DECONTAMINATION & STERILE SERVICES
The Institute of Decontamination Sciences (IDSc) chair Val O’Brien talks to NHE about the latest issues in decontamination and how new challenges affect the advice provided to professionals working in the health service.
M
aintaining high standards for decon- taminating reusable medical devices is proving a challenge with the rise of more complicated surgical techniques, especial- ly those involving robotic devices.
The IDSc is the UK’s largest professional body for the decontamination of reusable medical devices. It provides advice and guidance to members and other healthcare professionals working within the health sector. Its current chair, Val O’Brien – who is due to step down at the end of Novem- ber 2011 – explained some of the current challenges in decontamination and the in- fluence on practice that new guidance and legislation brings.
These challenges include trying to influ- ence the policy makers at government and at the Department of Health to develop guidance that offers practical solutions to the way reusable devices are decontami- nated. Decontamination is a science and the IDSc has to constantly update informa- tion to ensure it is relevant and fitting for current practice and regulations, as well as providing cleaning solutions for compli- cated instruments.
There are different approaches to decon- tamination: the debate concerning single- use versus re-useable medical devices has been long-standing, for example, but both can have their place, O’Brien suggests, de- pending on ease of cleaning and complex- ity of design.
O’Brien said: “The majority of surgical instruments are re-useable, and decon- taminated between patient uses, but there are situations where a single-use device is more appropriate; for example, devices that are difficult to clean. There’s a whole list of benefits, for and against for both re- useable and single use.
“For some devices, for example hollow or lumened devices, although you can subject them to a validated cleaning process, you cannot actually inspect them to validate the ultimate cleanliness of the device, vis- ual inspection would not allow you to see inside the device.”
Complexity
The design of instrumentation is also a huge challenge for cleaning, O’Brien said,
“No single standard fits all the parts of da Vinci instruments, and so this complexity requires different types of approach to de-
and this may be a situation in which single- use instruments should be considered in- stead. Ease of cleaning is prioritised below effectiveness in the process of designing instruments, which means that developing appropriate methods of decontamination can be difficult.
O’Brien explained: “We have long consid- ered that the key to successful decontami- nation of devices lies in ‘engineering out the problems” before devices are placed on the market.
“Manufacturers tend to design an instru- ment to perform a particular function and then it’s up to people who work in decon- tamination and sterile services to challenge the design.
“Every CE marked medical device needs to come with a manufacturer’s instructions, which describe how it should be decon- taminated effectively, and how it should be used safely for the patient, although sometimes these instructions are not par- ticularly clear.”
The complexity of certain devices, particu- larly da Vinci robotic instruments, provides decontamination experts with “the biggest headache”, O’Brien said.
contamination for different pieces within that set of instruments. They do create a huge challenge for people working in de- contamination services,” she said.
Maintenance of sterility
Once devices have been decontaminated in a Sterile Services unit, mechanisms must be in place to ensure sterility is main- tained. Sterilisation packaging comes in many forms, from standard sterilisation papers through to different types of rigid containers. All act as a means of protecting the product but also to support the mainte- nance of sterility on the products journey to patient and point of use.
The Institute has a range of training ma- terials which cover different aspects of the decontamination process including a Standards and Practices document, pack- aging and transport are described in detail within this literature.
O’Brien explained: “It describes the prac- tices and principles that would be applied to the different elements of the process, literally from the point of use and collec- tion and transporting to washing, disinfec- tion, inspection and assembly, packaging, through to sterilisation. There are quite clear standards for storage and distribu- tion and recommendations on how that should be undertaken.”
Continued overleaf > national health executive Nov/Dec 11 | 61
Roswell Park (da Vinci surgical robot)
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