MULTILEVEL MODEL OF EPIDEMIOLOGICAL SAFETY OF ENDOSCOPIC PROCEDURES
Abstract
Background. Traditional control of endoscopic procedures based on recording individual nonconformities does not reflect the mechanisms of epidemiological risk formation and limits the prioritization of management decisions. Objective. To substantiate both a multilevel model of epidemiological safety of endoscopic procedures and its application in a risk-based epidemiological audit. Material and Methods. A methodological study of the epidemiological safety system was conducted using an audit checklist. A structural analysis of control criteria was performed with their grouping into functional blocks and identification of critical control points based on their association with infection transmission risk and the possibility of compensating for deviations at subsequent stages. International guidelines and current regulatory documents were used. Results. A multilevel model was developed, including the levels of initial readiness, endoscope reprocessing, fluid systems, as well as control and traceability. A distinction between control points and critical control points was substantiated: critical control points are localized at stages of the technological process and determine the possibility of infection transmission, whereas control points reflect system stability. It has been shown that epidemiological risk arises from a combination of violations at different system levels. Conclusion. The proposed model enables a shift from recording nonconformities to analyzing the mechanisms of epidemiological risk formation and allows prioritization of management decisions with a focus on critical control points.
References
Kolomiets N, Aliaksejewa M, Romanova O, Kastsiukevich L, Hanenko O, Tonko O, Gapeenko E. Primenenije metodologii analiza riska pri epidemiologicheskom slezhenii v endoskopii (Soobshchenije 1) [Application of risk analysis methodology in epidemiological audits in endoscopy (Report 1)]. Gepatologija i gastroenterologija [Hepatology and Gastroenterology]. 2025;9(1):12-21. https://doi.org/10.25298/2616-5546-2025-9-1-12-21. https://www.elibrary.ru/adqkfa. (Russian).
Aliaksejewa MG, Kolomiets ND, Hanenko ON, Tonko OV. Organizacija sanitarno-jepidemiologicheskogo audita dlja profilaktiki razvitija infekcij, svjazannyh s okazaniem medicinskoj pomoshhi [Organization of sanitary and epidemiological audit for the prevention of healthcare-associated infections]. In: Rubnikovich SP, Reutovich MYu, eds. BGMU v avangarde medicinskoj nauki i praktiki. Recenziruemyj ezhegodnyj sbornik nauchnyh trudov [Advances in medicine and medical sciences: collection of Belarusian state medical university. Peer-reviewed annual collection of scientific papers]. Minsk: BSMU; 2025. Iss. 15; p. 17-23. (Russian).
Kolomiets N, Alekseeva M, Hanenko O, Tonko O, Romanova O, Jushko Ja. Primenenie metodologii analiza riska pri jepidemiologicheskom slezhenii v jendoskopii (Soobshhenie 2) [Application of risk analysis methodology in epidemiological audits in endoscopy (Report 2)]. Gepatologija i gastrojenterologija [Hepatology and Gastroenterology]. 2025;9(2):139-146. https://doi.org/10.25298/2616-5546-2025-9-2-139-146. (Russian).
World Health Organization. Global report on infection prevention and control 2024 [Internet]. Geneva: WHO; 2024. Available from: https://www.who.int/publications/i/item/9789240103986
Rutala WA, Weber DJ. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 [Internet]. 2024. Available from: https://www.cdc.gov/infection-control/media/pdfs/Guideline-Disinfection-H.pdf
Beilenhoff U, Biering H, Blum R, Brljak J, Cimbro M, Dumonceau JM, Hassan C, Jung M, Kampf B, Neumann C, Pietsch M, Pineau L, Ponchon T, Rejchrt S, Rey JF, Schmidt V, Tillett J, van Hooft JE. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA). Endoscopy. 2018;50(12):1205-1234. https://doi.org/10.1055/a-0759-1629.
Ministry of Health of the Republic of Belarus. O profilaktike infekcionnyh zabolevanij pri nesterilnyh endoskopicheskih vmeshatelstvah. Prikaz № 1612 (Nojabr 8, 2023) [Internet]. Available from: https://minzdrav.gov.by/upload/lcfiles/%D0%BF%D1%80%D0%B8%D0%BA%D0%B0%D0%B7_%D0%9C%D0%97_2023_1612.pdf (Russian).
O sanitarno-epidemiologicheskom blagopoluchii naselenija. Zakon Respubliki Belarus № 340-Z (Janvar 7, 2012) [Internet]. Available from: https://pravo.by/document/?guid=3871&p0=H11200340 (Russian).
Mortimore S, Wallace C. HACCP: A Practical Approach. 3rd ed. New York: Springer; 2013. 475 p. https://doi.org/10.1007/978-1-4614-5028-3.
Reason J. Human error: models and management. BMJ. 2000;320(7237):768-770. https://doi.org/10.1136/bmj.320.7237.768.
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