DECONTAMINATION
Tackling endoscope decontamination issues
John Prendergast highlights the fact that there are differing priorities between ‘hands on’ clinical staff and dedicated professionals with responsibility for undertaking, managing or supplying endoscope decontamination services.
While training a group of endoscopy nurses, a question was asked to give their opinion as to what is the the most important part of the patient experience while attending a typical endoscopy unit within the UK. To my surprise, the answer I expected to be the highest priority was in fact the fifth to be highlighted: 1 Equality. 2 Privacy/dignity. 3 Timeliness. 4 Comfort. 5 Safety/cleanliness.
Safety/cleanliness of devices used was well down the list. After working in healthcare establishments for many years, should I have been surprised? To professionals dedicated to the field of decontamination, like ourselves, such answers are horrifying; however, we need to understand the pressures clinical staff are under and, in many cases, the training received concentrates on other priorities which are highly important in their own right. Such differences in priorities can be understandable. However, the fact that we have such
opposing priorities can lead each one of us to misperceive situations, despite the best of intentions – it is one of the main reasons that our decisions and actions can often be flawed and risks of healthcare-acquired infections elevated as a result of process errors.
Such highlights the importance of best
practice for the total decontamination process, and the need for such responsibility to come under the wing of appropriately trained management and technicians, supported by a team of appropriately
qualified professionals as identified in healthcare guidance documents such as Health Technical memorandums (HTMs) and equivalent. The disciplines referenced are Authorised Persons (Decontamination), Authorising Engineers (Decontamination), Microbiologist, Infection Control, Decontamination Leads etc. But what is ‘Best Practice’? Best Practice
as defined in the HTM revision covers non- mandatory policies and procedures that aim to further minimise risks to patients; deliver better patient outcomes; promote and encourage innovation and choice; and achieve cost efficiencies. Over the recent years, there has been a
clear emphasis on endoscopy and endoscope decontamination. Driven by the national screening programmes and JAG, this has seen a move to centralise decontamination activities to dedicated units, with suitably segregated areas for dirty/clean activities with
Errors can occur when people are asked to perform tasks or do jobs for which they are neither trained nor competent.
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new AERs/EWDs equipped with monitoring systems that recognise individual scopes and the required channel configuration and working pressures required for suitable irrigation of each lumen. Such dedicated units have suitable
manual preparation facilities, ventilation regimes and electronic trace-ability systems. Transportation systems need to be organised. However, such problems are not insurmountable and just needs a little thought and organisation. Where such units are complete, it is hard
to argue that decontamination should have stayed local under the management of the Endoscopy Unit Management. Where decontamination is still within such clinical zones, it is clear the staff are working with the many pressures, combining complex decontamination activities while having to deal with patients at first hand. Distractions are accepted as inevitable in busy health environments. There are situations with the advent of dedicated units that can and should be minimised. One of the major advantages of dedicated
staff within an appropriate environment is that the focus is completely on the job or task. Errors can occur when people are
OCTOBER 2016
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