a maximum use life of 14 days. Like all other reusable products, its actual use life must be ermined by testing that the solution remains at or above its minimum effective concentration of 0.3%. Studies indicate that OPA may remain above its MEC despite reuse and dilution better than glutaraldehyde (Gregory, Schaalje, Smart, and Robison, 1999; Alfa and Sitter, 1994).

Like other high level disinfectants, meticulous manual cleaning of medical devices must precede exposure to this product. CIDEX® OPA may be used in manual or automated reprocessing protocols. Check with manufacturers of automated reprocessors for specific compatibility statements.

Ortho-phthalaldehyde has a wide range of material compatibility. Pentax lists it as a compatible product. Olympus has not issued a compatibility statement at this time. No information is available from Fujinon.

CIDEX® OPA is a clear blue solution with little odor. It is a potential irritant of eyes, skin, nose and other tissues resulting in symptoms such as stinging, excessive tearing, coughing and sneezing. It is a potential skin and respiratory sensitizer that may cause dermatitis with prolonged or repeated contact and may aggravate pre-existing bronchitis or asthma. In addition, the product stains proteins on surfaces to grey/black.

Small spills may be cleaned up with a damp sponge or absorbent pad. Larger spills should be deactivated with 25 grams of glycine (free base) powder per gallon over 5 minutes. See the MSDS for specific control measures. Triple rinse empty containers with water prior to disposal. Spent solutions of ortho-phthalaldehyde may be disposed of down the drain unless prohibited by state and local regulations.Summary

Glutaraldehyde, 0.2% peracetic acid, 7.5% hydrogen peroxide, and 0.08% peracetic acid/1% hydrogen peroxide, and 0.55% ortho-phthalaldehyde are cleared by the FDA for reprocessing flexible gastrointestinal endoscopes. Each product has advantages and disadvantages. All require adherence to published reprocessing protocols in order to maintain the integrity of equipment while providing the public with endoscopic instruments that are safe and effective. All chemicals must be handled with respect. Selection of a product must be weighed against the needs of a particular setting, taking into consideration factors such as


compatibility, toxicity, environmental controls and cost.

References

Advances Sterilization Products. (1999). Cidex® OPA solution material safety data sheet (015, revision C). Irvine, CA: Author.

Advanced Sterilization Products. (1998a). Cidex™PA material safety data sheet (011). Irvine, CA: Author.

Advanced Sterilization Products. (1998b). Compatibility of CidexPA solution with endoscopes (AD-07732). Irvine, CA: Author.

Advanced Sterilization Products. (1998, June 8). Materials compatibility warranty. Irvine, CA: Author.

Akamatsu, T, Tabita, K, Hironga, M., Kawakami, H., & Uyeda, M. (1996). Transmission of Helicobacter pylori infection via flexible fiberoptic endoscopy. American Journal of Infection Control, 24, 396-401.

Alfa, M., & Sitter, D. (1994). In-hospital evaluataion of orthophthalaldehyde as a high level disinfectant for flexible endoscopes. Journal of Hospital Infection, 26, 15-26.

American Conference of Governmental Industrial Hygienists. (1998). Threshold limit value and biological exposure indices. Cincinnati, OH: Author, 40.

American Society for Gastrointestinal Endoscopy. (1996). Reprocessing of flexible gastrointestinal endoscopes. Gastroenterology Nursing, 19, 109-112.

Association for the Advancement of Medical Instrumentation. (1995). Glutaraldehyde: Safe use and handling document. Philadelphia: Author.

Association of Operating Room Nurses. (1996a). Recommended practices for chemical disinfection. In Standards and recommended practices (pp.147-150). Denver, CO: Author.

Association of Operating Room Nurses. (1996b). Top 10 most frequently asked questions: Disinfection/glutaraldehyde. Denver, CO: AORN Center for Nursing Practice, Research and Health Policy.

Association of Professionals in Infection Control and Epidemiology. (1996). APIC guideline for selection and use of disinfectants. American Journal of Infection Control 24, 313-342.

Bronowicki, J., Venard, V., Botté, C., Monhoven, N., Gastin, I., Chloné, L., Hudziak, H., Rhin, B., Delanoë, C., LeFau, A., Bigard, M., & Gaucher, P. (1997). Patient to patient transmission of hepatitis C virus during colonoscopy. New England Journal Medicine 337, 237-240.

Burkhart, J. (1991). NIOSH health hazard evaluation report (NIOSH Report No. 90-296). Washington, DC: U. S. Government Printing Office, 12.

Burton, J. (1994). Laboratory ventilation workbook (2nd ed.). Bountiful, UT: IVE, Inc.Chu, N., McAlister, D., & Antonoplos, P. (1998). Natural bioburden levels detected on flexible

gastrointestinal endoscopes after clinical use and manual cleaning. Gastrointestinal Endoscopy, 48, 137-142.

Cotrell, Ltd. (1994). ProCide® 14 N.S. activated dialdehyde material safety data sheet. Englewood, CO: Author.

Fuselier, H., & Mason, C. (1997). Liquid sterilization versus HLD in the urologic office. Urology, 50, 338-340.

Goldstine, Steve. (1998, October 19). Dear healthcare practitioner [information memo]. Melville, NY: Olympus America.

Gregory, A., Schalje, G., Smart, J., & Robison, R. (1999). The mycobactericidal efficacy of orthyphthalaldehyde and the comparative resistances of Mycobacterium bovis, Mycobacterium terrae, and Mycobacterium chelonae. Infection Control and Hospital Epidemiology, 20, 324-330.

Jordan, S. (1995). The correct use of glutaraldehyde in the healthcare environment. Gastroenterology Nursing, 18, 142-145.


Notarianni, G. (1992). Glutaraldehyde overexposure: Myth or reality? Libertyville, IL: Passim Publishing, 20, 22, and 24. (Reprinted from Notarianni, G. (1992). Glutaraldehyde overexposure: Myth or reality? Journal of Healthcare Materials Management, 10.)

Olympus America. (1999, October 15). Compatibility of Olypus flexible endoscopes with Sporox and Sporox II (Covered Models: All fiberoptic and videoendoscopes). (Technical bulletin.). Mellville, NY: Author.

Olympus America. (1998, November 2). Compatibility testing of Sporox™ with Olympus flexible endoscopes (technical bulletin). Melville, NY: Author.

Olympus America. (1998, April 15). Compatibility of Cidex*PA™ solution with Olympus flexible endoscopes (technical bulletin). Melville, NY: Author.

Reckitt & Colman, Inc. (1997). Sporox™ material safety data sheet. Wayne, NJ: Author.Reckitt & Colman, Inc. (1998). Sporox™ package insert. Wayne, NJ: Author.Rutala, W. (Ed.). (1998a). Disinfection, sterilization and antisepsis in health care.

Washington, DC: Association for Professional in Infection Control and Epidemiology, Inc.Rutala, W. (1998b, May). Infection control update. Lecture presented at 25th Annual SGNA

Educational course, Denver, CO.Rutala, W., & Weber, D. J. (1995). FDA Labeling requirements for disinfection of

endoscopes: A counterpoint. Infection Control & Hospital Epidemiology 16, 231-235.Rutala, W., & Weber, D. J. (1999). Disinfection of endoscopes: Review of new chemical

sterilants used for HLD. Infection Control and Hospital Epidemiology, 20, 69-76.Sattar, S., Taylor, Y., Paquette, M., & Rabino, J. (1996). In-hospital evaluation of 7.5%

hydrogen peroxide as a disinfectant for flexible endoscopes. Canada Journal of Infection Control, 11:51-54.

Society of Gastroenterology Nurses and Associates. (1997). Standards for infection control and reprocessing of flexible gastrointestinal endoscopes [Monograph]. Gastroenterology Nursing, 20, insert after 70 .

Spach, D., Silverstein, F., Stamm, W. (1993). Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Annals of Internal Medicine, 118, 117-128.

STERIS Corporation. (1997a). STERIS SYSTEM 1 operator manual (612025 REV. F). Mentor, OH: Author.

STERIS Corporation. (1997b). STERIS 20™ material safety data sheet (No: 612038 REV.E). Mentor, OH: Author.

Union Carbide. (1995a). Long-term human health hazard evaluation of glutaraldehyde. Bioshare Focus Sheet (UC 508). Danbury, CT: Author.

Union Carbide. (1995b). Skin contact, irritation, sensitization, & prevention of glutaraldehyde. Bioshare Focus Sheet (UC-504). Danbury, CT: Author

Vesley, D., Norlien, K., Nelson, B., Ott, B., & Streifel, A. (1992). Significant factors in the disinfection and sterilization of flexible endoscopes. American Journal of Infection Control, 20, 291-300.

Walsh, S., Maillard, J-Y., & Russel, A. (1999). Ortho-phthalaldehyde: A possible alternative to glutaraldehyde for high level disinfection. Journal of Applied Microbiology, 86, 1039-1046.

Appendix A: Sample MEC Log


Facility NameMINIMUM EFFECTIVE CONCENTRATION LOG

FOR :________________________

Pan/Reprocessor: _____DATE # PASS/FAIL MEC INITIAL COMMENT

EXAMPLE:

Smith Endoscopy CenterMINIMUM EFFECTIVE CONCENTRATION LOG FOR : 2.4%

GLUTARALDEHYDE

Pan/Reprocessor: B

DATE # USES PASS/FAIL MEC INITIALS COMMENT2/1/99 16 Pass MJ Last changed on 1/26/992/2/99 24 Pass MJ2/3/99 31 Pass MJ2/4/99 38 Pass MJ2/4/99 39 Pass MJ2/4/99 40 Pass MJ2/4/99 41 Fail MJ Changed 11am 2/4/992/5/99 3 Pass MJ

Appendix B: HLD Compatibility with Endoscopes (Data provided by endoscope manufacturers)

Olympus Pentax FujinonGlutaraldehyde C C C0.2% Peracetic Acid NC C NS7.5% Hydrogen peroxide NC* NC NS0.08% peracetic acid/1% hydrogen peroxide

NC NC NS

0.55% Orthy-phthalaldehyde NS C NS

C = company lists as compatibleNC = company does not list as compatible


NS = no statement* with most series endoscopes; see Olympus Technical Bulletin for specific models

Appendix C

Sterilants and High Level Disinfectants cleared by FDA in a 510(k) as of 10/1/98 with General Claims for Processing Reusable

Medical and Dental Devices

CENTER FOR DEVICES AND RADIOLOGICAL HEALTH OFFICE OF DEVICE EVALUATION DIVISION OF DENTAL, INFECTION CONTROL AND GENERAL HOSPITAL DEVICES

Sporicidin International

Sporicidin Sterilizing and Disinfecting Solution (0.95% glut and 1.64% phenol/phenate), K983194

Sterilant Claim - 12 hours at 25 ° C, maximum reuse of 7 daysHigh Level Disinfection Claim - 20 minutes at 25 ° C, maximum reuse of 7 days

Johnson & Johnson Medical Products, IncCidexTM Activated Dialdehyde Solution (2.4% glut), K924434

Sterilant claim - 10 hours immersion at 25 ° C, maximum of 1 4 days reuse High Level Disinfection claim - 45 minutes at 25 ° C, maximum of 14 days reuse

Cidex Formula 7TM Long-Life Activated Dialdehyde solution (2.5% glut), K924334Sterilant claim - 10 hours at 20 - 25 ° C, maximum reuse of 28 daysHigh Level Disinfection claim - 90 minutes at 25 ° C, maximum reuse of 28 days

Cidex PlusTM 28 Day Solution (3.4% glut), K923744Sterilant claim - 10 hours at 20 - 25 ° C, maximum reuse of 28 days High Level Disinfection claim - 20 minutes at 25 ° C , maximum reuse of 28 days

Metrex Research, Inc.Metricide® Activated Dialdehyde Solution (2.6% Glut), K930284


Metricide Plus 30® Long-Life Activated Dialdehyde Solution (3.4% Glut), K931592



Metricide® 28 day Long-Life Activated Dialdehyde Solution (2.5% glut), K931052Sterilant Claim - 10 hours at 25 ° C, maximum reuse of 28 daysHigh Level Disinfection Claim - 90 minutes at 25 ° C, maximum reuse of 28 days

Cottrell LimitedProcide® 14 N.S. (2.4% glut), K932922


OmnicideTM Long Life Activated Dialdehyde Solution ( 2.4% glut), K932922Sterilant Claim - 10 hours at 20 ° C, maximum reuse of 28 daysHigh Level Disinfection Claim - 45 minutes at 20 ° C, maximum reuse of 28 days

OmnicideTM Plus (3.4% glut), K932922 Sterilant Claim - 10 hours at 20 ° C, maximum reuse of 28 daysHigh Level Disinfection Claim 45 minutes at 20 ° C, maximum reuse of 28 days

Wave Energy SystemsWavicide® - 01 (2.5% glut), K914749


STERIS ®CorporationSTERIS 20™ Sterilant (0.2% peracetic acid), K875280

Sterilant Claim - 12 minutes between 50-56 °C, single use only. Only cleared for use with the STERIS System 1TM Processor.

Minntech Corporation

Peract™ 20 Liquid Sterilant/Disinfectant (0.08% peroxyacetic acid and 1.0% hydrogen peroxide) K960513

Sterilant Claim - 8 hours at 20 °C, maximum reuse of 14 daysHigh level Disinfection Claim - 25 minutes at 20 °C, maximum reuse of 14 days.

Reckitt & Colman Inc.Sporox™ Sterilizing & Disinfection Solution (7.5% hydrogen peroxide), K970230

Sterilant Claim - 6 hours at 20 ° C, maximum reuse life of 21 daysHigh Level Disinfection Claim - 30 minutes at 20 ° C, maximum reuse life of 21 days


MedSci, Inc.MedSci 3% Glutaraldehyde (3% glut), K974062


Cetylite Industries, Inc.Cetylcide-G® Concentrate and Diluent Concentrate (3.2% glut), K974188


(Updated March 20, 1999)

http://www.fda.gov/cdrh/ode/germlab.html


REPORT TO THE SGNA BOARD OF DIRECTORS FEBRUARY 2000

FROM: Sallie Walker BA RN CGRN X ActionChair, Practice Committee

SUBJECT: Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes

RECOMMENDATIONS: Practice Committee recommends that the SGNA Board of Directors approve the attached revisions to Standards for Infection Control and Reprocessing of Flexible Gastrointestinal Endoscopes. In addition, Practice Committee recommends that SGNA Board of Directors notify the ASGE Board of Governors that this document has been revised.

Relevant Strategic Goal/Objective: Goal 5: SGNA is positioned as the expert provider of information and data on practice issues within our specialty and identifies bridges between the scientific community and the practicing GI nurse.

Justification: SGNA guidelines, standards and position statements are generally reviewed every two to three years. This document was last adopted by the Board in 1996 and published in Gastroenterology Nursing, vol. 20, March/April 1997. The Committee reviewed current practice and published information and recommends the revisions shown in the attached draft.

This standard is part of SGNA’s Self-Study Module on Reprocessing. Revisions of the other components of this module are also being presented to the Board at this time.

The ASGE Board of Governors has incorporated the original edition of this standard into its Practice Guideline: Infection Control in Gastrointestinal Endoscopy and makes SGNA’s Standard available on the ASGE website. ASGE should use the revised standard or delete the original edition, substituting a link to SGNA for its current standard.

Time Frame: With the Board’s approval the standard can be forwarded to Gastroenterology Nursing for publication in the next available issue. Reprints can be made available for purchase via Headquarters and the web site. The revised standard will be incorporated into the second edition of SGNA’s Self-Study Module on Reprocessing at the same time as other components are updated.

Financial Impact: The cost of producing this item is carried as an inventory item on SGNA’s balance sheet, therefore no additional budgeted monies are required.

Staff Impact: Can be absorbed by current staff.

Action: _____ Approved _____ Deferred _____ Rejected


Standards forof


Infection Controlandin Reprocessing of FlexibleGastrointestinal Endoscopes

DisclaimerThe Society of Gastroenterology Nurses and Associates, Inc. presents this guideline for

use in developing institutional policies, procedures, and /or protocols. Information contained in this guideline is based on published data and current practice.

The Society of Gastroenterology Nurses and Associates, Inc. assumes no responsibility for the practices or recommendations of any member or other practitioner, or for the policies and practices of any practice setting.

The registered nurse functions within the limits of state licensure, state nurse practice act, and institutional policy.

AcknowledgmentsPrepared and written by the Society of Gastroenterology Nurses and Associates, Inc.


Practice Committee, chaired by Darlene Modelski, MBA, RN CNOR, CANSallie B. Walker, BA RN CGRN, and adopted by the Society of Gastroenterology Nurses and Associates, Inc. Board of Directors, 19962000. Published as a service to members by the Society of Gastroenterology Nurses and Associates, Inc.

Copyright © 19972000, Society of Gastroenterology Nurses and Associates, Inc. Additional reprints are available for purchase from Society of Gastroenterology Nurses and Associates, Inc. Headquarters. To order, please write or call SGNA.


401 N. Michigan Avenue3620 Swenson AvenueChicago, IL 60611-4267St. Charles, IL 60174

312/321-5165800/245-SGNA

www.sgna.orgSTANDARDS FOR OF INFECTION CONTROL AND IN REPROCESSING OF

FLEXIBLE GASTROINTESTINAL ENDOSCOPES

IntroductionPrefaceThese standards are presented jointly by the Society of Gastroenterology Nurses

and Associates, Inc. (SGNA) and the American Society for Gastrointestinal Endoscopy (ASGE) as the guideline to be used for all settings where gastrointestinal endoscopy is practiced. These standards complementwere originally developed to complement the 1996 position statement Reprocessing of Flexible Gastrointestinal Endoscopes published in 1996 by SGNA and the American Society for Gastrointestinal Endoscopy (ASGE), and serve as the interpretive document for the 1994 guidelines of the AmericalAmerican Society for Testing and Materials (ASTM) F 1518,-1994 ASTM Standard Practice for Cleaning and Disinfection of Flexible Fiberoptic and Video Endoscopes Used in the Examination of the Hollow Viscera. The current version complements SGNA’s 2000 Guidelines for the Use of High Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes.

Proper reprocessing of endoscopes and accessories is critical to the safe and successful treatment of patients. SGNA and ASGE support increased research in the areas of endoscope design and encourage manufacturers to develop flexible gastrointestinal endoscopes that can be easily disassembled for reprocessing and verification of cleaning and high level disinfection. Because endoscopes which cannot be completely immersed in liquid cannot be adequately cleaned, tThe use of non-immersible endoscopes is no longer acceptable because endoscopes which cannot be completely immersed in liquid cannot be adequately cleaned and high-level disinfected.

PersonnelOnly individuals who are able to read, understand, and implement instructions on

the proper cleaning and high level disinfection of gastrointestinal endoscopes and accessories should be given the responsibility to reprocess such instruments. In addition, these individuals must meet annual competency standards for endoscope reprocessing. Temporary personnel should not be allowed to clean or disinfect instruments in either a manual or an automated reprocessing system.

Education and TrainingAll staff in any setting where gastrointestinal endoscopy is performed must adhere to


http://www.sgna.org/

infection control principles that will maintain a safe environment, free from the possibility of spreading disease to patients and coworkers. This is true regardless of the setting, that is, hospital, clinic, or office, or the variety of gastrointestinal (GI) procedures performed.

Infection control education, therefore, is a critical part of the orientation and continuing education for all personnel, including physicians, nurses, and assistive personnel who work in the gastrointestinal endoscopy setting. Components of this education program should include the following: (1) universal precautions; (2) Occupational Safety and Health Administration (OSHA) rules on occupational exposure to bloodborne pathogens (OSHA Law 29 CRF part 1910); (3) reprocessing procedures for endoscopes and accessory equipment; (4) mechanisms of disease transmission; (5) maintenance of a safe work environment; (6) safe handling of liquid chemical germicideshigh level disinfectants and sterilants; and (7) procedures for waste management. Additional training with documented competency must be done for new models of endoscopes or automatic endoscope reprocessors as they are introduced in the facility. Annual updates are recommended in order to stay up to date to ensure compliance with current standards and manufacturers’ guidelines.

Decisions must be made in each endoscopy setting regarding the number and category of personnel who will be responsible for instrument reprocessing. All persons involved, even on an occasional basis, must be properly trained and their performance subject to periodic review and continuing education. All individuals who reprocess endoscopes and accessories require detailed knowledge of the instruments and specific methods required to produce an instrument safe for use. This knowledge is developed through repetition and the guidance of a preceptor. There should be documentation of completion of the initial infection control orientation/reprocessing competency and subsequent annual competency review and infection control update for each individual who reprocesses instruments. (See Appendicxes I and II, Sample Formats for Reprocessing Competency.)

Quality AssuranceEach setting where gastrointestinal endoscopy is performed must have an effective

quality assurance program with special emphasis on cleaning and high level disinfection of flexible endoscopes. Elements of the quality assurance program include supervision, training, annual competency review, methods of assuring the availability of appropriate equipment and supplies, and procedures for reporting infections.

Supervisory personnel must be familiar with the principles and practices of instrument reprocessing if they are to properly train and monitor staff. Knowledgeable supervisors also serve to impress upon peer groups and subordinates of the importance of these functions.

There must be a policy of invariable adherence to the reprocessing protocol. The protocol and its implementation should be reviewed periodically to assure that it is being followed routinely and that there is no new information that would require a modification. Modifications should be made with care. Consultation with an infection control advisor should be considered when modifications to the reprocessing protocol are made. The review process and protocol modifications should be documented.

There should be a designated individual in the endoscopy setting assigned to monitor compliance with the reprocessing protocol. The understanding and performance of each individual involved in reprocessing should be reviewed at least annually.

Monitor reusable liquid-chemical germicideshigh-level disinfectants and sterilants for minimum effective concentrations at least each day of use. A log of results should be maintained. Liquid-chemical germicidesHigh-level disinfectants and sterilants must be


changed when the solutions fail to meet minimum effective concentration or exceed the manufacturers’ recommended use life, whichever comes first.

Document Mmonitoring of liquid-chemical germicidehigh-level disinfectant and sterilant vapor levels annually and when a change in the disinfection phase of the reprocessing protocol occurs, when a different liquid-chemical germicidehigh-level disinfectant or sterilant is used, or when a staff member exhibits symptoms of overexposure. For details, refer to SGNA’s Guideline for the Use of High Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes.

A preventative maintenance plan should be in place for all automated reprocessors. Quality controls recommended by manufacturers should be adhered to and documented.

Report any suspected or identified infections to those responsible for infection control in the endoscopy setting. Performing routine cultures of endoscopes is not recommended but may be done in the event of an identified outbreak.

Procedure RoomsTo prevent cross contamination in an endoscopic procedure room, most areas of the

room should be designated as clean areas. Contaminated areas where accessories and specimens are handled should be separated from clean counter areas. All contaminated areas must be cleaned and decontaminated between patients with an Environmental Protection Agency (EPA)-registered hospital grade disinfectant.

Negative pressure rooms or rooms with air circulated through high-efficiency particulate air (HEPA) filters are recommended when endoscopy is performed on patients with known or suspected tuberculosis.

Reprocessing RoomReprocessing of contaminated patient equipment should be done in an area designated

and dedicated for this function. This should be a room separate from where endoscopic procedures are performed. Current local and state codes and federal guidelines should be incorporated in the design of any reprocessing area. Considerations include adequate space for reprocessing activities, proper airflow and ventilation requirements, work flow patterns, work surfaces, lighting, adequate utilities such as electrical support and water, handwashing and eye washing facilities, air drying capability, and storage.

Tap water and/or water that has been filtered by passage through a 0.2 micron filter or water of equivalent quality (i.e., suitable for drinking) should be available in the reprocessing area. Bottled sterile water may be used.

Reagents needed for reprocessing include a low-sudsing, enzymatic detergent formulation recommended for endoscopes, ana Food and Drug AdministraionAdministration (FDA)-cleared liquid chemical germicide high-level disinfectant or sterilantappropriate for high-level disinfection of endoscopes, and 70% isopropyl alcohol. An EPA-registered hospital-grade disinfectant should be sused for surface cleaning.

Liquid-Chemical GermicideHigh-Level Disinfectant/Sterilant Spill Containment Plan

Each endoscopy setting should have a spill containment plan specific for the liquid-chemical germicidehigh-level disinfectant or sterilant used. The information from the specific material safety data sheet should be incorporated into the plan. The plan should include written procedures for actions to contain the spill and deactivate the chemical, an intra- and inter-departmental communication plan, and an evacuation plan. All persons working in the setting must be trained on the safe handling of liquid-chemical germicideshigh-level disinfectants or sterilants and spill containment procedures upon assignment to the department and annually


thereafter. Refer to manufacturer’s instructions for information on the specific solution.

Accessories The FDA requires manufacturers of reusable devices to provide instructions for cleaning and high-level disinfection or sterilization. Refer to manufacturer’s guidelines for specifics on reprocessing of endoscopic accessories. Accessories which are classified as critical devices (break the mucus membrane and/or come into contact with sterile tissue or the vascular system) require sterilization. Critical items labeled for single-use should not be reprocessed and/or reused.

Reprocessing ProtocolThe reprocessing protocol presented here outlines basic steps to clean and perform

high level disinfection of gastrointestinal endoscopes. Manufacturers’ instructions should always be consulted for design features unique to a particular instrument which require specific reprocessing detail. While this protocol specifically addresses gastrointestinal endoscopes, its steps may be applied to reprocessing other types of flexible endoscopes.

1. PREPARING THE ENDOSCOPE FOR CLEANINGThe initial steps in the reprocessing protocol begin in the patient room

immediately after removal of the insertion tube from the patient and prior to removing the endoscope from the power source.

Have the following available:- Personal protective equipment (gloves, eye protection, impervious gown, face

shield or simple surgical mask that will not trap vapors).- Container with enzymatic detergent solution.- Sponge or soft, lint-free cloth.- Air and water channel cleaning adapters per manufacturer's instruction.- Protective video caps (if using video endoscopes).

Immediately after removing the endoscope from the patient, wipe the insertion tube with the wet cloth or sponge soaked in the freshly-prepared enzymatic detergent solution.- Dispose of the cloth/sponge between cases.

Place the distal end of the endoscope into the enzymatic detergent solution. Suction the solution through the biopsy/suction channel until the solution is visibly clean. Alternate suctioning detergent solution and air several times. Finish by suctioning air.- Alternate suctioning of fluid and air is more effective than suctioning fluid alone

in the removal of debris from internal lumens.- Immediate flushing of the biopsy/suction and air/water channels precludes

drying of organic and inorganic debris on lumen surfaces and may remove large numbers of microorganisms.

Flush or blow out air and water channels in accordance with the endoscope manufacturer's instructions.

Detach the endoscope from the light source and suction pump.

Attach protective video cap (if using video endoscope).


Transport the endoscope to the reprocessing area in an enclosed container.- Containers, sinks and basins should be large enough that the endoscope will not

be damaged by being coiled too tightly.- A container will prevent contamination during transport.- Reprocessing should occur in a room separate from the procedure room.

2. CLEANING THE ENDOSCOPE IN THE REPROCESSING AREA Have the following available:

- Personal protective equipment (gloves, eye protection, impervious gown, face shield or simple surgical mask that will not trap vapors)

- Leakage testinger equipment- Channel cleaning adapters (per manufacturer's instructions)- Large basin of enzymatic detergent solution prepared according to

manufacturer's instructions- Channel cleaning brushes and lint-free cleaning swabs- Sponge and/or lint-free cloth

3. LEAK TESTING Leak test the endoscope following manufacturer's instructions.

Attach the leak tester and pressurize the scope before submerging it in water. Some manufacturers specify removing detachable parts prior to leak testing, some do not.

Remove the detachable parts of the endoscope.

With the pressurized endoscope insertion tube completely submerged, flex the distal portion of the scope in all directions, . Oobservinge the insertion tube, distal bending section and the universal cord for bubbles. Submerge the entire endoscope and observe the head of the scope, the insertion tube, distal bending section and the universal cord for bubbles coming from the interior of the scope.- The leak test will detect damage to the interior or exterior of the endoscope. The

leak test is done before immersion of the endoscope in reprocessing solutions in order to minimize damage to parts of the endoscope not designed for fluid exposure.

Follow the manufacturer's instructions if a leak is detected or the endoscope appears damaged.

4. CLEANINGManual Mechanical cleaning of endoscopes is necessary immediately after

removing the endoscope from the patient and prior to automated or manual disinfection. This is the first and most important step in removing the microbial burden from an endoscope. Retained debris may inactivate or interfere with the capability of the active ingredient of the liquid-chemical germicide solution to effectively kill and/or inactivate microorganisms. Cleaning gastrointestinal endoscopes is necessary prior to automated or manual disinfection. Fill a sink or basin with freshly made solution of water and a low-sudsing enzymatic

detergent compatible with the endoscope.

Dilute according to the detergent manufacturer's instructions.


- Depending on the detergent formulation used, a specific water temperature may be essential to activate the detergent solution.

- Use fresh detergent solution for each endoscope to prevent cross contamination.

- Low-sudsing detergents are recommended such that the device can be clearly visualized during the cleaning process to preclude personnel injury and to allow for complete cleaning of lumen surfaces. Excessive sudsing can inhibit good fluid contact with the device surfaces.

Immerse the endoscope.

Wash all debris from the exterior of the endoscope by brushing and wiping the instrument while submerged in the detergent solution. Whenever practical, leave the endoscope submerged in the detergent solution when performing all subsequent cleaning steps.- The instrument should be left under water during the cleaning process to

prevent splashing of contaminated fluid.

Detach the suction and air/water valves, the biopsy channel cover, the distal end hood, if present, and all other removable parts. Discard those parts that are designated as disposable.- The endoscope must be completely disassembled so that all surfaces may be

reached for thorough cleaning.

Use a small, soft brush and/or lint-free cleaning swab to clean all removable parts including inside and under the suction valve, air/water valve, and biopsy port cover and openings.- Use of non-abrasive and lint-free cleaning tools will prevent damage to the

endoscope.

Brush all accessible endoscope channels including the body, insertion tube and the umbilicus of the endoscope. Use a brush size compatible with each channel.

After each passage, rinse the brush, removing any visible debris in the detergent solution before retracting and reinserting it.

Continue bushing until there is no debris visible on the brush.

Discard single use channel cleaning brushes. Clean and high-level disinfect reusable brushes between cases.- Reusable brushes should be inspected between uses and replaced when worn,

frayed, bent, or otherwise damaged. Worn bristles are ineffective in cleaning, and damaged brushes may damage endoscope channels.

Attach all the manufacturer’s cleaning adapters for suction, biopsy, air and water channels.

Attach the manufacturer’s cleaning adapters for special endoscope channels (e.g., elevator channel, forward water jet, double-channel scopes).- In order to achieve adequate flow through all lumens, various adapters or

channel restrictors may be required. Refer to the manufacturer's instructions.


- Because the elevator channels of these scopes have small lumens, force greater than can be generated by an automated reprocessor is needed to force fluid through them. This channel requires manual reprocessing (all steps) using a 23- to 5-milliliter syringe. Although the elevator channels of these scopes have channel adapters that may be made to fit reprocessors, this channel must be manually reprocessed.

Flush all channels with the detergent solution to remove debris.

Soak the endoscope and its internal channels for the period of time specified by the label of the enzymatic detergent. Prolonged soaking of the channels in the enzymatic detergent solution may be beneficial if there has been a delay in beginning the cleaning process.

5. RINSE AFTER CLEANING Thoroughly rinse the endoscope and all removable parts with clean water to remove

residual debris and detergent.

Purge water from all channels using forced air. Dry the exterior of the endoscope with a soft, lint-free cloth to prevent dilution of the liquid chemical germicide used in subsequent steps.

6. HIGH LEVEL DISINFECTIONHigh level disinfection (HLD) is recognized as the minimum standard of

care recommended for the reprocessing of gastrointestinal endoscopes by the Society of Gastroenterology Nurses and Associates (SGNA), the American Society for Gastrointestinal Endoscopy (ASGE), the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), the Association for Professionals in Infection Control and Epidemiology (APIC), and the American Society for Testing and Materials (ASTM. ), and aAgencies such as the Centers for Disease Control and Prevention (CDC) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO) recognize HLD as appropriate for gastrointestinal endoscopes. The only circumstance where sterilization of the endoscope is required is for use in a sterile, operative field.

HLD destroys all vegetative microorganisms but not necessarily all bacterial spores. The liquid-chemical germicide (LCG)high-level disinfectant or sterilant used to achieve HLD should be prepared in accordance with manufacturer's directions. Because these LCGs most high-level disinfectants/sterilants are typically reused, they must be tested to assure that they remain above their minimum effective concentration (MEC). Refer to the Guideline for the Use of High Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes for additional information on this topic. There are a variety of LCGs available such as glutaraldehyde, which is marketed in a variety of concentrations, and peracetic acid. In 1995, ACG, AGA, APIC, ASGE and SGNA adopted the following position on use of non-surfactant 2% glutaraldehyde products: after meticulous cleaning, high-level disinfection is achievable with a 20-minute soak at room temperature using a 2% glutaraldehyde solution that tests above its minimum effective concentration. Follow manufacturer's recommendations to achieve high-level disinfection for all other liquid-chemical germicideshigh-level disinfectants and sterilants. Refer to the position statement entitled Reprocessing Flexible Gastrointestinal Endoscopes for


additional information on this topic. The only circumstance where sterilization of the endoscope is required is for use in a sterile, operative field.

7. USING LIQUID CHEMICAL GERMICIDES HIGH-LEVEL DISINFECTANTS AND STERILANTS Prepare the germicide product according to manufacturer's labeling instruction.

Test the germicide product for the MEC on each day of use and more frequently as dictated by the number of endoscopes being reprocessed.- The use-life of a reusable high-level disinfectant/sterilant is related to several

factors including, but not limited to: dilution, time/temperature and number of uses. It is essential that the level of active ingredient be at or above that required to kill and/or inactivate the desired microorganisms.

- In each facility a quality study is recommended to assist in determining guidelines for your particular circumstances.

Use the test strip specific for the brand of germicide. Keep a log of the test results. The MEC may not be used to extend the use-life claim of the germicide.

Use a product-specific test strip and keep a log of the test results.

- * The use-life of a reusable LCG is related to several factors including, but not limited to: dilution, time/temperature and number of uses. It is essential that the level of active ingredient be at or above that required to kill and/or inactivate the desired microorganisms.

8. MANUAL DISINFECTION Completely immerse the endoscope and all removable parts in a basin of LCGhigh-

level disinfectant/sterilant. The basin must be of a size to accommodate the endoscope without undue coiling and must have a tight-fitting lid to contain the vapors of the LCG.- In order to prevent damage to the endoscope, do not soak any sharp instruments

with the endoscope that could potentially damage the endoscope.

Inject disinfectant solution into all channels of the endoscope until it can be seen exiting the opposite end of each channel. Take care that all channels are filled with LCG the chemical and that no air pockets remain within the channels.- Complete microbial destruction cannot occur unless all surfaces are in complete

contact with the LCGchemical.- Because Since internal contact cannot be visually confirmed because of scope

design, perfusion until a steady flow of solution is observed is necessary to ensure complete contact.

Cover the LCG soaking basin with a tight-fitting ledlid to minimize chemical vapor exposure.- Exposure to chemical vapors may present a health hazard. The reprocessing

area should have engineering controls to ensure good air quality.

Soak the endoscope in the LCG high-level disinfectant/sterilant for the time/temperature required to achieve HLD. Use a timer to verify soaking time.


Flush Purge all channels completely with air before removing the endoscope from the high-level disinfectant/sterilant LCG.- Purging the LCG from the channels preserves the concentration and volume of

LCG the chemical and prevents exposure from dripping and spilling.

9. RINSE AFTER MANUAL DISINFECTION Thoroughly rinse all surfaces and removable parts, and flush all channels of the

endoscope and its removable parts with large copious amounts of clean water.- Rinsing prevents exposure and potential injury of skin and mucous membranes

from chemical residue.- Use fresh water for each endoscope.

10. DRYING Purge all channels with air.

- Bacteria such as Pseudomonas aeruginosa, a common contaminant of have been identified in both tap and filtered water, and fungi may multiply in a moist environment.

- Avoid the use of excessively high air pressure. High pressure air can damage the internal channels of flexible GI endoscopes.

Flush all channels, including accessory channels, with alcohol until the alcohol can be seen exiting the opposite end of each channel.- 70 to 80% isopropyl alcohol is used as a solvent to assist in drying the interior

channel surfaces. Alcohol mixes with the remaining water on the channel surfaces and acts to encourage evaporation of the residual water as air flows through the channel.

- Use fresh alcohol which has been properly stored in a closed container between uses. Alcohol, when exposed to air, rapidly evaporates, and if below the recommended percentage level, cannot be relied upon to assist in the drying process.

- Alcohol purges flushes should be used even when sterile water is used for rinsing.

Purge all channels with air.- Alcohol mixes with the remaining water on the channel surfaces and acts to

encourage evaporation of the residual water as air flows through the channel. Air assists alcohol in evaporating any retained moisture.

Remove all channel adapters.

Dry the exterior of the endoscope with a soft, clean lint-free towel.

Thoroughly rinse and dry all removable parts. Do not attach removable parts (valves, etc.) to the endoscope during storage.- Storage of endoscopes with the removable parts detached lowers the risk of

trapping liquid inside the instrument and facilitates continued drying of the channels and channel openings.

11. STORAGE Hang the endoscope vertically with the distal tip hanging freely in a well-ventilated,


dust-free cabinet.- Correct storage of the GI endoscope will prevent damage to the exterior of the

device by protecting the device from physical impact.- A storage cabinet with good ventilation will encourage continued air drying of

the surfaces and prevent undue moisture build-up in the cabinet interior thus discouraging any microbial contamination of the cabinet surfaces.

- Correct storage of the GI endoscope will prevent damage to the exterior of the device by protecting the device from physical impact. Padding the lower portion of the cabinet with non-porous material will prevent damage to the distal end of the scope.

12. AUTOMATED REPROCESSINGEndoscope reprocessors standardize the disinfection process and decrease

personnel exposure to high-level disinfectants and sterilants. However, nNo currently available automated reprocessors provide adequate cleaning of endoscopes. It is necessary to follow all steps for the mechanical manual cleaning of the endoscope prior to using an automated reprocessor.

An automated endoscope reprocessor should have the following features: (1) the machine should circulate fluids through all endoscope channels at an equal pressure without trapping air; (2) the detergent and disinfectant cycles should be followed by thorough rinse cycles and forced air to remove all used solutions; (3) the disinfectant should not be diluted with any fluids; (4) the machine should be self-disinfecting; (5) no residual water should remain in hoses and reservoirs; and (6) cycles for alcohol flushing and forced air drying are desirable.

Prepare the endoscope reprocessor according to manufacturer's guidelines.

Place the endoscope in the reprocessor and attach all channel adapters according to manufacturer's instructions.- As of 1996, there are no automated reprocessors on the market which perfuse

fluids at sufficient pounds per square inch (psi) to access elevator channels of ERCP scopes, including all Olympus and Fujinon duodenoscopes and all Pentax duodenoscopes manufactured prior to 1992.

- Because tThe elevator channels of these most dudenoscopes have is a very small lumens., force greater than can beSince most automated reprocessors cannot generated by automated reprocessors is the pressure required needed to force fluid through them the lumen, a 3-5 ml syringe must be used to. This channel requires manually reprocessing (all steps) using a 2-5cc syringethe elevator channel. Although the elevator channels of these scopes have channel adapters that may be made to fit reprocessors, this channel must be manually reprocessed. Users should check with their endoscope manufacturer for model-specific information.

Place valves and other removable parts into the soaking basin of the reprocessor. Unless the reprocessor has a dedicated space for accessories, reprocess these items separately.

If the machine has a cycle which uses enzymatic detergent, it should be a product which is compatible with the reprocessor and the endoscope.- Improper amounts and dilution of the enzymatic detergent may allow detergent

residue to remain on the internal and external surfaces of the endoscope, and/or


on the sink surfaces of the reprocessor. DEnzymatic detergent residue may interfere with the action of the high-level disinfectant or sterilantLCG.

Set the machine for the appropriate time and temperature depending on the disinfectant chemical used.

Start the machine and allow it to complete all cycles/phases.- If cycles/phases are interrupted, HLD cannot be ensured.

If a final alcohol rinse cycle is not included in the automated reprocessor, this step should be done manually followed by purging all the channels with air.

Drying and storage are the same as described in manual disinfection.

***************************

SGNA's videotape Reprocessing of Flexible Gastrointestinal Endoscopes (19962000) and the cleaning chart Steps Necessary to Thoroughly Clean and High Level Disinfect Immersible GI Flexible Endoscopes (2000) are companion pieces to this document.

BIBLIOGRAPHYAlvarado, C. J., & Reichelderfer, M. (in press). APIC guidelines for infection prevention and

control in flexible endoscopy. Association for Professionals in Infection Control and Epidemiology, Inc. American Journal of Infection Control.

American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Society of Gastroenterology Nurses and Associates. (1996). Reprocessing of flexible gastrointestinal endoscopes. Gastroenterology Nursing, 19 (3), 109-112.

American Society for Testing and Materials. (1994). ASTM standard for cleaning and disinfection of flexible fiberoptic and video endoscopes used in the examination of the hollow viscera (F-1518-1994). West Conshohocken, PA: Author.

EPA begins testing hospital disinfectants as sterilant testing program nears completion. (1995). Infection Control and Hospital Epidemiology, 16 (4), 248-250.

Cheung, R. J., Ortiz, D., & DiMarino, Jr., A. J. (1999). GI endoscopic reprocessing practices in the United States. Gastrointestinal Endoscopy, 50, 362-368.

Food and Drug Administration and Centers for Disease Control and Prevention. (1999, September 10). Public Health Advisory: Infections from endoscopes inadequately reprocessed by an automated endoscope reprocessing system. (1999, September 10). Rockville, MD: Author.

Favero, M. S. (1991). Strategies for disinfection and sterilization of endoscopes: The gap between basic principles and actual practice. Infection Control and Hospital Epidemiology, 12, 279-281.

Kobs, A. (1996). Glutaraldehyde: The controversy. Infection Control and Sterilization Technology, April.

Liquid disinfection and sterilizing reprocessors used for flexible endoscopes. (1994). Health Devices, 23, 212-253.

Martin,. M. A., & Reichelderfer, M. (1994). APIC guidelines for infection prevention and control in flexible endoscopy. Association for Professionals in Infection Control and Epidemiology, Inc. 1991, 1992, and 1993 APIC Guidelines Committee. American Journal of Infection Control, 22, 19-38.


Rutala, W. A. (1996). APIC guideline for selection and use of disinfectants. 1994, 1995, and 1996 APIC Guidelines Committee. Association for Professionals in Infection Control and Epidemiology, Inc. American Journal of Infection Control, 24, 313-342.

Rutala, W. A., & Weber, D. J. (1995). FDA labeling requirements for disinfection of endoscopes: A counterpoint. Infection Control and Hospital Epidemiology 16, 231-235.

Society of Gastroenterology Nurses and Associates. (1996). The safe and effective handling of glutaraldehyde solutions [Monograph]. Gastroenterology Nursing, 19, insert after 190.

Society of Gastroenterology Nurses and Associates. (1996). The steps necessary to thoroughly clean and high level disinfect or sterilize immersible GI flexible endoscopes (2nd ed.). [Wall chart]. Chicago: Author.

Society of Gastroenterology Nurses and Associates, Inc. (in press). Guideline for the use of high level disinfectants and sterilants for reprocessing of flexible gastrointestinal endoscopes. Gastroenterology Nursing.

Society of Gastroenterology Nurses and Associates, Inc. (2000). The steps necessary to thoroughly clean and high level disinfect or strilize immersible Gi flexible endoscopes (3rd ed.). [Wall chart]. Chicago: Author.

Spach, D. H., Silverstein, F. E., & Stamm, W. E. (1993). Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Annals of Internal Medicine, 118, 117-128.

APPENDIX IENDOSCOPE REPROCESSING COMPETENCY

OUTPATIENT SERVICESCENTRAL BAPTIST HOSPITAL

I have read the Standard for Infection Control and Reprocessing of Flexible Gastrointestinal Endoscopes, the ASTM Standard for Cleaning and Disinfection of Flexible Endoscopes and the SGNA Cleaning and Disinfection chart, the SGNA Guideline for the Use of High-Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes, and reviewed SGNA's videotape on reprocessing before presenting for competency review.

Signature __________________________________Date ____________________________

COMPETENCY CRITERIA

MET/NOT MET * Wears personal protective equipment including gown, gloves, eye protection

MET/NOT MET * Avoids contaminating clean objects with dirty gloves

MET/NOT MET * Bubbles air to clear air/water channel

MET/NOT MET * Suctions scope until fluid is clear, ends by suctioning air to clear fluid from scope

MET/NOT MET * Wipes exterior of scope with clean wet cloth

MET/NOT MET * Leak tests scope


MET/NOT MET * Brushes all valves and channels

MET/NOT MET * Brushes lip of biopsy port

MET/NOT MET * Loads endoscope properly in reprocessor with correct attachments

OLYMPUS gastroscope/colonscope PENTAX gastroscope/colonscope OLYMPUS 2-channel gastroscope OLYMPUS bronchoscope

MET/NOT MET * Disinfects brush

MET/NOT MET * Empties pan

MET/NOT MET * Removes personal protective gear

MET/NOT MET * Washes hands before leaving reprocessing room

I certify that this individual has met all competencies for reprocessing endoscopes.

Signature _____________________________________ Date ___________________________

Reprinted with permission APPENDIX II

UNIVERSITY OF MICHIGAN HEALTH SYSTEMS

COMPETENCY CHECKLIST CLINICAL PRACTICEENDOSCOPE WASHING AND DISINFECTION

NAME: ___________________________________________DATE: ____________________________

Critical Behavior

1. Recognizes cleaning and disinfecting solutions used and length of effective use-life and soak times.

2. Verbalizes knowledge of initial gross decontamination and process immediately following procedure.

3. Demonstrates the process of manual washing and brushing

Evaluation

Observation by staff experienced in endoscope cleaning and disinfection process.

Verbalization to experienced staff/preceptor.

Observation by experienced staff.

Initials of Reviewer


all channels for the following endoscopes:

Upper and lower endoscopes Double channel endoscopes Duodenoscope Bronchoscope Endoscopic ultrasound scopes

4. Demonstrates the process of manual disinfection for endoscopes including final rinse, alcohol purge and forced air drying.

5. Demonstrates the use of automatic reprocessor for high-level disinfection for appropriate endoscopes including alcohol; the final process of pumping with alcohol and forced air drying.


___________________________________Signature of Reviewer

Reprinted with permission APPENDIX II

UNIVERSITY OF MICHIGAN HEALTH SYSTEMSCLINICAL PRACTICE

COMPETENCY:ENDOSCOPE WASHING AND DISINFECTION

Critical Behavior

1. Recognize cleaning and disinfecting solutions used and length of effective use-life and soak times.

2. Verbalizes knowledge of initial gross decontamination and process immediately following procedure.

3. Demonstrates the process of manual washing and brushing all channels for the following endoscopes:

Upper and lower endoscopes Double channel endoscopes


Duodenoscope Bronchoscope

4. Demonstrates the use of automatic reprocessor for high-level disinfection for appropriate endoscopes including alcohol; the final process of pumping with alcohol and forced air drying.


Learning Resources

1. Infection Control Manual;2. Product labeling; enzymatic detergents and chemical disinfectants.3. SGNA Position Statement "Reprocessing of Flexible Gastrointestinal Endoscopes"4. ASTM standards for cleaning and disinfection endoscopes.5. SGNA's Consensus Standard for Infection Control and Reprocessing Flexible Gastrointestinal Endoscopes6. Manufacturer's Operating Manual7. SGNA's videotape on reprocessing endoscopes

Evaluation

Observation by staff experienced in endoscope cleaning and disinfection process.

Verbalization to experienced staff/preceptor.


Observation by experienced staff

Reprinted with permission


EPORT TO THE SGNA BOARD OF DIRECTORSFEBRUARY 2000

FROM: Sallie Walker BA RN CGRN X ActionChair, Practice Committee

SUBJECT: Guidelines for Nursing Care of the Patient Receiving Sedation and Analgesia in the Gastrointestinal Endoscopy Setting.

RECOMMENDATION: Practice Committee recommends that the SGNA Board of Directors approve the attached revisions to Guidelines for Nursing Care of the Patient Receiving Sedation and Analgesia in the Gastrointestinal Endoscopy Setting.

Relevant Strategic Goal/Objective: Goal 5: SGNA is positioned as the expert provider of information on practice issues within our specialty and identifies bridges between the scientific community and the practicing GI nurse.

Justification: SGNA guidelines, standards and position statements are generally reviewed every two to three years. This document was last adopted by the Board in 1996 and published in Gastroenterology Nursing, vol. 20, March/April 1997. The Committee reviewed current practice and published information and recommends the revisions shown in the attached draft.

Time Frame: With the Board’s approval the Guideline can be forwarded to Gastroenterology Nursing for publication in the next available issue. Reprints can be made available for purchase via Headquarters and the web site.

Financial Impact: The cost of producing this item is carried as an inventory item on SGNA’s balance sheet, therefore no additional budgeted monies are required.

Staff Impact: Can be absorbed by current staff.

Action: _____ Approved _____ Deferred _____ Rejected


DRAFT

Guidelines for

Nursing Care of the Patient


Receiving Sedation and Analgesia in the Gastrointestinal Endoscopy Setting

Society of Gastroenterology Nurses and Associates, Inc.

DisclaimerThe Society of Gastroenterology Nurses and Associates, Inc. presents this guideline for use in developing

institutional policies, procedures, and/or protocols. Information contained in this guideline is based on published data and current practice.

The Society of Gastroenterology Nurses and Associates, Inc. assumes no responsibility for the practices or recommendations of any member or other practitioner, or for the policies and practices of any practice setting.

The registered nurse functions within the limits of state licensure, state nurse practice act, and institutional policy.

AcknowledgmentsPrepared and written by the Society of Gastroenterology Nurses and Associates, Inc. (SGNA) Practice

Committee, chaired by Darlene Modelski, MBA RN CNOR CNASallie B. Walker, BA RN CGRN and adopted by the Society of Gastroenterology Nurses and Associates, Inc.SGNA Board of Directors, 19962000. Published as a service to members by the Society of Gastroenterology Nurses and Associates, IncSGNA.

Copyright © 19972000, Society of Gastroenterology Nurses and Associates, Inc. Additional reprints are available for purchase from Society of Gastroenterology Nurses and Associates, Inc. (SGNA) Headquarters. To order, please write or call SGNA.


401 N. Michigan Avenue3620 Swenson AvenueChicago, IL 60611-4267St. Charles, IL 60174

312/321-5165800/245-SGNA or 630/584-9200

www.sgna.org


IntroductionThe delivery of health care in the field of gastroenterology and endoscopy is expanding, thus modifying the traditional role of the registered nurse (RN). Comprehensive care of the patient undergoing an endoscopic procedure continues to be more critical in nature, and more technically complex in technology, and more comprehensive in scope. Nursing care of the patient has changed to includes a continuous comprehensive nursing assessment, monitoring, administration and maintenance of conscious sedation and analgesia under the direction of a physician, administration of reversal agents, use of state-of-the-art equipment during diagnostic and complex therapeutic procedures, and documentation of all of the above.The safe administration and maintenance of sedation and analgesia are the most important responsibilities of the RN who is working in a gastrointestinal endoscopy setting. The Society of Gastroenterology Nurses and Associates, Inc. (SGNA) supports the position that RNs trained and experienced in gastroenterology nursing and endoscopy be given the responsibility of administration and maintenance of sedation and analgesia by the order of a physician. In addition, the gastroenterology RN can be given the responsibility for the administration of reversal agents prescribed by the physician. The gastroenterology RN has education and experience in endoscopy, knowledge of medications used, and the skills to assess, diagnose, and intervene in the event of complications. Whether or not the RN actually administersed the medications, he/she is responsible for monitoring and assessing the patient receiving sedation and analgesia throughout diagnostic and therapeutic gastrointestinal procedures. Automatic monitoring devices may enhance the ability to accurately assess the patient, but these are no substitute for the watchful, educated assessment by the RN.Because of the importance assigned to managing the patient who is receiving sedation and analgesia, a second nurse or associate is required to assist the physician with those procedures that are complicated either by the severity of the patient’s illness and/or the complex technical requirements associated with advanced diagnostic and therapeutic procedures.

Definition of TermsSedation and Analgesia describes a state that allows patients to tolerate unpleasant procedures while

maintaining adequate cardiorespiratory function and the ability to respond purposefully to verbal command and/or tactile stimulation.

Monitoring is the measurement of physiologic parameters, including the use of mechanical devices as well as clinical observations. The RN may delegate this function.

Assessment is the continuous, systematic collection, validation, and communication of patient data for the purpose of planning, implementing and evaluating nursing care. Assessment is directed toward the attainment of specific patient outcomes. The RN should not delegate this function.

Assistive personnel are staff without a nursing license (e.g., GI assistants, medical technicians, repiratory therapists) who have direct patient care responsibility and are supervised by an RN.

Sedation and Analgesia: General PrinciplesThe information in this guideline applies to all patients receiving sedation and


analgesia for diagnostic or therapeutic gastrointestinal procedures, inpatient or outpatient, adult or pediatric. The standard of care should be consistent throughout all settings where gastrointestinal endoscopy is performed, such as the physician’s office, outpatient clinic, or hospital endoscopy unitsetting.

Throughout the entire endoscopyic process, the nurse or associate assistive personnel should provide verbal reassurance to the patient. This minimizes patient discomfort and adverse response to stress, promotes patient cooperation, and potentially lessens the amount of sedation and analgesia required.

Every patient receiving sedation and analgesia for a diagnostic or therapeutic procedure requires assessment and monitoring throughout the entire process. Patient assessment is provided by an RN. Included in the RN’s assessment are physiologic parameters, level of comfort, warmth and dryness of skin, and level of consciousness. The task of monitoring the patient shouldmay be assigned to an Licensed Practical Nurse/Licensed Vocational Nurse R(LPN/LVN) or associate assistive personnel, although responsibility for patient assessment remains with the registered nurse. Minimal physiologic monitoring for patients of all ages includes observation of oxygen saturation, blood pressure, pulse, and respiratory rate and effort. Patients who have a history of cardiac disease or anomaly require ECG monitoring throughout the sedation and analgesia process. Individuals who are responsible for assessment and/or monitoring of patients receiving sedation and analgesia should be trained in basic cardiac life support. The Society of Gastroenterology Nurses and Associates, Inc. (SGNA) It is recommendeds that an individual who is trained in advanced cardiac life support be immediately available in the practice setting.

Physiologic data from continuous monitoring should be documented at baseline, at least every 5 minutes during medication titration and at least every 15 minutes thereafter. until the patient meets preestablished discharge criteria. Intervals should be shortened with changes in the patient status, need for additional medication, and increased complexity of the procedure. Monitoring may be discontinued when the patient meets criteria established by the facility.SGNA recognizes that there is variation betweenamong individual state nurse practice acts regarding the intravenous administration of sedation and analgesia by the RN and the licensed practical nurse/licensed vocational nurse (LPN/LVN). The nurse responsible for administeringration of sedation and analgesia should have knowledge of all medications administered, including the manufacturer’s recommendations regarding dosages, titration, possible side effects, and the use of reversal agents. The nurse responsible for administration of the patient receiving sedation and analgesia should have knowledge and skills to assess, diagnose, and intervene in the event of complications or undesired outcomes resulting from medication administration. Reversal agents should be available, but routine administration of reversal agents is not recommended.A quality improvement program is essential in any practice setting where sedation and analgesia are administered. Outcome monitors are a critical component of this program.

Pre-procedure PhaseNursing Care of the Patient and Documentation Before and Endoscopic Procedure.A nursing assessment can only be performed by an RN. The purpose of the pre-procedure assessment is to

evaluate the status of the patient, obtain baseline physiologic parameters, and identify factors that may increase the patient’s risk during the procedure. (Refer to SGNA’s Guidelines for Documentation in the GI Setting.) Minimal nursing assessment includes, but is not limited Special attention should be paid to, the following:

Age Communication barriers Vital signs (pulseheart rate, blood pressure, respiration rate, oxygen saturation) Current weight Warmth, color, dryness of skin


Allergies (drugs, foods, latex) Current medications History of alcohol, tobacco, and substance use or abuse Medication history for sedation/analgesia/anesthesia and/or problems Relevant medical/surgical history (e.g., renal, hepatic, cardiacheart, lungpulmonary, neuro, glaucoma,

pregnancy) Airway patency Current health problems Level of comfort (e.g., pain, nausea, vertigo, weakness) Level of consciousness Mobility and safety measures Nothing-by-mouth status Mental status Type of bowel preparation and results Laboratory results, if indicated Pregnancy status, if applicable.

Verify signed, informed consent before the procedure.Verify outpatient is accompanied at discharge by a person responsible for transportation with a responsible adult for outpatients.

Establish venous access for the administration of intravenous medications and for intravenous fluids.Obtain baseline cardiac rhythm strip for patients whose physical status warrants such monitoring.

Explain the procedure, including medications used for sedation and analgesia and what the patient can anticipate before, during, and after the procedure.

Post-procedure instructions may also should be reviewed with the patient before sedation and analgesia.

Intra-procedure PhaseNursing Care of the Patient and Documentation during the Endoscopic Procedure.

Sedation and analgesia are administered upon the order of a licensed physician.Intravenous sedative/analgesic medications should be given in small incremental doses and titrated to the desired end points of sedation and analgesia, while maintaining intact protective reflexes. Sufficient time must elapse between dosages to allow the effect of each dose to be assessed.Assessment of level of consciousness the effects of sedation and analgesia includes:

1. Level of consciousness on a continuum from:Purposeful communication Verbal response Onset of slurred speech Response to verbal and/or tactile stimuli Response to painful stimuliVerbal responsePurposeful communication.

Desired effects of sedation include1. Intact protective reflexes


2. Relaxation3. Cooperation4. Diminished verbal communication5. Easy arousal from sleep6. Decreased pain perception.

Monitor and document the patient’s vital signs response throughout the entire procedure. This Monitoring includes:

1. Physiologic monitoring blood pressure, pulse,heart rate respiration rate, and oxygen saturation. C c ontinuous cardiac monitoring may be indicated according to patient status.

2. Observe and assess lLevel of consciousness, medication response, and 3. pPatient’s tolerance to the procedure (e.g., pain)and medications. 4. Other Eevents such as (but not limited to)

emesis, cardiorespiratory depression and/or distress, vasovagal reaction, or diaphoresis should be documented. In addition, documentation should include

5. Interventions and subsequent patient response.6. Document tTime, dosage, route, and response for all medications administered; document 7. tType and amount of fluids and blood products infused.

8. Assess and document the status and disposition of the patient upon completion of the procedure.

Post-procedure PhaseNursing Care of the Patient and Documentation After and Endoscopic Procedure.

Continue assessment and monitoring until the patient meets discharge criteria established by the facility.

Document any unusual events or post-procedure complications, the management of those events, and patient response.

Review and provide written instructions regarding diet, medications, activity restrictions, follow-up care, and course of action if a complication develops.

Verify Ooutpatients should be is accompanied at discharged to by a person responsible for transportationadult.

Special ConsiderationsAdult Patients.

Special consideration should be given to medication dosages, staffing, and monitoring for patients who are at increased risk for developing complications secondary to sedation/analgesia. Risk factors include the following:

Age >60 years Inability to cooperate Significant developmental delay Severe comorbidity (e.g., cardiac, pulmonary, hepatic, renal, or central nervous system disease) Morbid obesity


History of sleep apnea History of drug or alcohol abuse Pregnancy Emergency procedure with lack of patient preparation Metabolic or aAirway anomaliesdifficulties

Pediatric Patients.Staffing: Procedures performed on pediatric patients often require more time and personnel than procedures

performed on adults. In acknowledgment of the unpredictable nature of the response of the pediatric patient to sedative and analgesic medications, SGNA takes the position that all endoscopic procedures performed on pediatric patients require dthe availability of two staff members, including at least one RN.

Developmental Approach: When working with the pediatric patient and family, verbal reassurance during the procedure, as well as pre-procedure teaching, needs to be done according to the developmental stage of the patient.

Medications: Nurses involved in the sedation of children should be aware of the unpredictable absorption, metabolism, and excretion of medications in this population. Medication doses should be titrated accordingly.

Monitoring: Pediatric patients undergoing sedation and analgesia should be monitored by individuals who are familiar with normal pediatric vital signs and are trained in basic life-support measures. Patient assessment is provided by an RN. SGNA It is recommendeds that an individual who is trained in pediatric advanced life support (PALS) be immediately available in the practice setting.

Discharge criteria: Individuals caring for the child who has been given conscious sedation and analgesia should be given activity restrictions that are appropriate for the child’s developmental level. Activities that require good coordination and alertness to ensure safety are not appropriate for children who have been sedated (e.g., bicycle riding, swimming, climbing). Infants should be placed on their sides for sleeping after the procedure. Discharge criteria established by the American Academy of Pediatrics include the following:

Cardiovascular function and airway patency are satisfactory and stable. The patient is easily arousable and protective reflexes are intact. The patient can talk (if age-appropriate). For a very young or handicapped child, incapable of the usually expected responses, the pre-sedation

level of responsiveness or a level as close as possible to the normal level for that child should be achieved.

The state of hydration is adequate.

Assessing Competency for the Administration of Conscious Sedation and AnalgesiaTo ensure uUniformity of quality patient care must be ensured in areas where conscious sedation and

analgesia is administered., cCompetency-based education should be a part of orientation and review for all staff members involved in the administration of sedative agents or monitoring patients who have received sedation and analgesia. Current literature suggests that the following criteria be used for development of such a program. The nurse should:

The nurse should dDemonstrate acquired knowledge of anatomy, physiology, pharmacology, cardiac ardysrhythmia recognition, and complications related to intravenous conscious sedation and analgesia and medications.

The nurse should dDemonstrate total patient assessment during intravenous conscious sedation and analgesia and recovery.

The nurse should uUnderstand the principles of oxygen delivery, respiratory physiology, transport and uptake., and

D emonstrate proficiency in airway management, including the ability to use oxygen-delivery devices. The nurse should bBe knowledgeable of the potential complications of intravenous conscious sedation

and analgesia in relation to the type of medication being administered. The nurse should deDmonstrate skills to assess, diagnose, and intervene in situations consistent with

institutional protocols and guidelines. The nurse should demonstrate proficiency in airway management. The nurse should bBe knowledgeable regarding age-specific needs of patient populations under his/her

care.


Suggested Readings Allgayer, H., Pohl, C., & Druis, S. (1999). Arterial oxygen desaturation during endoscopic ultrasonography

combined with gastroscopy: A safety evaluation in out-patients. Endoscopy, 31, 447-451.American Society for Gastrointestinal Endoscopy. (1995). Sedation and monitoring of pateints undergoing

gastraointestinal endoscopic procedures. In ASGE Procedure Manual (Publication No. 1022). Manchester, MA: Author. <http://www.asge.org/resources/manual/pe_sedation.html>

American Society of Anesthesiologists. (1996). Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology, 84(2), 459-471.

Beck, M., & Evans, N. G. (Eds.). (1993). Gastroenterology nursing: A core curriculum. St. Louis: Mosby-Year Book.

Bell, G. D. (1991). Recommendations for standards of sedation and patient monitoring during gastrointestinal endoscopy. Gut, 32(7), 823-827.

Committee on Drugs, American Academy of Pediatrics. (1992). Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics, 89(6), 1110-1115.

Higgins, T. L., Hearn C. J., Maurer, W. G., & Vidt, D. G. (1996). Conscious sedation: What an internist needs to know. Cleveland Clinic Journal of Medicine, 63, 355-361.

Joint Commission on Accreditation of Healthcare Organizations. (19995). 19962000 comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: Author.

Kidwell, J., (1991). Nursing care of the patient receiving conscious sedation during gastrointestinal endoscopic procedures. Gastroenterology Nursing, 13(3), 134-139.

Murphy, E. K. (1991). Issues surrounding intravenous conscious sedation. AORN Journal, 54(1), 105-107.Murphy, E. K. (1988). Legal considerations in RN monitoring of intravenous sedation. AORN Journal, 48(6),

1184-1187.Proctor, D. D., Price, J., Minhas, B. S., Gumber, S. C., & Christie, E. M. (1999). Patient recall and appropriate

timing for obtaining informed consent for endoscopic procedures. American Journal of Gastroenterology, 94, 967-971.

Rayhorn, N. (Ed.). (1995). Manual of gastrointestinal procedures, pediatric supplement (2nd ed.). Baltimore: Williams & Wilkins.

Rayhorn, N. (1998). Sedating and monitoring pediatric patients: Defining the nurse's responsibilities from preparation through recovery. The American Journal of Maternal/Child Nursing, 23(2), 76-86.

Schaffner, M. (Ed.). (1994). Guidelines for documentation in the gastrointestinal endoscopy setting. Chicago: Author.

Society of Gastroenterology Nurses and Associates, Inc. (19984). Guidelines for documentation in the gastrointestinal endoscopy setting. Chicago: Author.

Society of Gastroenterology Nurses and Associates, Inc. (1998). Gastroenterology nursing: A core curriculum (2nd ed.). St. Louis: Mosby.

Society of Gastroenterology Nurses and Associates, Inc. (1998). Role delineation of assistive personnel. Gastroenterology Nursing, 21, 103.

Walsh, S. (1995). Oh, no, the patient is six, not sixty!: The pediatric endoscopy patient. Gastroenterology Nursing, 18(2), 57-61.

Watson, D. (1992). Developing a competency-based education program for nurse-monitored sedation. Seminars in Perioperative Nursing, 1(4), 224-231.

Watson, D. (1994). Intravenous conscious sedation: Policy, procedure and competency guideline manual. Palos Verdes Estates, CA: Academy Medical Systems, Inc.


Appendix

Sedation and Analgesia for Diagnostic or Therapeutic Procedures

Training Equipment/Set-up Pre-sedation Sedation Post-sedation

All nurses administering sedation and analgesia should be trained in the following: BLS Airway

management IVF

administration Patient

monitoring of the following: pulse oximetry, BP, RR, HR, and cardiac dysrhythmias

Titration of medications and potential side effects

Knowledge in the administration of reversal agents

For pediatric procedures: knowledge of age-specific vital sign norms and psychological preparation based on developmental level

Must be in room: O 2 and cannula Suction

equipment Pulse oximeter Sphygmomano-

meter Naloxone

(Narcan™) Flumazenil

(Romazicon™)

Readily available: Bag-valve-mask

system (Ambu™ bag)

Code cart with defibrillator

Cardiac monitor Oral airway Atropine

Resuscitation equipment must be of appropriate size for the patient being sedated.

Must have H&P Nursing

assessment must include baseline HR, RR, BP O2 saturation, and medication allergies

Assessment of NPO status

Informed consent obtained

Patent IV access Review discharge

instructions Confirm person

responsible for post-procedure transportation

Medications administered by RN under the direction of the physician

IV medications are to be given in small incremental doses and titrated to desired effect

Monitoring will include O2 saturation, HR, RR, BP throughout the entire procedure. Cardiac monitoring if history of cardiac disease or anomaly

Patient must be continuously monitored with documentation at least every 5 minutes during titration of medications, and at least every 15 minutes during the procedure

Supplemental O2 may be administered as needed

Patient monitoring may be discontinued when the patient meets criteria established by the facility

Adequate safety measures will be provided



FROM: Virginia Walter, MS RN CGRN X___ ActionDirector, Communication and Collaboration

SUBJECT: Rechartering of Regional Societies

RECOMMENDATION(S): That the Board of Directors endorse probation status of the following regional societies. These Regionals have not submitted to SGNA Headquarters their requirements for rechartering. Rechartering information was due 12/31/00. (Attachment 1)

1. Region 51 East Texas1. Region 56 South Central Texas

Relevant Strategic Goal/Objective: Goal 7: SGNA will maximize efficiency and effectiveness of its structure and governance.

Justification: As per policy H-1, Regional Society Chartering, the Regional Societies are to recharter by December 15th of each year. This year in addition to the other requirements, the regionals needed to submit their revised bylaws to come into compliance with SGNA’s bylaws. Education and support for the regionals to complete these requirements has been given by the bylaws committee, the regional society coordinators and SGNA Headquarters. Each of the above regionals has received a letter notifying them of their probationary status. (Attachment 2)

Time Frame/Target Date for Completion: ASAP

Financial/Staff Impact: There is a potential financial impact to SGNA related to membership. Member dissatisfaction with the regional could negatively effect SGNA’s membership. There is increased staff time necessary to coordinate the contacts with these regionals that have not completed their rechartering requirements.



January 31, 2000

Sarah HillPresident- Region 51 East TexasRR3 Box 950 Hallsville, Texas 75650

Dear Sarah,

This letter is to inform you that SGNA Headquarters has not received your Regional chartering requirements, which were due by December 15, 1999. In order to maintain your Regional chartering status please review the enclosed policy, “H1 - Regional Society Chartering”.

According to the policy, the Board of Directors may place your regional society on probation at the February Board Meeting. If your regional society submits all required information before the May Board Meeting, your region will be taken off of probation and will be included in the rechartering ceremony in Anaheim. However, if


your materials are not received before February 12, your region will not participate in the House of Delegates. Because of the seriousness of this letter, a copy has also been sent to your region’s president-elect. As your advocate I am more than willing to assist you in any way in order to meet

the chartering requirements and avoid probation by submitting materials before the February meeting. Your Divisional Coordinators are also available to assist you.

I look forward to hearing from you and working on completing the requirements.

Sincerely,

Linda Holmes, BSN RN CGRNRegional Societies Chair

cc: Karen Laing Nancy Schlossberg Virginia Walter Kathryn South

January 31, 2000

Linda IruegasPresident- Region 56 South Central Texas8415 Timber FlatSan Antonio, Texas 78250

Dear Linda,

This letter is to inform you that SGNA Headquarters has not received your Regional chartering requirements, which were due by December 15, 1999. In order to maintain your Regional chartering status please review the enclosed policy, “H1 - Regional Society Chartering”.

According to the policy, the Board of Directors may place your regional society on probation at the February Board Meeting. If your regional society submits all required information before the May Board Meeting, your region will be taken off of probation and will be included in the rechartering ceremony in Anaheim. However, if your materials are not received before February 12, your region will not participate in the House of Delegates. Because of the seriousness of this letter, a copy has also been sent to your region’s president-elect. As your advocate I am more than willing to assist you in any way in order to meet

the chartering requirements and avoid probation by submitting materials before the February meeting. Your Divisional Coordinators are also available to assist you.

I look forward to hearing from you and working on completing the requirements.

Sincerely,

Linda Holmes, BSN RN CGRNRegional Societies Chair

cc: Karen Laing Nancy Schlossberg Virginia Walter Kathryn South


Society of Gastroenterology Nurses and Associates, Inc.Board Policy &Administrative ProcedureManual

Policy No:Page:Effective Date:Revision Date:Review Date:

H-11 of 22/851/92, 10/99

Subject: Regional Society CharteringReview Responsibility: Director of Communication and Collaboration

Policy Statement: “ Regional Societies formed of persons active in the fields of gastroenterology and/or endoscopy nursing may be recognized by the Society. Each Regional Society must conform to guidelines approved by the Board of Directors.” (Bylaws Article 14.01)

Focus: Primary: Regional Societies, Regional Society Committee, SGNA Members Secondary: SGNA Board of Directors

Purpose: To define the guidelines for obtaining and maintaining a Regional Society charter.

Procedure:1. A minimum of ten regional society members who are also national SGNA members may

apply to SGNA for a Regional Society charter.1.1 Regional groups desiring information on chartering may obtain a Regional Society

packet from SGNA Headquarters.

2. Regional groups must be active for a minimum of six months and have completed at least two educational meetings which provided a minimum total of six hours of education for their members prior to making application for charter.

3. Application for charter will be submitted to the Regional Society Chair through SGNA headquarters and will include the following:3.1 Name of the Regional Society which incorporates the name “Society of Gastroenterology

Nurses and Associates”3.2 Name of at least ten regional members who are current national SGNA members. 3.3 Names of Regional Society officers, all being national SGNA members.3.4 Names of a regional delegate and an alternate delegate to the House of Delegates, both

being national SGNA members.


Policy H-1 Page 2 of 2

3.5 A copy of their current organizational Bylaws which comply with the current SGNA Bylaws.

3.6 Proof of at least six educational contact hours.

4. The Board will consider each new Regional Society application at the regularly scheduled Board meeting.

5. The Regional Society Chair will notify the applying Regional Society when the application has been received and if it is approved.

6. A new Regional Society will receive its charter at the next Annual Course.

7. The Regional President will function as the liaison between the Regional Society and the SGNA via communication with the Regional Society Chair and the Divisional Coordinator.

8. The Regional Society will be responsible for its own actions and financial support.

9. In order to maintain its charter, the Regional Society will annually submit to the Divisional Coordinator, by January 15th of each year, the following:9.1 List of names of at least ten national members who are current national SGNA members.9.2 Completed Data Sheet9.3 Organizational Bylaws9.4 Proof of at least 6 hours of education instruction provided for members during the

preceding year.

10. Failure by a Regional Society to submit the required items by the January 15th deadline will result in a period of one year probation and loss of all rights and privileges including loss of seating on that year’s House of Delegates.10.1 January 1 reminder sent to all Regional Societies who have not yet submitted required information (see #9) for charter renewal.10.2 January 15th Divisional Coordinators forward all submitted information and list

of delinquent Regional Societies to Regional Societies Chair.10.3 A registered letter is then sent to all delinquent Regional Societies by the Regional Societies Chair with notification of pending probationary status.10.4 At the Winter Board meeting, the Regional Society Chair will present the list of delinquent Regional Societies to be approved for placement on probation for one year.10.5 The Regional Societies whose charters have been placed on probation at the Winter Board meeting will not be seated at the May House of Delegates.

10.6 However, by submitting required information at a later date, the charter may be renewed by the Board at any regular Board Meeting.



FROM: Paulette SmithSecrectary __X_ Consent

SUBJECT: Approval of Executive Committee Electronic Vote

RECOMMENDATION: That the SGNA Board of Directors accept the Executive Committee Electronic vote decision as follows:

NFSNO Executive Directors’ Retreat

>>APPROVED that SGNA allocated $800 out of the professional organizations budget for SGNA’s Executive Director to attend the National Federation of Specialty Nursing Organizations (NFSNO) Executive Directors’ Retreat.

Relevant Strategic Goal/Objective:

Goal 1: SGNA,CBGNA and the SGNAFER have a unified, seamless approach for soliciting money from vendors via coordinated fund-raising efforts.

Goal 2: Provide current and expanded educational opportunities to SGNA members and customers by maintaining and enhancing delivery mechanisms.

Goal 3: SGNA will be a relevant organization through successful use of Internet resources in order to communicate with the Gastroenterology and Endoscopy community.

Goal 4: Enhance SGNA’s ability to increase scientific research and the number of scientist’s within our specialty.

Goal 5: SGNA is positioned as the expert provider of information and data on practice issues within our specialty, and identifies bridges between the scientific community and the practicing GI Nurse.


REPORT TO THE SGNA BOARD OF DIRECTORSFebruary 1, 2000

FROM: Marilee SchmelzerResearch Committee Chair __X_ Consent

SUBJECT: Approval of the SGNA Research Committee’s Nomination for the 1999 Outstanding Research Article Award

RECOMMENDATION(S): The research committee recommends that the 1999 Outstanding Research Article Award be presented to Jackie Sincock, Sandra V. Dunn, and Leigh Pretty for the article, “Patient satisfaction with an outpatient endoscopic service”, Gastroenterology Nursing, 22(5), 193-8.


Objective 3.2: SGNA will promote the value of research in GI practice.

Justification: The SGNA Board of Directors has approved both the award and the procedure and policy for determining the award. The research committee followed the approved procedure when determining who would get the award.

Time Frame/Target Date for Completion: According to the procedure, the Outstanding Research Award for 1999 will be presented to the recipient by the research chair at the 2000 Annual Course

Financial Impact: $150 has already been designated for the award.

5. Staff Impact: SGNA headquarters will prepare the award which includes:

Check to be given to the first author (who is responsible for dividing it among co-authors)Certificate of recognition for each author of the selected article.Article recognizing the recipients in the SGNA News and/or Gastroenterology Nursing.

Relation to Strategic Plan: The research award will help promote the value of research within GI practice.





FROM: Budget and Finance Committee __X___Information Members: Donna Reeves, Chair Marilyn Schaffner, Karen Laing, Nancy Schlossberg, Margaret Coffey, Theresa Morse, Heather Bagby, Mary Beth Hepp SUBJECT: Budget and Finance Report

Relevant Strategic Goal/Objective: End of the 1999 year report. Goal 6, Fiscal Resources: SGNA will maintain a well-managed, dynamic and financially stable organization responsive to member needs.

Progress to Date/Barriers to Progress: The following is an unaudited report of the year end financial status of SGNA. Heather has completed her financial analysis and 1999 was an AMAZING (in Heather’s words) year. Projected year-end net surplus will be approximately $198,327. The audit will show $52,014 from the 1998 surplus was designated for the web site in 1999 and was used, thus decreasing the net surplus to $146,313 (See the Budget and Finance Action Report). Congratulations to everyone for a job well done! Investment Income: Budgeted amount: $56,000 realized $53,322. With the volatility in the investment market, this is an amazing amount of interest income. The total account value as of 12/31/99 of the Permanent Fund: $737,832.00The total account value as of 12/31/99 of the Operating Fund: $565,126.00

Expense Reductions: Membership Directory, Special Interest Groups, Product and Publications, Committee/Task Force, Regional Societies, Annual Course, Strategic Plan, Future Expenses, Newsletter, Journal, Professional Organization

Revenue Increases: Annual Course, Operations, Membership(affiliate dues), Education and the Journal. Revenue Losses: Membership Directory (ad sales), Special Interest Group, HEP

SIG, SGNA Publications.

The SGNA realized 103% of the amount budgeted as revenue and 92% of the amount budgeted as expenses. As you can see there were many factors in our success for 1999(see above). There are also factors that altered our success with deficits in our revenue projections. We will need to monitor these factors for the Year 2000. Heather anticipated these trends by altering in advance the negative projections in the 2000 budget.

Current Status/Target Date for Completion: The 2000 Strategic Plan Budget has a balance of $31,450. The allocated monies are as follows ($60,000):$18,000 – ½ fundraising time for the joint fund-raising project$1,500 – on-line shopping form for web site $850 – Board discussion Forum$1,000 – on-line survey $5,000 – Foundation contribution$31,450 – TBD (balance)


A reminder for new board members: The Strategic Plan Budget is for expenses throughout the year that fit into the strategic plan. When requests are made for funds; the goals, objectives, and priorities which pertain to the plan must be outlined.

Staff Support: This past year has been a challenge for our staff. Mary Beth and Heather in particular have stepped up to the plate and functioned as if they had always been with SGNA. It has been a pleasure to work with these two professionals. Heather has been a great help to me with her monthly analysis of the finances of SGNA and her knowledge of accounting principles. The rest of the staff has always been responsive to any request I have made. It is a pleasure to speak on the phone to all of them. The staff is a great asset to the BOD and our members. Thanks to everyone at SBA.



FROM: Nancy Schlossberg, President elect x Information

SUBJECT: Letter to Editor, AJN re: “Conscious Sedation, Getting it Right,” Dec., 1999

Relevant Strategic Goal/Objective: Goal 5: SGNA is positioned as the expert provider of information and data on practice issues within our specialty, and identifies bridges between the scientific community and the practicing GI Nurse.

Progress to Date/Barriers to Progress: See following Letter to Editor, which discusses issue

Current Status/Target Date for Completion: Await response or publication

Staff /Board of Director Support: Thanks to Mary Beth Hepp, Kathleen Domkowski, Karen Laing, Marilyn Schaffner and Kathy Wright for editorial comments and rewrites.

Diana J. Mason, PhD, RN, FAAN, EditorAmerican Journal of NursingLippincott Williams & Wilkins345 Hudson Street, 16th FloorNew York, NY 10014

January 5, 2000

Dear Dr. Mason:

Thank you for highlighting the topic of bedside administration of conscious sedation during an upper endoscopy in the December 1999 issue of AJN. Bedside endoscopic procedures, occurring after hours and when it might be unsafe for a patient to travel to the endoscopy lab, may require floor nurses to administer conscious sedation and analgesia. These nurses must be familiar with providing and monitoring the patient before, during and after receiving this type of medication.

The majority of inpatient and outpatient endoscopy takes place in a designated endoscopy unit. There, the responsibility of administration and maintenance of sedation and analgesia by order of a physician usually falls within the purview of registered nurses trained and experienced in gastroenterology nursing and endoscopy.

I want to refer your readers to the Society of Gastroenterology Nurses and Associates’ Position Statement, “Sedation and Analgesia.” The Society of Gastroenterology Nurses and Associates (SGNA) is a national nursing specialty organization comprised of nearly 7,000 nurses and associates practicing in the field of gastroenterology and endoscopy nursing. Gastroenterology nurses look to SGNA for Position Statements, Standards, and Guidelines to manage safe practice. The SGNA Practice Committee is currently revising “Guidelines for Conscious Sedation.” This document will be available in Spring 2000. SGNA Position Statements are available on the web at www.sgna.org. SGNA Guidelines and Standards can be purchased for a minimal fee on the SGNA website, as well.

We welcome the opportunity to make this information available to your readers, and encourage them to contact us directly for these and other publications addressing practice issues of mutual interest. We also offer our expertise to your editorial staff when similar topics are prepared for publication.

Nancy S. Schlossberg, BSN, RN, CGRNPresident-Elect Society of Gastroenterology Nurses and AssociatesChicago, Illinois


http://www.sgna.org/



SUBJECT: Endorsement for H. Con. Res 133, a Sense of Congress Resolution

Relevant Strategic Goal/Objective: SGNA must remain an up-to-date, relevant society, which encourages and mentors current and future leaders.

Advocacy must be a component of our organizational initiatives and we must leverage our programs via alliances with other organizations, the membership expects us to represent their needs in this arena. Alliances, external, internal and international are important to our future and we must drive the agendas at these meetings and enhance our relationships with other organizations whenever possible.

Progress to Date/Barriers to Progress: In collaborating with The Cancer Research Foundation of America (CRFA)--(outgrowth of CRC Roundtable) the brains behind “March 2000,” SGNA was asked as part of the "coalition" of interested organizations and partners of national colorectal Cancer Awareness Month" to sign a letter regarding colorectal cancer and the importance of screenings and early detection for prevention of the disease.

The letter is to Congressman Jim Moran and is in support of of the resolution introduced by him and Congressmen Spencer Bachus, Billy Tauzin, Ken Bentsen, Bob Clement and Mark Sanford. This resolution highlights the disease of crc and the importance of education about screening and a healthy lifestyle in preventing a disease that will strike approximately 130,000 men and women in 2000, resulting in approximately 56,000 deaths. This Sense of Congress is critical in initiating a dialogue among health educators, physicians, patients, and advocates that will lead to an increase in the number of individuals that get screened each year.

Current Status/Target Date for Completion: Ongoing

Staff Support: Mary Beth supportive of legislative efforts.




SUBJECT: National Colorectal Roundtable/March 2000


Advocacy must be a component of our organizational initiatives and we must leverage our programs via alliances with other organizations, the membership expects us to represent their needs in this arena. Alliances, external, internal and international are important to our future and we must drive the agendas at these meetings and enhance our relationships with other organizations whenever possible.

Progress to Date/Barriers to Progress: I attended the NCCRT meeting Dec. 5-6, 1999, Washington, DC. SGNA representation is funded by American Cancer Society.

The group, founded by The American Cancer Society ACS and the Centers for Disease Control and Prevention, (CDC) includes at least 34 groups representing professional patient and medical organizations, academic centers and corporate sponsors. This national coalition of public, private and voluntary organizations dedicates itself to reducing the incidence and mortality from colorectal cancer in the U.S. through leadership, strategic planning, advocacy, coordination and data gathering.” Our goal aims at crafting a national agenda and coordinate messages to the public. The December 5-6, 1999 meeting discussed methods for implementing the strategic plan developed over the past year.

I presented the SGNA’s contributions to promoting awareness of colorectal cancer screening and prevention among consumers, patients and their families, and other health care providers. I included SGNA guidelines and position statements regarding performance of flexible sigmoidosopy for purposes of colorectal cancer screening, our cleaning and disinfection video module, SGNA Journal articles, and annual course sessions.

Dr. Levin, Chair of the Roundtable asked the group for their opinions of non physician performed flex sigs for screening. Dr. Douglas Rex, ACG, representative spoke in favor.

An outgrowth of NCCRT, SGNA is now partnered with The Cancer Research Foundation of America (NRFA). This group is coordinating “March 2000,” events promoting National Colorectal Cancer Awareness Month. “March 2000,” will be heavily promoted. Activities will include: A March 1st Capitol Hill event to bolster support from members of Congress and congressional staff for colorectal cancer screening and prevention; launching a Web Site to serve as a resource for researchers, policy makers, media and consumers; airing a colorectal cancer television segment on CNBC and the Bravo network; developing radio and print public service announcements; creating bylined articles for distribution in medical journals; conducting an advertising campaign; holding a press conference to unveil the results of a colorectal cancer survey.

SGNA was invited to attend the March 1, 2000 event. They also asked for names of members who might also like to attend.

As part of this coalition, I was invited to attend “Colorectal Cancer: Under-Recognized and Under-Treated”—a CRFA and ADHF (American Digestive Health Foundation) Conference, March 17-18, 2000, Washington, DC. Funding is being provided through unrestricted educational grants by Bristol-Myers Squibb and Kellog, Inc.






SUBJECT: Women in Gastroenterology Committee


Advocacy must be a component of our organizational initiatives and we must leverage our programs via alliances with other organizations, the membership expects us to represent their needs in this arena

Progress to Date/Barriers to Progress: Follow up to May, 1999 discussion re: possible involvement of SGNA on Women in GI Committee with the goal of an alliance where we are kept informed and asked for our feedback.

From the Chair, Brenda Hoffman to Amy Foxx Orenstein 01/04/00: The chair of the ACG Auxiliary attends the Women in Gastroenterology Committee meetings and events regularly. The president of the SGNA as a representative would be a nice addition, I believe. Let me run this by the ACG staff and pres and see if they agree.

Potential future projects of Committee: The ACG is going to establish a web connection for the public (women in particular) regarding the

importance of screening, questions to ask yourself regarding symptoms, or lack of symptoms, etc. Hopefully, it will be a link from the Women in GI Committee web site. In the future, it will also link to brochure's we have produced on GI symptoms and conditions common in women.

Current Status/Target Date for Completion: On going. As our strategic plan outlines, advocacy is not top of the list; however, alliances to improve practice are. They may even be able to help us network more with international entities to increase international membership, sales of SGNA materials to other countries, resources to translate materials, etc. We need to continue to explore a relationship where SGNA is "in the loop" of information and asked for opinions.

Staff /Board of Director Support: Mary Beth supportive of continued exploration of criteria to get into information loop.




SUBJECT: Flex Sig Survey Results and Followup


Advocacy must be a component of our organizational initiatives and we must leverage our programs via alliances with other organizations, the membership expects us to represent their needs in this arena. (Priority Number: 11 Time frame 12 months)

Alliances, external, internal and international are important to our future and we must drive the agendas at these meetings and enhance our relationships with other organizations whenever possible. (Priority Number: 15 Time frame 18 months)

Progress to Date/Barriers to Progress:

768 surveys mailed out. 76 returned. 71 completed1. How many screening flexible sigmoidoscopy for colon rectal cancer were performed at your institution in:

1996 0-13,000 (670.58)* *Average from numbers provided1997 5-13,200 (619.54)*1998 5-13,500 (699.77)*

2. As of this date, how many days until your next available FS for CRC screening appointment? 49 responses 40 or 49 responses were less than 60 days

0-5 days = 24 16-20 =0 greater than 2 months = 9 (rang 60 days – 18 months)6-10 = 5 21-30 = 411-15 = 5 31-59 = 2

3. Does your institution utilize nurse endoscopists to perform flexible sigmoidoscopy for colon rectal cancer screening in your institution? 71 responses

Yes = 9 No = 60

4. If so, how would you describe the change in waiting times for FS for CRC screening? 1 Longer waiting time (Due to Medicare rules preventing nurses from seeing medicare patients) 2 No change 6 Shorter waiting time

5. Check all of the following that describe your institution.

71 responses * = Clinics using nurses to perform FS

5 for profit (2)* 18 not for profit (2)*

13 government (3)* 15 AEC (15)* 13 Private office (13)* 7 Clinic (0)*


Results: Disappointing, the response rate was so low that the data is inconclusive. The numbers do not help our cause. From this information, it appears that very few patients wait more than 30 days for their screening exam. Our discussion with HCFA implied that unless we could demonstrate the need for nurses to do it that there was no reason to be supportive.

Discussion: We could still go to Congress based on the nurses abilities and ask for a language change, keeping in mind that it might not be long before a colonoscopy every 10 years becomes the desired screening. And it appears that virtual colonoscopy isnot far behind.

Plan: I sent the packet of supporting data shared with HCFA to Sheila Abood, RN,MS, ANA Associate Director Government Affairs, who I met at NFSNO meeting in early November, 1999. Her response: Thanks for the packet of information. I have not had a chance to discuss this issue fully with my director as yet but will bring it up at our next strategy meeting to see if we can come up with a plan of action or at least some recommendations to assist you with this important issue.





FROM: CATHLEEN FERRARO, CBGNA PRESIDENT __X_ Informational

SUBJECT: CBGNA Report to SGNA

Relevant Strategic Goal/Objective: Objective 2.1: Develop and project a unified partnership with CBGNA and SGNAFER.

Progress to Date: This past October 109 candidates sat for the certification examination and 89 applied for recertification by contact hours.

Seven regions applied and were selected to be examination test sites on October 15, 2000. Most of these are multi-regional conferences. Four additional test sites were designated. It is hoped that increasing the number of test sites in the fall will afford many more GI nurses to advance to certification. Five test sites, in addition to Anaheim , will be testing site on May 20, 2000.

The names of four very qualified certified GI nurses have been forwarded to SGNA President Karen Laing for approval as new board members. Fifteen SGNA members have volunteered to work as non-board members on CBGNA committees.

A grant from PES will support continued CBGNA participation in a research project with ANCC/IREC that will create a description of the workforce of certified nurses and will document the value of certification. The outcome of this research will be published this May. CBGNA will sent two representatives to the ONCC conference on “Strengthening End Of Life Care In Nursing Practice Through Nursing Specialty Certification”.

CBGNA will be conducting final interviews for a testing service in May during the CBGNA Board of Directors meeting. It is with regret that computer based testing is on hold .

A drive is underway to have CBGNA board members visit as many regions as possible at regional meeting. All regional presidents have been contacted.

Financially CBGNA is keeping expenses below average. CBGNA is waiting reports from sponsorship efforts from Deb Cohen.

A certification scholarship will be offered ( through the Foundation ) in memory of Don Wilson. Don will be honored at the Gala.

Current Status/Target dates: Continue to maintain financial stability. Sponsorship commitment for “must” needs by 5/00. Newly appointed board of directors by 4/00. Selection of testing service company 6/00.

Staff/Other Support: SGNA and SGNAFER for the ongoing unified effort that continues to benefit our members. Executive management continued communication.

SBA staff is always a pleasure to do business with. 800 number is super, the web “links” are great, and the 2000 SGNA Advanced Program really did a super job supporting CBGNA. THANKS



FROM: Laura Strohmeyer _X__ InformationSGNA News Editor

SUBJECT: SGNA News

Relevant Strategic Goal/Objective: Programs and Services: SGNA will provide contemporary programs and services that advance the practice of Gastroenterology and endoscopy nursing.

Progress to Date/Barriers to Progress: For some time SGNA News has been mailing each issue around the middle of the month at the bulk rate charge. However many members did not receive their newsletters until 1-3 weeks later, even 6 weeks to Hawaii. In an effort to ensure a more timely delivery, the deadlines associated with each publication have been moved up approximately 14 days. For example, the deadline for articles for the April 2000 issue are due by February 15, 2000. This has taken a little getting used to, but will provide a better service to our members.

Boston Scientific Microvasive has expressed that they continue to be very pleased with the newsletter and plan to continue funding its production.

Current Status/Target Date for Completion: As of February 1, 2000, the February issue is ready to be mailed, the March issue is compiled and being sent for layout, and the articles for the April issue have been confirmed via conference call. The February Issue will feature an article on Colon Cancer Awareness Month, information on the Annual Course, Share the Wealth Campaign House of Delegates Resolutions, and GI Nurses Day. The March Issue will include articles on the Annual Course, the first Certification Course, GI Nurses Day, action items from the Fall SGNA BOD meeting, and a very inspirational President’s Report on networking by Karen Laing. The April Issue will feature an article on the Unified Partnerships, SIG Needs assessment, election results, the Annual Course, and Share the Wealth Honor Roll.

Staff Support: Christine Bennett initiated the change in the timeline to allow the timely delivery of our newsletter to the members’ mailboxes. Many thanks to the MARCOM staff for their continued guidance and support.



FROM: Nancy Gondzur, BS RN _X__ Information Chair, Education Committee

DATE: February 2000

SUBJECT: Procedure Manual Revision (4th edition)

Relevant Strategic Goal/Objective: Strategic Goal 1 Programs and Services: SGNA will provide contemporary programs and services that advance the practice of gastroenterology and endoscopy nursing.

Progress to Date/Barriers to Progress: It’s with a sigh of relief I can report that the procedure manual has gone to print and should be available by March 31st. We obtained corporate sponsorship from Astra in the amount of $25,000! Two thousand copies are being printed. If you are in touch with any members of the education committee or other contributors please thank them for their labors. I hope you will be pleased with the final product.

Current Status/Target Date for Completion: Completed.

Staff Support: There are not enough words to express my gratitude to Kathleen for the amount of support she provided during this project. Cheers to Deb Cohen for garnering the corporate sponsor. API also assisted us in converting some of the illustrations.



FROM: Karen Laing RN, CGRN X_ InformationPresidentNancy Schlossberg RN,BA,BSN, CGRNMaryBeth Hepp Executive Director

SUBJECT: Meeting with ASGE President Dr. James Frakes President -elect Dr. M. Kimmee

Ex. Director Bill Maloney

Description: Shared our strategic plan with them - they will send us theirs following approval at their upcoming Board

meeting WE discussed our upcoming shared event during DDW/SGNA “Endoscopy during Pregnancy”. We also

shared information regarding the successes of our WEB The re-use issues was again discusses- ASGE recommended a softer more neutral position Colon Cancer Awarness- ASGE has done nothing so far and feels that it should be more of a local issue Legislative Issues - urged Nancy to have a discussion with Brian Fennerty during the HC Policy Committee

mtg in April. ASGE would like to continue SGNA liaisons

They had high praise for Virginia Walter on the Practice Committee and felt that all participants were an asset to committee work.Nancy told them that Paulette would stay on Technology and other names would be sent to them when confirmed.

Collaborative Activities- ASGE asked if we would be interested in jointly developing a patient information brochure on colon prep which would be customizable for the practice. This will probably be initiated by the Technology Committee.

A Draft letter has been written which will be sent to our members regarding ASGE membership. SGNA members would be classified as Associate Members at a cost of $40.00 per year. This membership would receive The Policy and Procedure Manual, Guidelines for Training and Practice, bi-monthly editions of ASGE News, quarterly ASGE Clinical Updates and free registration to DDW. Additionally Associate members may receive the Gastrointestinal Endoscopy Journal at the Member rate of $60.00 per year.



FROM: Karen Laing RN, CGRN X_ InformationPresident X DiscussionNancy Schlossberg, RN, BA, BSN,CGRN Pres-electMaryBeth Hepp Executive DirectorKathleen Domkowski Director of Education

SUBJECT: Visit to Microvasive

Relevant Strategic Goal Objective: Goal 1 SGNA,CBGNA,and the SGNAFER have a seamless approach for soliciting money from vendors via coordinated fund-raising efforts

Description: Despite the fact that a heavy snowfall on the east coast threatened to cancel the meeting, we succeeded in having a productive meeting which will hopefully be successful in raising funds. They expressed interest in doing more in the international arena we believe that this is an area we could

partner with them. They stated they may go into their own Research & Development b/c "Wall street" is

not investing in any future technology in endoscopy The reuse issue is STILL of great interest to them - Bottom line, they want SGNA to "more aggressively"

promote and support our position statement on re-use. We told them that we already had a position statement on this issue, they said they would like us to be more aggressive. Kathleen had a good idea that perhaps they could fund the Foundation to do studies on re-use. That way, the studies would be done by an objective party, the Foundation would be supported to do more of their work, and we could get some answers about this issue.

They did express interest in our GI Procedure Manual at $25,000. Debby will be in contact with them to follow up on this possibility

They WILL NOT be funding the ASGE Learning Center.They WILL BE funding the SGNA Newsletter

To quote MaryBeth “Overall the meeting was relaxed and productive. Perhaps the snowstormbonded us all together.”



FROM: Heather Bagby __ X ___ Information Operations Manager SUBJECT: Board of Directors Tip Sheet

A quick reference guide regarding Board of Directors travel

Progress to Date/Barriers to Progress: None

Current Status/Target Date for Completion: Done

SGNA Board of Directors – TIP SHEETA reference guide for travel planning

Winter Board Meeting – 3 hotel/4 days per diemPosition Air Hotel Per DiemPresident X X XPresident-elect X X XTreasurer X X XSecretary X X XPast President X X XCurrent Directors (6) X X XIncoming Board Members X X XResearch Chair X X XEducation Chair X X XProgram Chair X X XProgram Co-Chair X X XPractice Chair X X XIncoming Research Chair X X XIncoming Education Chair X X XIncoming Practice Chair X X XSpeaker of the House X X XVice Speaker of the HouseNominations & Elections Committee (4)SGNA News Editor X X XGNJ Editor X X XDivisional Coordinators (5)SIG ChairsSIG Coordinators (3)

Annual Course – Per Policy D-4 & Policy G-5Position Air Hotel Per Diem Course Fee


PaidPresident X X – 8

nightsX – 9 days X

President-elect X X – 8 nights

X – 9 days X

Treasurer (if term is ending, reimbursement will be only 7 nights hotel, 8 days per diem)

X X – 8 nights

X – 9 days X

Secretary (if term is ending, reimbursement will be only 7 nights hotel, 8 days per diem)

X X – 8 nights

X – 9 days X

Past President X X – 7 nights

X – 8 days X

Current Directors (6) X X – 7 nights

X – 8 days X

Incoming Directors X X – 4 nights

X – 4 days

Incoming Secretary/Treasurer (includes post course Executive Committee Meeting)

X X – 4 nights

X – 4 days

Research ChairEducation ChairProgram Chair X X – 7

nightsX – 8 days X

Program Co-Chair X X – 7 nights

X – 8 days X

Awards ChairPractice ChairIncoming Research Chair X X – 2

nightsX – 2 days

Incoming Education Chair X X – 2 nights

X – 2 days

Incoming Awards Chair X X – 2 nights

X – 2 days

Incoming Practice Chair X X – 2 nights

X – 2 days

Speaker of the House X X – 7 nights

X – 8 days

Vice Speaker of the House X X – 2 nights

X – 3 days

Incoming Nominations & Elections Committee (4) X X – 2 nights

SGNA News Editor X X – 7 nights

X – 8 days X

GNJ Editor X X – 7 nights

X – 8 days X

Divisional Coordinators (5)SIG ChairsSIG Coordinators (3)CBGNA President XSGNAFER President XAward Winners XSIGNEA Chair XNFSNO Reps XProgram Committee (up to 6 including chair & X


co-chair)

Fall Board Meeting – 3 hotel/4 days per diem

Position Air Hotel Per DiemPresident X X XPresident-elect X X XTreasurer X X XSecretary X X XPast President X X XCurrent Directors (6) X X XIncoming Board MembersResearch ChairEducation ChairProgram ChairProgram Co-ChairPractice ChairIncoming Research ChairIncoming Education ChairIncoming Practice ChairSpeaker of the House X X XVice Speaker of the HouseNominations & Elections Committee (4)SGNA News Editor X X XGNJ Editor X X XDivisional Coordinators (5) X X XSIG ChairsSIG Coordinators (3)



FROM: Heather Bagby, Operations Manager _X__ Information

SUBJECT: 1999 Hepatology SIG Meeting

Relevant Strategic Goal/Objective: Goal 2: Provide current and expanded educational opportunities to SGNA members and customers by maintaining and enhancing delivery mechanisms.

Progress to Date/Barriers to Progress: The Hepatology SIG meeting was held in Dallas, Texas – November 1999.

Attendees: 128 totalMembers = 45Non members = 69Speakers = 9Chairs = 4Staff = 1

Financial SummaryRevenue Total = $30,385 (Registration = $10,385/Sponsorship = $20,000)Expense Total = $24,717 Net Profit = $5,668

Current Status/Target Date for Completion:.Project Complete



FROM: Allison Cline, Member Services Coordinator _X__ Information

SUBJECT: Business Reply Cards

Relevant Strategic Goal/Objective: Provide current and expanded educational opportunities to SGNA members and customers by maintaining and enhancing delivery mechanisms.

Progress to Date/Barriers to Progress: This is an ongoing project with reports to the board several times throughout the year. Current report from August to January.

Staff Support: A large part of the distribution of cards has been passed on to O’Brien Budd as of November 1999.

Total cards collected: 20 (some multiple answers)

1. What was the purpose of your inquiry?5 Membership Information13 Publications Orders1 Materials order7 Continuing Education Information0 Other

Rating: 0- N/A 1- not satisfied 2-somewhat satisfied 3-satisfied 4- very satisfied

2. Was our staff helpful and courteous in assisting you?1 0- N/A1 1- not satisfied0 2- somewhat satisfied10 3- satisfied7 4- very satisfied

3. Was your order request fulfilled in a timely fashion?0 0- N/A4 1- not satisfied0 2- somewhat satisfied9 3- satisfied5 4- very satisfied

4. Please rate the quality of your product in respect toAppearance

0 0- N/A1 1- not satisfied0 2- somewhat satisfied9 3- satisfied5 4- very satisfiedMeeting your expectations


0 0- N/A2 1- not satisfied1 2- somewhat satisfied7 3- satisfied6 4- very satisfiedContent0 0- N/A1 1- not satisfied1 2- somewhat satisfied7 3- satisfied6 4- very satisfied

Comments: Turn around time of 5-6 weeks too long. I expected more depth & breath to development of the standards. The wrong publication was sent. I ordered the flexsig monograph and received the sedation monograph. It

took over 3 weeks and I had to return it. Video ‘fuzzy’ Ordered in June and received in August- made several calls. Thank you Received one item I did not order and did not receive the item I did order. Glad to be member- Endoscopy-GI has really expanded in recent years.




SUBJECT: 2000 Membership Renewals

Relevant Strategic Goal/Objective: 3.2: Increase number of overall SGNA transactions via E-commerce by 50% from 1999 to 2000.

Progress to Date/Barriers to Progress: On February 1, 2000 the second round of renewal notices were mailed. As of January 31, 2000-

3,126 total members for 2000 (49% of renewal notices sent)67 new members ( 2.2%)77 two year renewal option (2.5%)163 online dues renewal (5.3%)

Current Status/Target Date for Completion: Dues renewals and new members are continuing to come in at an even flow. Final dues renewal notices will be mailed March 1, 2000 and 1999 membership benefits will end on March 15, 2000 for non-renewals.




SUBJECT: Students Nurses at Annual Course

Relevant Strategic Goal/Objective: 2.2: Increase visibility and promote practice through alliances with other nursing organizations including GI physician groups, government, vendors, other healthcare professional groups, and the public.

Progress to Date/Barriers to Progress: SGNA obtained mailing labels (1300) from NSNA of 2000 and 2001 nursing graduates in the state of California. All students were sent an Annual Course flyer and cover letter from Karen Laing inviting them to attend the annual course for free. The same material was also sent to local nursing schools in the Anaheim area for professors to hand out.

Current Status/Target Date for Completion: So far we have heard from four very enthusiastic nursing students who plan on attending.



FROM: Mary Beth Hepp _X__ InformationSGNA Executive Director

SUBJECT: NFSNO Executive Director Retreat

Relevant Strategic Goal/Objective: This meeting provided overall management input relevant to all 5 SGNA Strategic Plan objectives:

Goal 1: SGNA,CBGNA and the SGNAFER have a unified, seamless approach for soliciting money from vendors via coordinated fund-raising efforts.

Goal 2: Provide current and expanded educational opportunities to SGNA members and customers by maintaining and enhancing delivery mechanisms.

Goal 3: SGNA will be a relevant organization through successful use of Internet resources in order to communicate with the Gastroenterology and Endoscopy community.

Goal 4: Enhance SGNA’s ability to increase scientific research and the number of scientist’s within our specialty.

Goal 5: SGNA is positioned as the expert provider of information and data on practice issues within our specialty, and identifies bridges between the scientific community and the practicing GI Nurse.

Progress to Date/Barriers to Progress: Recently I attended an Executive Director’s retreat hosted by the Emergency Room Nurses Association (hosting rotates among attending NFSNO/NOLF associations). This was an excellent meeting and provided insight, suggestions, idea sharing and networking with other nursing specialty associations. The following Execs / Associations attended:

Pearl Moore (ONS) Bridget Culhane (ONS)Pat Palmer (AORN) Chris Laxton (APIC)Gail Kincaide (AWHONN) Mary Alexander (INS)Wanda Johanson (AACN) Phyllis Reading (AACN)John Garde (AANA) Ruth Corcoran (NLN)David Hennage (ANA) Linda Chreno (NANN)Diane Mancine (NSNA) Mary Beth Hepp (SGNA)Judy Robinson (NASN) Pat Blake (ENA)

The following topics were discussed:

1) Management Issues- Association journal editors - how is the relationship structured?- Annual Reports - usage and value?

2) Board and CEO Issues- Executive Director Evaluations - who does them, forms used, how often, etc.- Board nominations - Board operations - how of often they meet, educating the Board, etc.

3) Clinical Issues- Leadership development for staff nurses and others- Nursing shortage - IOM Report - what we can/should do together as nursing and how each organization is

addressing the report from a nursing specialty perspective.- Clinical competency a) trends away from continuing education and implications for

associations, b) ensuring quality


4) Alliance Issues- Internet partnerships and strategic alliances - Sigma Theta Tau's nursing image campaign - NOLF/NFSNO - next steps

5) Technology Issues- Continuing education and association e-commerce

Specifically, some of the areas I learned a great deal about and/or got some great ideas were:

Better communications with current and potential sponsors: adding annual report type of data to our Sponsorship Opportunities brochure.

Tips on creating better contracts with publisher. Tips on creating better contracts with exhibitors. Build recruiting leadership ideas into strategic planning Getting informal feedback from BOD – “how we doing” throughout the year, not just at Management Review

time. Media kit ideas to provide nurses to recruit young people to become a nursing professional. Correlation between competency and continuing education. Other associations also getting into distance learning Concerns of “giving away the store” with outside Internet companies. Confusion and concerns about NFSNO and NOLF doing the same things – not clear on why have 2

organizations, etc. (see Action Board Report on this issue). SGNA is ahead of many other organizations when it comes to our website and use of technology. SGNA is ahead of other organizations in the quality of our relationship with our sponsorship partners. Because SGNA is not a “stand-alone” association, I am able to concentrate more time on the work of the

mission of SGNA rather than the work of administration. Other Execs seem to spend a great deal of time on administrative issues that SBA takes care of (HR, support department work, etc.).

SGNA does very well in its nominations and elections process and getting candidates to run for offices.

Current Status/Target Date for Completion: This meeting is held every year and rotates hosts. Next meeting is the first weekend in February 2001. The National League of Nursing is hosting.

Staff Support: Executive Director’s attendance at the meeting and preparation to attend.



FROM: Mary Beth Hepp _X__ InformationExecutive Director

Debbie Cohen, CFRESponsorship Manager

SUBJECT: 1999/2000 Sponsorships

Relevant Strategic Goal/Objective: The objective for sponsorships is to continue building relationships within industry and to offer a broad array of partnering opportunities at different price points to vendors. A unified fund raising strategy has been implemented for 2000, whereby Debbie Cohen is actively seeking sponsorships for SGNA, CBGNA and the SGNA Foundation. The financial goals for each organization in 2000 are as follows:

SGNA: $465,000 (a 25% increase over 1999 sponsorship revenues)CBGNA: $ 75,700SGNA Foundation: $ 80,000

Progress to Date:

To date, sponsorship commitments for SGNA in 2000 total $401,750, $54,500 for CBGNA and $1,500 for the SGNA Foundation. New sponsorship commitments totalling $50,250 have been made since the December, 1999 report to the Board of Directors. A complete listing of confirmed sponsors is attached.

Several companies are still considering various sponsorships for the Society, CBGNA and/or the Foundation. Additionally, SGNA leadership met in Boston with Microvasive in January, and we expect to have an additional sponsorship commitment from them in the very near future.

Target Date for Completion: Cultivation activities will continue throughout the remainder of 2000. All funds are expected to be committed by the end of the first quarter of the year.

SGNA/CBGNA/SGNA Foundation2000 Confirmed Sponsorships(Through February 2, 2000)

Company Amount Purpose

Advanced Sterilization $ 10,000 Cleaning Wall Chart$ 3,000 (in-kind) Patient Brochure

Bard Interventional $ 20,000 AC/Tote Bags

Boston Sci Microvasive $ 90,000 Newsletter

CB Fleet $ 7,500 AC/Course Syllabus


cMore Medical $ 21,000 AC/Internet Pavilion

Custom Ultrasonics $ 11,000* CBGNA Newsletter FiberTech $ 7,500 AC/Badge Holders

GI Supply $ 1,000 AC/HOD Bev BreakIn-Kind AC/HOD Writing Pads

Herman Miller $ 3,000 AC/Clinical Session

Integrated Medical Systems $ 1,500* AC/CBGNA Pres Hospitality

MaxMed $ 1,250 AC/Speakers' Fund

Olympus America $100,000 Certification Review Course$ 40,000 AC/Welcome Reception$ 3,500* CBGNA Next Step Brochure

Pentax Precision $ 40,000 AC/Distance Learning$ 20,000 AC/Awards Gala

Roche Laboratories $ 7,500 AC/Junior Portfolios

The Scope Exchange $ 5,000 Web Related Links

STERIS $ 20,000 AC/Awards Gala

Ruhof $ 5,000 AC/Leadership Reception

Wilson-Cook $ 36,000* AC/CBGNA Gala$ 1,500 CBGNA Scholarships$ 1,000 AC/CBGNA Prof. Award$ 1,500 Foundation Scholarships$ 3,000 AC/ Room Keys

* amount not yet confirmedNotes:1. AC = Annual Course2. All commitments to SGNA unless otherwise indicated.3. New commitments since last report to Board are noted in boldface.



FROM: Virginia WalterChair, Web Site Committee ___X__ Information

SUBJECT: Web Site

Relevant Strategic Goal/Objective: 4.1 Provide a menu of products and services from which nurses and associate members can choose that most closely match their needs.

Progress to Date/Barriers to Progress: During the December 13, 1999 Web Site Committee Meeting the following topics were discussed and decisions made: The members only site was activated in mid-August 1999. SGNA’s Newsletters from June 1999 forward are available and searchable on-line. In late September the discussion forum will be moved to the “members’ only” section. The Career Connections site will also be available in the “members’ only” site in the near future. Concern was expressed with the difficulties that members experienced signing on to the first auditorium chat

and the expressed confusion related to protocols for auditorium chats. The technical difficulties for the moderator and speaker experienced for the first auditorium chat were

discussed. It was decided that a neology staff person would take over the role of the moderator with the assistance of a member who would provide nursing support and judgement. It was also decided that the criteria for speakers needs to be expanded to include the availability a computer that meets or exceeds the software’s requirements as well as the availability of two phone lines.

It was suggested that a capacity of 150 was a manageable limit for the next auditorium chat. To accommodate this increased capacity and to enhance the “user friendly” aspects of participating in an

auditorium chat, new software options will be explored. It was decided that we will use various sources (web site, e-Scope and newsletter) to increase the

membership’s knowledge related to auditorium chats. The neology staff will present five different options of software to the web site committee by the end of

January for evaluation. The web site committee will rate each program for appropriateness based on established criteria. The goal is

to have new software by the auditorium chat scheduled for March 2000. Dolores Saddler has agreed to speaker for the next chat. The topic will be “Colorectal Cancer Awareness”. Current Status/Target Date for Completion: The aggressive time line for the development of the website is on schedule.

Staff Support: Allison Cline has been invaluable in moving this program along. She communicates regularly with the SBA technical support teams and keeps the progress on track. Allison is very supportive of the committee. We wouldn’t

be this successful without her!



FROM: Virginia Walter ___X_ InformationLiaison, ASGE Practice Committee

SUBJECT: ASGE Practice Committee/ 12/99

Relevant Strategic Goal/Objective: Goal 2.2: SGNA will increase visibility and promote practice through alliances with other nursing organizations: including GI physician groups, government, vendors, other health professional groups and the public.

Progress to Date/Barriers to Progress: At the December 7, 1999 ASGE Practice committee the following documents were modified and sent to the ASGE Governing Board for endorsement: Upper Gi Bleeding Algorithm Lower GI Bleeding Algorithm Guideline on Age Modifications in Endoscopy Variceal Bleeding Algorithm

The March 18 &19, 2000 meeting’s work will be to respond to the suggestions of the Governing Board related to these guidelines/algorithms. The development of algorithms for all areas of GI endoscopy practice is the direction that the Governing Board has given to the Practice Committee. The feasibility of an ethnic endoscopy guideline is being explored. The Governing Board has requested that Dr. Petersen and I split the age modifications in endoscopy topic into two documents which we will present at the 3/2000 meeting.

Current Status/Target Date for Completion: NA

Staff Support: NA



FROM: Cathy McNeill Dykes MS RN CGRN XSpeaker of the House Information

SUBJECT: 2000 House of Delegates


SGNA will provide contemporary programs and services that advance the practice of gastroenterology and endoscopy nursing

SGNA will maximize the efficiency and effectiveness of its structure and governance


11 Resolutions were submitted for the 2000 House of Delegates. The deadline had to be extended due to the lack of resolutions submitted by November 1, 1999. Resolutions from the 1999 Workshop lacked the names of persons submitting the resolution which slowed the progress and is an excellent opportunity for improvement for 2000.

Resolutions have been numbered and grouped together, interested parties are being notified, and those who submitted resolutions are being contacted with opportunities to set them up for success at the 2000 House of Delegates.

The resolutions are on the e-Scope. An article was submitted for the February 2000 SGNA News with Resolutions and suggestions on sharing them in a regional setting and requesting nominations for 2000 HOD Speaker and Vice-Speaker.

Reference Committees are being formed.

Resolutions in their entirety have been sent to the Presidents along with the 2000 HOD Schedule and a description of each session.

The Workshop for the 2000 House of Delegates has been planned.

Current Status/Target Date for Completion: On Time

Staff Support: Allison Cline has stepped into her new role as HOD liason, has excellent suggestions, and reponds to requests in a timely manner.


REPORT TO THE BOARD OF DIRECTORSFEBRUARY 2000

FROM; Nancy Eisemon RN BS CGRN X InformationProgram Chair

DATE: January 14, 2000

SUBJECT: Update 2000 SGNA Educational Course“Building Partnerships in the 21st Century”

Relevant Strategies Goals/Objectives:Strategic Goal 2: Provide current and expanded educational opportunities to SGNA members and customers by maintaining and enhancing delivery mechanisms.Objective 2.2 Offer members and customers at least 2 new educational techniques/mechanisms for earning contact hours.

Progress to Date:The advanced program was mailed January 19, 2000. The Website for registration is completed and will be posted by the end of January.

There have been a total of 13 poster abstracts submitted. The Education and Practice committee Chairs are reviewing the abstracts. Acceptance letters will be sent to the applicants.

The video taping rights and contact hours for the Teleconference Session is completed.

The American Nurses Credentialing Committee (ANCC) Provider and Approver accreditation applications were sent January 14, 2000 with the $6,000 fee to the committee for review. The ANCC site visit will take place in Chicago sometime in April. The purpose of the visit is for accreditation as an Approver and Provider of CE in nursing. Two members of the Commission will spend time reviewing our records and interview individuals involved in this process.

Since there was not sufficient funding for the Regional Night, we are unable to support this event this year.

Current Status/Target Date for Completion:Letters of acceptance for the posters are scheduled to be mailed by January 12, 2000. The syllabus materials from the speakers are due the end of February and the printing is scheduled for early March.The educational program is on schedule.

Staff Support:Kathleen Domkowski, Mary Beth Hepp, Mary Talbott, Allison Cline, and Courtney Westman



FROM: Christine Bennett X Information Marketing & Communications

(MARCOM) Specialist

Mary Beth HeppExecutive Director

SUBJECT: MARCOM General Project Update

Relevant Strategic Goal/Objective(s): Goal 1, Programs and Services: SGNA will provide contemporary programs and services that advance the practice of gastroenterology and endoscopy nursing.

Goal 2, Image and Identity: SGNA will define the organization’s image and specialty’s identity. Objective 2.4: Project a clear, identifiable image to members and the public.

Objective 2.5: Increase visibility and promote practice through alliances with other nursing organizations, GI physician groups, government, vendors, other health professional groups, and the public.

Goal 4, Membership: SGNA will increase the value of SGNA membership.

Progress to Date/Barriers to Progress: Progressing on schedule.

Current Status/Target Date for Completion: This report summarizes the status of the numerous projects that MARCOM staff have been involved in over the last few months. This is part of our ongoing effort to provide the SGNA Board with a greater understanding of the depth and breadth of services that SGNA receives from the marketing and communications staff. The projects are summarized below.

Staff Support: MARCOM staff (Christine Bennett, Nan Hallock and Elizabeth Johnson) continue to work closely with the SGNA News Editor, internal SGNA staff, leaders and volunteers to manage a variety of projects.

Annual Course: 2000 Advance Program is complete; mailed January 21. Annual Course photographer will be selected in February; Headquarters staff will provide some of the simple

photographic duties again this year. As Debbie Cohen obtains sponsorships for registration giveaway merchandise, MARCOM will work with

designer to prepare artwork combining SGNA 27th Annual Course art with sponsor’s logo and placing orders for merchandise

Upcoming Annual Course projects include the On-Site Pocket Program, Syllabi, Awards and Business Meeting Brochure, and 2001 Exhibitor Prospectus.

Membership An updated membership brochure is being created with the new graphic identity.

SIG News Newsletters: March 1 is the next SIG newsletter deadline (for the Winter/Spring issue).

Regional Presidents’ Memo: MARCOM is finishing up the editing and layout for the Winter/Spring 2000 Regional Presidents’ Memo,

which will mail mid-February. Summer/Fall 2000 Regional Presidents’ Memo copy submission deadline is August 1.


SGNA News: December/January and February issues completed and mailed. March issue in design and layout stage; mailing date first week of March. April issue writing underway. Last President’s Report from Karen Laing will appear in the May issue. First President’s Report from Nancy

Schlossberg will appear in the June issue.

Graphic Identity: Continue to apply new graphic identity to reprints, revised pieces and new projects to ensure continuity in all

publications and printed materials.

Gastroenterology Nursing and GI Buyer’s Guide: Have been running various SGNA ads in issues of Gastroenterology Nursing. Ads include updated

membership application, endoscope module ad, Web site ad and publications information.

GI Nurses and Associates Day: GI Nurses and Associates Day will be held Wednesday, March 22, 2000. The event has been promoted in

several issues of SGNA News and on the SGNA Web site. GI Nurses and Associates Day cards are available this year and have been promoted in the February and

March issues of SGNA News and on the SGNA Web site.

SGNA Merchandise: MARCOM and Administration staff will discuss options for SGNA merchandise and place orders in February.

The goal is to have the merchandise offered for sale at the SGNA Marketplace in Anaheim.

Membership Directory & Resource Guide: Repeated follow up to ensure revenue check for directory ads was sent to SGNA.

Financials and Total Project Management: Ongoing planning and managing of MARCOM budget, both project and time expenses, to provide quality

MARCOM services on schedule.

Auditorium Chat: A postcard is being created to promote the May Auditorium Chat on colorectal cancer. The postcard will have

a similar design as the previous Auditorium Chat postcard, but a new photo will be added and different colors will be used.

The May Auditorium Chat has been promoted through SGNA News and the Web site.

Media Relations: Follow-up with Dateline television show on their segment on endoscopies. Dateline is using SGNA’s

Endoscope Cleaning and High Level Disinfection Guidelines as a reference in this segment. Broadcast date of this segment has not been confirmed yet.

MARCOM Alerts: Provide communications to SGNA Board of Directors when significant promotional pieces have been

completed and printed.



FROM: Nancy Shields, President, SGNA Foundation_X__ Information

SUBJECT: Foundation Activities

Relevant Strategic Goal/Objective: Goal 2.2, Objective 2.1,2.4


1. The Foundation is working on some small projects to raise money including the sale of nurse “angel” pins. Following notification in the SGNA news, several orders have already been received. The Foundation Executive Director is also displaying the pins to other nursing organization boards for purchase in bulk, with proceeds going to the SGNA Fdtn In addition, at the Anaheim 2000 Annual Course the Foundation will introduce a sterling silver flexible endoscope label pin that was originally developed in Canada. They are elegant and look like a nice piece of jewelry. Because of their cost (about $25 per pin) the Foundation will donate several to the Foundation Follies silent auction. We will also display them at the booth in Anaheim and request that members order them in advance.

2. Glaxo/Wellcome has donated a $10,000 research grant to the Foundation for Inflammatory Bowel Disease. Notification of the grant appeared in the last issue of SGNA News.

3. A list of Foundation Board of Trustees nominees will be presented for SGNA Board approval.

Current Status/Target Date for Completion:

Staff Support:


REPORT TO THE SGNA BOARD OF DIRECTORSWinter 2000

FROM: Marilyn Schaffner _X_ Information

SUBJECT: Society of Gastroenterology Nurses and Associates2000-2001 Elections

A total of 887 ballots were received.

President-Elect

Margaret Coffey, BSN, RN, CGRN 44650%

Virginia Walter, MS, BSN, RN, CGRN 43449%

Treasurer – Two year termNancy DeNiro, RN, CGRN 544

61%Cathy Dykes, MS, BSN, RN, CGRN 319

36%Board of Directors – Two year term (select three)Myra Almon, BSN, RN, CGRN 494

56%Patricia Maher, RN, CGRN 455

51%Jo Wheeler, BA, RN, CGRN 445

50%Marilee Schmelzer, PhD, MSN, BSN, RN 402

45%Nancy Eisemon, BS, RN, CGRN 372

42%Sallie Walker, BA, RN, CGRN 344

39%Nominations and Elections Committee (select four)Donna Reeves, LPN, CGN 590

67%Jane Allaire, RN, CGRN 518

58%Virginia Strickland, BSN, RN, CGRN 491

55%Mary Rogers, BSN, RN, CGRN 482

54%Mary Stirland, BSN, RN, CGRN 433

49%Peggy Gauthier, RN, CGRN 431

49%Julia Nist, RN, CGRN 365

41%



FROM: Kathy B. Wright X InformationEditor, Gastroenterology Nursing

SUBJECT: Board report


Manuscript status:Received since 11/01/99 – 6In review/revisions - 5Accepted – 2Rejected - 1Queries - 5

Sandy Kasko (Lippincott Associate Publisher), Mary Beth Hepp, Heather Bagby, and Kathy Wright participated in a conference call on January 14 to finalize plans for the first editorial board strategic planning session. The meeting will be held March 10-11 in Philadelphia at Lippincott headquarters. I am happy to report that Lippincott has generously covered the hotel accommodations, room, & meal expense for meeting attendees. SGNA will be responsible for airfare & ground transportation expenses. The meeting agenda was planned and it was such a pleasure to see the level of respect and support that exists between Lippincott and SGNA. Our initial discussions regarding the future potential for GNJ were exciting and reflected the true team approach that each organization contributes towards a win-win situation for everyone involved with the mission of SGNA & GNJ. Key members of the Lippincott team will also participate with the editorial board in the strategic planning process. I anticipate their active involvement will certainly enhance the outcomes of our meeting. I appreciate so much the active involvement and support that Mary Beth & Heather have contributed in making the meeting arrangements and facilitating a successful event. The strategic plan and recommendations for implementation will be presented to the SGNA BOD at the May meeting.

We have experienced some problems this past year with our authors not receiving their final proofs in a timely manner from the compositor which results in late mailing of the journal. As a result, Lippincott has elected to pull this process in-house. Cynthia Wells, Senior Production Editor, initiated the change as a result of our mutual frustrations and will oversee the process. It is anticipated that the problem will be resolved shortly with this change.

We are entering the new year in good shape as far as manuscripts go. We have at least 5 manuscripts planned for each issue of 2000 and if submission and acceptance rates continue, will be able to offer 6 manuscripts/issue. I anticipate adding several new columns during the current year including one with a focus on management (Marilyn Shaffner will be department editor) and alternative GI therapies (Lori Giese, department editor). The research committee (Marilee Schmelzer, Chair) is considering contributing a column on the research process (eg., defining a research problem and purpose, importance of the literature review, basic research designs, selecting a sampling plan, statistical analysis, etc.).

I am excited about the potential outcomes of our strategic planning session in March and appreciate the BOD's confidence and support of the editorial board. I am confident we will be able to develop a working plan that will guide GNJ towards further valuable contributions to the gastroenterology nursing discipline.


REPORT TO THE SGNA BOARD OF DIRECTORSJanuary 2000

FROM: Mimi Ruffing X InformationExhibits Manager

Mary Beth HeppExecutive Director

SUBJECT: Exhibit & Vendor Program Revenue

Relevant Strategic Goal/Objective: Goal 2 - Image and Identity: SGNA will define the organization’s image and specialty’s identity.

Objective 2.5: Increase visibility and promote practice through alliances with other nursing organizations, GI physician groups, government vendors, other health professional groups, and the public.

Goal 4 - Membership: SGNA will increase the value of SGNA membership.Objective 4.2: Explore alternative membership dues options.

Progress to Date/Barriers to Progress:The sales progress for the 27th Annual Course is going well, with current sales at 92% of goal revenue. All exhibitors from the past year have been contacted regarding participation in the 2000 show. We are currently contacting other leads that have shown interest in exhibiting at the show. We are currently waiting for 4 more contracts to be received.

As of January 21, 2000 exhibit sales as follows: 88 Exhibiting companies

6 new exhibitors in 2000 2 companies canceled their space 2 companies downsized their 1999 space for 2000

Reasons given by prospects for choosing not to exhibit at SGNA: Budget issues

Attachment 1 - Current exhibit sales report as of 1/29/00. As of January 29, 2000, SGNA will realize $353,575 in exhibit revenue ($32,225) under budget. To date, 198 booths have been assigned to 88 exhibiting companies compared to 203 booths sold to 100 companies last year (final numbers).

Attachment 2 - List of current Vendor Program participants. Due to the enormous positive response of the 1999 Vendor Program, SGNA added an additional 5 time slots for a total of 20. To date, 11 of them have been sold and one is on hold awaiting contract. As of January 29, 2000 SGNA will realize $19,250 in Vendor Program revenue. The current Vendor Program sales represent 73% of budget.

Current Status/Target Date for Completion: The sales process will continue for the next three months leading up to the show. Staff will continue to follow up with existing leads in the exhibitor database as well as focus on identifying new prospects with products and service that fit the SGNA profile. The Exhibitor Service kit is slated to mail at the end of the month.

Staff Support:Sue Griffin is serving as main contact for all SGNA sales efforts with Mimi Ruffing and Chris Goehrig focusing on operations and exhibitor support.


SGNA 27th Annual Course - Anaheim, CA


Exhibit Sales ReportDate Prepared: 01-29-2000

Company Name # of Total Exhibit Vendor Total Amount Cancelled

Bold = New this week Italised = Cancelled Booths

Sq. Ft. Revenue Program Credits Due Exhibitors

*3CPM Company 1 100 $1,875.00 $937.50 $937.50 Advanced Sterilization Products 4 400 $7,100.00 $1,750.00 $8,850.00 $0.00Amgen Inc. 2 200 $3,600.00 $1,775.00 $1,825.00AstraZeneca 2 200 $3,550.00 $1,750.00 $5,300.00 $0.00Bard Interventional Products 8 800 $14,200.00 $1,750.00 $15,950.00 $0.00Beutlich LP 1 100 $1,825.00 $975.00 $850.00Boston Scientific Microsvasive 15 1500 $26,625.00 $13,312.50 $13,312.50Braintree Laboratories 1 100 $1,875.00 $912.50 $962.50BW Medical Group Inc. 3 300 $5,425.00 $1,750.00 $2,712.50 $4,462.00Cadmet, Inc. 2 200 $3,600.00 $1,800.00 $1,800.00C.B. Fleet Co., Inc. 1 100 $1,925.00 $975.00 $950.00CBGN 1 100 $200.00 $0.00 $200.00Centocor Inc. 2 200 $3,600.00 $3,600.00 $0.00Chek-Med 1 100 $1,775.00 $1,775.00 $0.00CIRCON Corporation 1 100 $1,825.00 $1,825.00 $0.00cMore Medical Solutions, Inc. 2 200 $3,600.00 $1,000.00 $2,600.00Concord Endoscopy Services, Inc. 1 100 $1,775.00 $0.00 $1,775.00Crohn's & Colitus Foundation of America 1 100 $200.00 $200.00 $0.00Custom Ultrasonics Inc. 4 400 $10,650.00 $10,650.00 $0.00Dale Medical Products 1 100 $1,875.00 $1,875.00 $0.00Datascope Corp. 1 100 $1,825.00 $1,825.00 $0.00Encompas Unlimited Inc. 2 200 $3,800.00 $3,800.00 $0.00Endocare 1 100 $1,825.00 $925.00 $900.00EndoDynamics 2 200 $3,600.00 $3,600.00 $0.00Endorepair & Filter Co. 1 100 $1,775.00 $1,000.00 $775.00ERBE USA 2 200 $3,600.00 $3,600.00 $0.00Esco Medical Instruments Inc. 1 100 $1,875.00 $913.00 $962.00Ferndale Laboratories 1 100 $1,825.00 $1,925.00 -$100.00FiberTech Medical 2 200 $3,600.00 $1,750.00 $3,550.00 $1,800.00Fujinon 4 400 $7,100.00 $1,800.00 $5,300.00GI Supply 4 400 $7,100.00 $3,550.00 $3,550.00Gluten Intolerance Group 1 100 $200.00 $100.00 $100.00*Healthpoint 4 400 $7,500.00 $7,500.00 $0.00Herman Miller For Healthcare 2 200 $3,600.00 $3,600.00 $0.00HOBBS Medical 1 100 $1,925.00 $962.00 $912.50*InnerSpace Corporation 1 100 $1,925.00 $962.50 $962.50Integrated Medical Systems, Inc. 4 400 $7,100.00 $1,750.00 $5,300.00 $3,550.00*International Polymer Engineering 1 100 $1,875.00 $937.50 $937.50*Kimberly Clark 4 400 $7,500.00 $3,750.00 $3,750.00Lippincott Williams & Wilkins 1 100 $1,825.00 $1,825.00 $0.00Matlock Endoscopic 2 200 $3,600.00 $1,775.00 $1,825.00MaxMed, Inc. 1 100 $1,825.00 $1,825.00 $0.00MD Technologies inc. 1 100 $1,825.00 $912.50 $912.50Medical Chemical Corporation 1 100 $1,825.00 $1,825.00 $0.00


Medical Data Electronics (cancelled 12/17/99)

0 0 $100.00 $100.00 $0.00 Medical Data

Medical Design Systems 1 100 $1,925.00 $925.00 $1,000.00*Mediflex 1 100 $1,925.00 $1,825.00 $100.00Medi-Globe Corporation 1 100 $1,825.00 $912.50 $912.50Medovations 1 100 $1,925.00 $1,925.00 $0.00MedServ Int'l 2 200 $3,550.00 $1,800.00 $1,750.00Medtronic Functional Diagnostics 2 200 $3,600.00 $3,600.00 $0.00Metrex 1 100 $1,825.00 $1,825.00 $0.00Mill-Rose Laboratories 1 100 $1,925.00 $0.00 $1,925.00Mine Safety Appliances Company 1 100 $1,825.00 $1,825.00 $0.00Mobile Instrument Service & Repair 1 100 $1,925.00 $887.50 $1,925.00National Digestive Diseases Information Clearinghouse

1 100 $200.00 $200.00 $0.00

*Neoforma.com (cancelled 12/17/99) 0 0 $100.00 $100.00 $0.00 Neoforma

Novartis Nutrition 2 200 $3,750.00 $1,750.00 $1,875.00 $3,625.00Olympus America, Inc. 16 1600 $28,600.00 $1,750.00 $28,600.00 $0.00OneSource Services, Inc. 2 200 $3,600.00 $1,800.00 $1,800.00Ortho-Kinetics, Inc. 4 400 $7,100.00 $3,550.00 $3,550.00Pentax 8 800 $14,200.00 $1,750.00 $8,850.00 $7,100.00Precision Endoscopy 2 200 $3,600.00 $1,800.00 $1,800.00PriMed Instruments, Inc. 1 100 $1,775.00 $887.50 $887.50Priority Healthcare Corporation 1 100 $1,825.00 $1,825.00 $0.00Procter & Gamble Health Care 1 100 $1,925.00 $1,925.00 $0.00Propper Manufacturing Co., Inc. 1 100 $1,925.00 $900.00 $1,025.00Protocol Systems, Inc. 2 200 $3,600.00 $1,900.00 $1,700.00Roche Laboratories 2 200 $3,600.00 $3,600.00 $0.00Ross Products / Division Abbott Lab. Inc. 1 100 $1,775.00 $0.00 $1,775.00Sandhill Scientific 2 200 $3,600.00 $1,750.00 $1,825.00 $1,775.00Schering Oncology/Biotech 2 200 $3,600.00 $1,900.00 $1,700.00SGNA Foundation 1 100 COMP $0.00 $

- SmithKline Beecham Consumer Healthcare

2 200 $3,600.00 $1,800.00 $1,800.00

*Sporicidin International 1 100 $1,925.00 $962.50 $962.50STERIS Corporation 8 800 $14,200.00 $0.00 $14,200.00TechniPharm 1 100 $1,925.00 $925.00 $1,000.00Telemed Systems, Inc. 1 100 $1,925.00 $962.50 $962.50*TheASCnetwork.com 1 100 $1,825.00 $1,825.00 $0.00The Ruhof Corporation 4 400 $7,100.00 $1,000.00 $6,100.00The Scope Exchange Inc. 2 200 $3,800.00 $3,800.00 $0.00TAP Pharmaceuticals Inc. 2 200 $3,600.00 $3,600.00 $0.00US Endoscopy Group 4 400 $7,100.00 $3,550.00 $3,550.00UTECH Products, Inc. 1 100 $1,825.00 $0.00 $1,825.00Vanguard Medical Concepts, Inc. 1 100 $1,925.00 $1,925.00 $0.00V. Mueller / Allegiance Healthcare Corporation

1 100 $1,775.00 $1,775.00 $0.00

W.B. Saunders / Mosby 1 100 $1,925.00 $1,925.00 $0.00Wilson-Cook Medical Inc. 9 900 $16,025.00 $1,750.00 $17,775.00 $0.00Windquest Companies Inc. 2 200 $3,600.00 $1,775.00 $1,825.00Zevex Inc. 2 200 $3,800.00 $1,900.00 $1,900.00


TOTAL 198 19800 $353,575.00 $19,250.00 $253,912.50 $123,349.00BUDGET $385,800.00 VARIANCE AMOUNT ($32,225.00)VARIANCE PERCENTAGE 91.65%# Exhibitors = 88 # of New Exhibitors+6 # Canceled Exhibitors = 2 # Canceled Sq. Ft. = 200

* = New Exhibitor

SGNA 27th Annual Course 2000Vendor Program Sales

01/29/1999

Company # Programs Sold

Revenue Total Credits Amount Due

Olympus America 1 $1,750.00 $ 1,750.00 $ - Pentax 1 $1,750.00 $ 1,750.00 $ - Integrated Medical Systems Inc. 1 $1,750.00 $ 1,750.00 $ - Wilson-Cook Medical Inc. 1 $1,750.00 $ 1,750.00 $ - Bard Interventional Products 1 $1,750.00 $ 1,750.00 $ - FiberTech Medical Inc. 1 $1,750.00 $ 1,750.00 $ - AstraZeneca 1 $1,750.00 $ 1,750.00 $ - Sandhill Scientific 1 $1,750.00 $ 1,750.00 $ - Novartis 1 $1,750.00 $ 1,750.00 $ - Advanced Sterilization 1 $1,750.00 $ - $ 1,750.00 BW Medical Group 1 $1,750.00 $ - $ 1,750.00

Total 11 $ 19,250.00 $ 15,750.00 $ 3,500.00

BUDGET TOTAL 15 $ 26,250.00 VARIANCE AMOUNT $ (7,000.00)VARIANCE PERCENTAGE 73.33%



FROM: Kathleen Domkowski, MS RN C _X_ Information Director of Nursing Education

DATE: 1 February 2000

SUBJECT: ANCC Accreditation


Progress to date/Barriers to Progress: The applications for ANCC accreditation as a Provider and Approver of continuing education in nursing have been submitted.

Current Status/Target Date for Completion: A two-day site visit will be scheduled between April and June. We have prioritized three options in April, and expect to be notified by early March which have been selected.

We expect the site visit to include review of policies, procedures and documents on file, and interviews with staff, faculty, peer reviewers (CEPRG members), Program and Education Committee Chairs (and possibly members), and other individuals who may be identified by the site visitors. These interviews are generally scheduled in advance, and most involving volunteers can be handled by telephone.

Staff Support: Staff will continue to monitor ongoing processes and complete updating of files to ensure that all documentation is complete in advance of the visit. Participants in the site visit interviews will be notified as soon as the schedule is provided from ANCC. Kathleen Domkowski will coordinate the site visit with the assistance of Courtney Westman.





SUBJECT: CE credit for Auditorium Chats


Progress to date/Barriers to Progress: No activity has taken place on this goal yet.

Current Status/Target Date for Completion: After a successful trial of the new software and procedures, staff will cooperate with the Website Task Force to establish a mechanism for awarding CE credit to participants in an auditorium chat.

Staff Support: None additional needed at this time.



FROM: Kathleen G. Domkowski, MS RN C _X__ InformationDirector of Nursing Education

SUBJECT: Information Requests

Relevant Strategic Goal/Objective: Goal 5: SGNA is positioned as the expert provider of information and data on practice issues within our specialty, and identifies bridges between the scientific community and the practicing GI nurse.

Progress to Date/Barriers to Progress: Members and non-members alike make frequent telephone (and increasingly, email) requests for information on a variety of subjects. Common questions are answered by staff; questions of a more technical nature requiring clinical GI expertise are referred to the Practice Committee.

Current Status/Target Date for Completion: This approach is ongoing, and becomes more effective and efficient as staff becomes more informed on a variety of subjects. Attached is a list of commonly-asked questions handled during 1999.

Staff Support: Having a registered nurse available to respond to these questions has speeded dissemination of information about many frequently-asked questions.

1999 Questions Posed to HeadquartersADA – How much assistance can an RN provide to a physician no longer physically able to cannulate the

ampulla?Advancing scopeAge-specific competenciesASA risk classification - where to locate it?ASA risk classification – can the RN assign the score?Background on reuse position statementBenchmarking data on reversal agent useBotox useBowel sounds pre- and post- procedure – is there a protocol?Bronchoscopes in STERIS?Bronchoscopy standardsBSN needed for certification?CA BRN w/ role questionsCertification for flex sig by RNCidex PACidex soak timeCleaning scopesCode of ethicsColonoscopy by RN?Competency for endo roomCost per procedure comparisons dataCredentialing GI labsCulturing scopesDesigning tech program at community collegeDocument sedation totals, or each increment w/ time?Endorse a course – will SGNA do this?ERCP training - where available?Expanded role status by stateGastric analysis - how to perform since pentagastrin no longer available?


GI Nurses day – when?GI role for office CNSG-tube care & feeding instructions for familiesGuidelines for PEG placementH. pylori testingHep C genotyping infoHepatitis C therapyHLD statisticsIndia ink preparation for useIndia ink sourceInfection control guidelinesInformed consents – what aspects of conscious sedation should be covered?JCAHO info on conscious sedationLab designLatex allergyLPN doing sclerotherapyLPN role in conscious sedationManipulation of scopeNS vs. sterile water to flush ERCP catheterNurse endoscopistsNurse practitioner roleOSHA guidelines recommend gas sterilization over glutaraldehydePacers PEG assisting – trocar palcementPEG position statementpH monitoringPlacing NGTPoliciesPrep required for nurse practitioners doing flex sigs in office settingProcessing scopesPulmonary procedures in procedure manual?Recommendations for paperworkRecovering IVCS patients from endo w/ ORRenting colon models – sourceReprocessing duodenoscopesReprocessing elevator channelResearch project infoReusable cleaning brushesRNs assisting with PEGRNs doing flex sigs – by stateSaw commercial on GERD, seeks reputable physicianSclerotherapy – OK for LPNs to perform?Scope cleaningSeeking assistance with writing nutrition textSelecting HLD agentSingle-use vs. reusable biopsy forcepsSoak timeStaffing standardsStandards for infection controlStandards for ventilation w/ glutStandards of practice & roles Statement on changing gownsStatement on reusable biopsy forceps reprocessingStatement on wearing scrubsSTERIS irrigatorSTERIS vs. glutaraldehyde


Sticking buttons on sigmoidoscopeSubstitute for secretin?Tap water vs. sterile waterTattooingTech role during PEG – insufflation?Techs positioning stentsTitle 22 log of patients – contents?Topical anesthetics by administered by techs?Training NPs to do flex sigsTube feedings by RNs only?Use of lidocaine injection to decrease gag reflexUsing EGD scope for flex sig Water bottles – HLD or sterilize?Why should suction tubing be changed?YAG laser

Additional questions January 2000:Abstract form request for 2001Academic credit for presenting lecturesArticles on nurse endoscopistsBowel prepsCE application questionsCidex with & without surfactantClinical validation of standards before implementationConscious sedation & pregnant staffDischarge patients by taxi after sedation?ERCP training coursesFeeding tube flushing protocols, references, dataGI-specific topics for recertificationGuidelines, how to purchaseLapsed member – how to re-joinManometry - # procedures recommended per year to maintain competencyParamedic as tech in proceduresPatient ed. video on sigmoidoscopyPermission to copy crossword from journalRatio of recovery beds to procedure roomsReversal agent use statisticsStandards of careSyllabus questionsTech duties in exam roomsUAP job descriptionUse of fans in procedure roomsVendor program CE creditVenous access required for flex sig without sedation?Water bottle reprocessing





SUBJECT: Audiotape modules


Progress to date/Barriers to Progress: Three audiotape modules have been out for pilot testing for several months. None have had the required five pilot tests completed, despite repeated reminders to the volunteers. In several instances, additional tapes have been purchased and distributed to more volunteers in an attempt to complete the testing. It was exciting to see more than 85 volunteers to participate in this activity, but very frustrating that those contacted have not fulfilled their commitment to do so once they accepted the materials.

Sale of these modules have been lower than anticipated because the variety of titles available is so limited.

Current Status/Target Date for Completion: Because of the delay in completing these modules based on 1998 presentations, further 1998 topics will be bypassed. The volunteers holding these particular modules (Rectal and Anal Surgery, Pharmacology Update, and GI RN-GI Tech Partnership) are being contacted and instructed to either complete the pilot test or return the materials no later than February 15.

Development of 1999-based modules has begun, with pilot testing scheduled for April 2000. As was done before, volunteer pilot testers will be contacted by telephone to obtain their consent to complete the test within two weeks of receiving the materials. Staff plan to track these modules more closely and make reminder calls if materials are not returned at the end of that time. If these efforts are not successful, other strategies for increasing returns will be developed.

Staff Support: Kathleen Domkowski will compile the learning guide contents, and Courtney Westman will be oriented to formatting the material and tracking the pilot testing process.



FROM: Kathleen G. Domkowski, MS RN C _X__ InformationDirector of Nursing Education

SUBJECT: Certification Preparation Course


Progress to Date/Barriers to Progress: The first five sections of this course have been developed, and are presently being reviewed by staff while additional sections are completed. A date (September 9, 2000) has been selected for the first presentation, with a site in the Chicago area being sought. Funding for this project has been pledged by Olympus America, who is also working with faculty to identify clinical images to be used in the presentation.

Staff has held preliminary discussions with an independent publisher to explore the feasibility of producing the Course syllabus as a stand-alone study guide in addition to its use at the Course. Not knowing the extent of revisions which will be made after this first pilot presentation, faculty and staff both recommend waiting until after the September session before committing to a minimum quantity of sales.

Current Status/Target Date for Completion: The presentation site should be selected and the registration procedure and fee determined by February 15, with publication of the information scheduled for the April 2000 SGNA News. Target for completion of the manuscript is April 1, 2000. A further report will be made at the May Board meeting.

Staff Support: Kathleen Domkowski is coordinating the CE component and assisting with manuscript review. Courtney Westman will handle syllabus production.





SUBJECT: Contact Hour Feature in Gastroenterology Nursing


Progress to date/Barriers to Progress: The Director of Nursing Education will participate in the Gastroenterology Nursing strategic planning meeting in March.

Current Status/Target Date for Completion: Kathleen Domkowski has discussed several approaches with Kathy Wright over the past year, and they are in agreement that alternatives to the previous format will likely better meet the needs of SGNA members. This meeting will help provide key linkages between the journal and the educational efforts of the Society, and is an excellent opportunity to tap the expertise of Lippincott Williams & Wilkins in this are.

A follow-up report on this meeting will be provided at the May SGNA Board meeting.






SUBJECT: Assisting Regional Societies to Conduct Hands-on Training


Progress to date/Barriers to Progress: No activity has taken place on this goal yet.

Current Status/Target Date for Completion: Staff plans to develop an outline to assist Regionals in conducting these kinds of activities. When available, a notice will be included in an upcoming Regional Presidents’ Memo, inviting Regions to contact Headquarters for the information and assistance.






SUBJECT: Priority Practice Issues

Relevant Strategic Goal/Objective: Goal 5: SGNA is positioned as the expert provider of information and data on practice issues within our specialty, and identifies bridges between the scientific community and the practicing GI nurse.

Progress to date/Barriers to Progress: The committee discussed this goal, and identified the following issues:1) sedation and analgesia2) reprocessing of gastrointestinal endoscopes and 3) the issue of reprocessing single use devices Current Status/Target Date for Completion: Discussion will continue with the new committee beginning in May 2000. On target for completion as scheduled.




FROM: Judith W. Fullhart _X__ Information Chair, CEPRG

SUBJECT: CEPRG (Continuing Education Peer Review Group)

Relevant Strategic Goal/Objective : Goal 2: Provide current and expanded educational opportunities to SGNA members and customers by maintaining and enhancing delivery mechanisms. 1. Serve as approver for educational programs offered by regional societies and others. 2. Maintain Approver status through American Nurses Credentialing Center

Progress to Date/Barriers to Progress: 1. In 1999, 76 applications for contact hour approval were reviewed by CEPRG members.2. Application for accreditation as an Approver was submitted to the ANCC.3. Attached are QA statistics from the latest responses received. All reflect 1999 applicants’ responses.


Current Status/Target Date for Completion: 1. Applications are reviewed as received. 2. Headquarters visit by ANCC projected for Spring 2000 Staff Support: Applications for review have been distributed efficiently to CEPRG members with clear expectations about due dates. Kathleen has been extremely knowledgeable and supportive. Through revisions, she has made both the Educational Design packet and the review formnearly fool proof. Her work on the application to ANCC for accreditation (almost 100 pages!) was superlative.

Summary – 9/24/99 through 2/2/00N=3

You recently made application through SGNA’s Continuing Education Approver Unit for approval of a nursing continuing education activity. We would appreciate your feedback on the following brief questionnaire. Feel free to add any comments or suggestions on the reverse.

Thank you for helping us to improve the process.Continuing Education Peer Review Group

Name:Application #: Please rate the following aspects of the application and review process below:

Stro

ngly

A

gree

Agr

ee

Neu

tral

Dis

agre

e

Stro

ngly

D

isag

ree

Not

A

pplic

able

5 4 3 2 11. Application materials were provided promptly from SGNA Headquarters on

request.5

2. The Guidelines document provided clear explanation of policies and expectations.

5

3. The application form was clear and easy to complete. 54. Sample forms (evaluation, certificate, sign-in sheet) were helpful. 4.675. I was able to easily get my questions answered by Headquarters staff. 56. The fee charged is reasonable. 4.677. The application deadline was easily achievable. 58. I was notified promptly of the decision of the CEPRG. 59. If changes were requested before final approval was granted, the items needed

were clearly explained.5

10. I feel confident that I can correctly complete my next application. 5

We would also appreciate your responses to the following:

11. The most difficult part of the application process was. . . Finding time to read through the process before compiling information for the application.

12. I would like more information about. . . Creating printed CNE for brochure or from web download.


Continuing Education Applicant Follow-Up Questionnaire

ASGE Repetitive Use Syndrome Survey

Documents

Transcript of ASGE Repetitive Use Syndrome Survey