INFECTION PREVENTION AND CONTROL
Consistent sterilisation of reuseable medical devices
Healthcare facilities are committed to delivering high quality care in a safe environment to safeguard patients from avoidable harm.1
One area of paramount importance in protecting patients against infection is the decontamination and sterilisation function provided by the Central Sterile Services Department (CSSD). Here, Angelo Giambrone, Healthcare Business Development manager at Spirax Sarco UK, explores how decontamination leads and Authorising Engineers can drive improvements in steam quality to deliver reliable and consistent sterilisation of reusable medical devices. He also touches on what the future may hold for the Sterile Services Department ‘in a decarbonising world’.
Vulnerable hospital patients, often with compromised immune systems, are
Acquisition •Purchase •Loan
unfortunately at increased risk of infection. One report in the British Medical Journal stated that between 2016 and 2017, there were an estimated 653,000 healthcare-associated infections (HCAIs) among the 13.8 million adult inpatients in NHS general and teaching hospitals in England, of which 22,800 patients died as a result of their infection. HCAIs are closely monitored, and the data has been particularly scrutinised over the past year with the ongoing efforts to minimise the spread of COVID- 19. The National Institute for Health and Care Excellence (NICE) reported in 2016 that ‘the six most common types of healthcare-associated infections, which accounted for more than 80% of all HCAIs, were pneumonia and other respiratory infections (22.8%), urinary tract infections (17.2%), surgical site infections (15.7%), clinical sepsis (10.5%), gastrointestinal infections (8.8%), and bloodstream infections (7.3%)’.
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At all stages Location Facilities Equipment Management
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Figure 1: The reusable surgical instrument lifecycle, as published in HTM 01-01, Management and decontamination of surgical instruments (medical devices) used in acute care.
As regards surgical site infections, there is guidance on the preparation of the surgical site, procedures during the operation, and post-operation care of the wound. One critical area in minimising risk of surgical site infection is in the effective decontamination of surgical equipment, and in particular ensuring that the equipment used in surgery is sterilised to the standards required by the industry. As a key infection control measure, decontamination is an ‘umbrella’ term used to describe the process of cleansing to remove contaminants such as microorganisms – making equipment safe
for reuse in operating theatres, clinics, A&E departments, and wards. There are three levels of decontamination within the healthcare environment – the first line of defence is general cleaning, the second is disinfection, and, finally, the third is sterilisation for the removal of viable infectious agents, including viruses and bacterial spores. Effective decontamination can be achieved by applying the appropriate actions at all stages of the decontamination lifecycle process (Fig 1).
The sterilisation element In this feature we will focus on the sterilisation element of the decontamination cycle. Steam provides the most reliable and efficient method of achieving effective sterilisation, which is why the healthcare industry standard for sterilisation is to use
steam, delivered at a specific pressure and temperature. It is a simple, fast, and safe way to decontaminate reusable medical devices such as surgical instruments. However, it is important to consider how the steam is produced and delivered to the sterilisers in order to ensure that the necessary quality standards are met, and to achieve a successful and repeatable outcome from every sterilisation cycle. The time taken for a cycle can depend on the steriliser and its contents. Another factor is the steam pressure. Steam temperature varies with pressure, and Health Technical Memorandum (HTM) 01-01 Part C (Table 1) indicates how steriliser holding times vary with steam temperature, in order to achieve sterilisation. Optimising sterilisation cycle
times of course has an impact on departmental efficiency, economy, and, most importantly, patient safety. Whatever steam pressure or cycle time is used, underpinning it all is the provision of high quality steam into the sterilisation process, to ensure that the desired quality of the end-product is reached.
Steam for safe sterilisation A recent global study of sterilisation facilities conducted by Spirax Sarco aimed to understand the key processing barriers to delivering successful sterilisation outcomes. One issue seen repeatedly around the world was the presence of ‘wet packs’, together with the associated actions of dealing with, and establishing, the root cause of the problem. The phenomenon is recognised and explained in HTM 01-01 4.113, as
April 2021 Health Estate Journal 37
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