SURGICAL INSTRUMENT DECONTAMINATION
is too difficult, we won’t use it’, which may have been the response of other users.
The research project
I set up a research team to evaluate the use of alternative chemistry types, washer- disinfector cycles and decontamination processes to determine the efficacy of brain homogenate removal from a PCD. The research team included the Decontamination Service manager, a decontamination scientist, a decontamination specialised engineer, and representation from the chemical manufacturer. The initial tests were to monitor the performance of hybrid chemistries (mild alkaline/enzymatic) on the removal of residual proteins. Previous research identified that enzymatics are more effective in the removal of residual proteins than neutral/alkaline detergents. The thought process was that with the use of alkaline detergents, excellent results were being received on soil tests, so with the combination of alkaline and enzymes we should see improved results on the protein challenge.
Test 1
A testing day was arranged, and the washer-disinfector was primed with a mild alkaline enzymatic and set at a dosing of 4 mL/L. The wash cycle parameters were not changed from the initial test, to try to identify whether alternative chemistry types would make a difference. Again, a soil test cycle was deployed, with the cycle being aborted after the rinse. The first test again showed failures on all four PCDs, with the alternative chemistry having no effect on breaking down the residual soil. (Fig. 3)
Increasing the dose
The chemistry manufacturer requested increasing the dose for the second test, which was implemented at 5 mL/L. Again, failures on all four tokens were received. A final test was agreed, dosing at 6 mL/L and reducing the wash temperature to 45˚C, in an attempt to optimise the performance of the enzymes. The final test
Test 2
The second test was arranged to evaluate whether a hybrid chemistry from an alternative manufacturer would have an impact on the results. A second manufacturer was invited to take part in the research, with the same wash cycle and dosing deployed. Again, poor results were received on the five cycles performed, with all four tokens regularly failing the test.
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Smart Key Storage and
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With the combination of alkaline and enzymes we should see improved results on the protein challenge
Ultrasonic cycle 1806 printout Washer-disinfector cycle 20842 printout
Figure 6: Washer-disinfector IMS graphs.
did show a slight breakdown of protein on token three, but all four tokens presented a failed result. At this stage it was agreed to abandon the testing, due to 12 tokens all presenting failed results.
Replicating the established process At this stage of the research, the Sterile Services manager identified that the test being performed did not replicate the actual decontamination process deployed in the HSDU. Due to the time from patient to HSDU at the University Hospital of Wales, all visually contaminated instruments are manually pre-cleaned pre-washer disinfector. To replicate this process, it was agreed to soak the four tokens in a measured enzymatic solution for 15 minutes, and then put them through the washer-disinfector, to see if this had an impact on the results. On examination of the tokens following the soil test, all four were visually clear, and on measurement using the in situ-monitoring system, the average residue was 1.7 μg. (Fig. 4). These results pre-empted a discussion, with the specialist engineer asking the question: ‘How can we replicate the pre- soak as part of the washer-disinfector process?’ It was agreed to extend the pre-rinse to 15 minutes at below 30˚C, and to dose this part of the cycle at 4 mL/L with the enzymatic; this would replicate a manual soak/pre-clean through the sinks.
PLUG and PLAY – SECURE R int us
RFID Fobs can be submerg d to antibacterial solution af er se to protect against viruses
ed te
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July 2020 Health Estate Journal 31
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