SURGICAL INSTRUMENT DECONTAMINATION Test 3


The cycle was optimised with the additional phase and a soil test cycle commenced. On completion, the tokens were analysed, with significant progress being achieved. (Fig. 5). Repeated cycles with the pre-rinse deployed were performed with improved results (over 15 cycles), but there was still inconsistency, in particular on token two. The aim of the testing was to arrive at a process where we achieved consistent passes on all four test tokens.


Additional ultrasonic process Previous research has indicated that ultrasonic activity is very effective at breaking down residual proteins. On this basis, it was agreed to try a 20-minute ultrasonic cycle (dosed with mild alkaline enzymatic) pre-washer-disinfector. Following the sonic cycle, the tokens were visually inspected, with significant removal of the residual protein observed. The test device was then put through the optimised washer-disinfector, and on completion all four tokens were visually clear. In situ-monitoring testing confirmed 0 ng residual on all four tokens. This was the first time that a consistent pass had been achieved, with no residual protein present (Fig. 6).


With the implementation of the ultrasonic stage, continual testing has been performed, and to date over 30 cycles have been completed (120 tokens), with all tokens consistently achieving 0 ng. This work has proven that with optimisation of process, chemistry, and parameters, we can effectively remove residual proteins from surgical instruments.


It should be noted that this initial research project has been limited to the volume of PCDs used. Many more PCDs will be required to establish consistent and reliable results as the project develops, to include the placement of the PCD blocks in various positions within the washer-disinfector chamber and alternative decontamination equipment. The conclusions returned can only be verified with the chemical solutions used under this test; other products may produce differing results for the single or two-stage process when tested using identical methodologies.


The next steps


The next question for the research group is to investigate if human brain protein behaves the same way as the ovine protein being used for the testing to date. A research group has been agreed ,with representation from Cardiff and Vale Health Board, the PCD manufacturer, Glasgow University, and medical device manufacturers, to assess further the process in use, to gauge a greater


32 Health Estate Journal July 2020 Mark Campbell


Mark Campbell, Decontamination Service manager at the University Hospital of Wales, has worked in healthcare for over 20 years, starting as an Operating Department practitioner in theatres, and then moving into theatre management. Acting Decontamination Service manager for the past 12 years for Cardiff and Vale University Health Board, he is very active in the continuous improvement of decontamination processes both locally and nationally, as a representative on the All Wales Assembly Government


Decontamination Committee, and a participant in reviewing and updating national guidance for the Department of Health & Social Care. He is currently researching optimisation of process and chemistry to effectively remove residue proteins/prion proteins, and processes to remove biofilms from flexible endoscopes.


understanding of what is actually happening to the protein during reprocessing. The second half of the study will entail producing similar tokens with human brain homogenate with an elevated level of amyloid protein (the cause of Alzheimer’s disease), and assessing the effectiveness of the process on human proteins. This will be a three- year project, with a PhD student deployed to publish the findings. It should be noted that previous research has only proven de-activation of prion. Potentially with this project we will be able to prove that we can effectively remove prion with effective optimisation of decontamination processes. If the work proves successful, the aim of the wider research group will be to present the findings to the DH and NICE (the National Institute for Health & Care Excellence) for a potential revision of guidance, to include optimisation of washer- disinfector cycles and decontamination processes etc.


Graham Stanton


Graham Stanton IEng, FIHEEM, AE (D), started his engineering career in 1967, joining the Merchant Navy as an Engineer Officer Cadet, and attending an officer training facility at Warsash, near Southampton, followed by a very rewarding service at sea, which he believes ‘formed a very solid platform’ for his engineering career. He retired from the health service after 42 years’ service in 2016, having first joined the NHS in 1974 in the mechanical design section of the Welsh Health Technical Services Organisation (now NHS Wales –Shared Services Partnership – Specialist Estate Services), and then transferred to the Special Services section, where he worked in the sterilising and decontamination field, in various capacities, from December 1981 until he retired. During that time, he represented the Welsh Health Service in the formation of national guidance, both for Wales and the English Department of Health. He also led audits for the Welsh Government, and was instrumental in setting up and chairing active decontamination groups in both Sterile Services and Endoscopy.


Graham Stanton has been an Authorised Person (Sterilisers) since 1995, changing, in July 2008, to Authorising Engineer (Decontamination), and is still registered with IHEEM. Still invited to the All Wales Decontamination committee as an IHEEM advisor, he has represented the Wales IHEEM Branch on the Council. He currently chairs the IHEEM AE (D) Registration Board – having retired from his role as chair of the IHEEM Decontamination Technology Platform – and also represents the Institute on the Professional Bodies Group (the Decontamination Professional Expert Communication Forum), a forum of representatives of the main decontamination institutes and bodies.


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