SURGICAL INSTRUMENT DECONTAMINATION
Challenging existing protein residue removal methods
Mark Campbell, Decontamination Service manager in the Hospital Disinfection & Sterilisation Unit at the University Hospital of Wales in Cardiff, and Graham Stanton IEng, FIHEEM, AE (D), who spent 42 years in the Welsh NHS, 35 of them in specialist sterilisation and decontamination roles, describe ongoing research – including a recent research initiative at the hospital – on the most effective ways to remove protein residue from surgical instruments – acknowledged as a considerable challenge using current, established methods.
The Department of Health & Social Care has led investigations for several years into the optimal means of removing residual protein from surgical instruments, building from initial research projects from the original Engineering and Scientific Advisory Committee (ESAC) around 20 years ago. This quickly developed and expanded with the results and findings by the various groups, universities, scientists, and people involved. The research looked at a broad range of areas, including proteins, adhesion, surgical instrument materials, types of surfaces, detergents, washer- disinfectors and cycles, optimum cycle parameters, flexible endoscopes, gas plasma processes, new surgical instrument coatings, known protein detection methods, patient safety, operating theatre techniques and policies, and Sterile Service Departments etc. The work looked in all directions of decontamination, and, new materials that could be used.
The group developed, and with advice and consultation, was widened, to include observers from the NHS in Scotland, Northern Ireland, and Wales. The results were highlighting a real problem for patient safety, and the conclusion of the group was to hand the results and comments over to the Advisory Committee on Dangerous Pathogens (ACDP).
Three nation research teams Path During this period, the Department of Health (as it was then) funded three National Research Teams (in Southampton, London, and Edinburgh) with a brief to investigate whether the presence of protein residuals is a concern on reprocessed reusable surgical instruments that have been through a washer-disinfector. All three research teams developed systems to measure residual proteins on surgical instruments, and indeed all came to the same conclusion – that protein residuals were indeed present on processed instruments,
Figure 1: The system comes with a holder, which takes four tokens.
and in particular prion protein, which has been proven to be extremely difficult to remove with current wash processes and chemistries.
On completion of the research, the Advisory Committee on Dangerous Pathogens Guidance was updated in May 2015, which in turn saw an instruction
‘‘
Protein residuals were indeed present on processed instruments, and in particular prion protein, which has been proven to be extremely difficult to remove with current wash processes and chemistries
given by the Chief Medical Officer to update the CFPP [HTM]/WHTM 01-01 (on the management and decontamination of surgical instruments). A working group was set, chaired by the DH, and included representatives from the Devolved Administrations, the Infection Prevention Society, and Public Health England, and individuals as invited at times to join the team for specific advice. The updates recommended additional measures to combat residual proteins on surgical instruments.
As Decontamination Service manager at the University Hospital of Wales in Cardiff I was invited as an advisor to the working group to participate in the updating of CFPP [HTM]/WHTM 01-01. The research teams came up with alternative detection systems for monitoring protein residuals on instruments (in-situ protein detection), and with the proposal to reduce the time from patient to washer-disinfector for high-risk instruments. If there is a delay in reprocessing (preferably within the six-
July 2020 Health Estate Journal 29
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