DECONTAMINATION


asked to perform tasks or do jobs for which they are neither trained nor competent or for which standard policies and procedures are either absent or out of date. The environment in which services are delivered is very important. Factors such as adequate light, heat and ventilation, attention to the condition of equipment and workplaces and robust maintenance and repair processes are necessary to support safe practice. Staff carrying out such duties diligently


over many years should be applauded. However, it is time to review and minimise potential risks associated with increasing responsibilities on very busy clinical units and engineer appropriate environments suitable for highly important tasks. It is time to provide 21st century facilities, with dedicated professionals educated for decontamination. One of the major risks I see is within the


world of ENT (Ear, Nose and Throat) provision. Clinics are held at certain times and in a typical district general hospital, the patient volume is significant where outpatient departments hold such clinics (ENT). Busier departments are known to see over fifty patients per session and the use of endoscopes for diagnostic technique has grown significantly. Unless a unit is well equipped and well organised, there is little chance of supplying appropriately decontaminated scopes to match clinical demand. What do we mean appropriately decontaminated scopes; well re-usable medical devices should be reprocessed in line with the ‘decontamination life cycle’, manufacturer’s instructions and techniques that are in compliance with the regulatory framework of the United Kingdom. Where units cannot use automated


systems, there is a large number of examples where standard operating procedures have been put in place to use manual cleaning systems using such solutions such as ‘multi stage’ disinfection wipes. Such systems were brought in at many units as an interim measure as it did provide a base element of decontamination and limited trace-ability as the information on both the product and date/time process was carried out can be recorded in a log. However, such systems are far from ideal and users should try and seek alternative solutions as both technology and knowledge expands. Can a central unit supply an ENT


department? They can but there needs to be collaboration between user and decontamination provider to ensure everyone is aware of the. There are many fine examples of such ‘central’ activity and this provides both patient and staff the protection


they require, both from healthcare-associated infections and accountability of process. Interim solutions can no longer be


accepted and there has to be a drive to engineer and resource solutions that comply with the mandates of the healthcare guidance.


Unscheduled healthcare activity additionally presents major challenges. Historically certain scopes were found in cupboards within the department waiting for an ‘it may come in handy’ day. Organisations need to use asset registers to locate what is under their umbrella. Such registers enable resources to be located to area of need, for instance rather that a particular unit owning a number of nasendoscopes and another being short on a clinic day, the nasendoscopes can be diverted to the area of activity on the relevant clinic day. Such technology has long since been available; however reluctance to implement is a major stumbling block. Departments working in isolation are a


major concern within a healthcare facility. Such attitude provides a conspirator to change and will result in everyone finding the required resource and obstacles to maintaining practises in line with technological change. Operational leads within each


organisation have a duty to provide a measure of reassurance that all the processes involved in decontamination of flexible endoscopes and non lumen probes comply with regulatory requirements and accord with guidance developed to help ensure patient safety. Each organisation should develop action plans for continuing improvement and identify areas of weakness which may be the result of environmental, financial or organisational restrictions. It is not a sin to identify a weakness; but it is to not act upon it! The Medical Device Alert – MDA 2012/2012/037 highlighted the


It is time to provide 21st century facilities, with dedicated professionals educated for decontamination.


OCTOBER 2016 John Prendergast


John Prendergast is a senior decontamination engineer working within the specialist team at NHS Wales Shared Services Partnership/Specialist Estates Services (formerly named Welsh Health Estates) that is dedicated to all aspects of decontamination/reprocessing techniques of medical devices. John is a member of a team that provides validation services, advice and guidance to Health Boards/Trusts within Wales and works closely with Welsh governmental departments to deliver policy and strategy in this unique and often complex field. This article is a personnel review and does not highlight any policy of NWSSP/SES or NHS Wales.


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consequences of poor practice. The MHRA issued the alert in response to an an incident where the death of a patient from hepatitis B infection may have been associated with a failure to appropriately decontaminate a transoesophageal echocardiography probe between each patient use. Incompetent people are 1% of the


problem. The other 99% are good people trying to do a good job who make very simple mistakes and it is the processes that set them up to make these mistakes. Let’s learn, let’s share knowledge, and let’s prioritise decontamination.


CSJ


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