ENDOSCOPE DECONTAMINATION UNITS


Extract boost activation button


Controlled staff


entrance and dirty returns


Example layout - double Endoscopy Decontamination Room Storage cabinet


Transfer hatch


Extract Table EWD Direction of air movement EWD Table Table EWD Extract Direction of air movement Storage Note:


1. Low-level extracts (for removal of PA) to provide a minimum of 10 ACH to comply with HTM 03-01, with capacity to provide 15 ACH boosted extract for emergency spillage situations. ACH calculations to be based on the total floor area of the department. 2. Position of low-level extracts subject to room design.


“Draining board” level


EWD Storage cabinet Supply EWD Supply


Controlled staff entrance and clean Endoscope exit


KEY


Differential pressure guage


Endoscope


washer-disinfector Exposure indicator


Extraction boost activation button Low-level extract PA sensor


Room pressure Pressure-regulating


damper


Figure 2: An example of ventilation regimes within a segregated Endoscopy Decontamination Unit.


void should not contain any branch trimmer heaters, cooling coils, humidifiers, or filters. 8) The isolation/fire dampers mounted in the wall should be installed so that access for annual testing is from the corridor side. 9) The doors in and out of the decontamination facility must be fitted with automatic door closers. Consideration should be given to interlocked entrance/ exit lobbies for new designs where space allows. 10) The endoscope cleanroom should be maintained at +5 Pa, and the washroom at -5 Pa, with respect to the surrounding areas. A pressure stabiliser fitted in the wall between the rooms should be set to open at 10 Pa. [Note: general principles of HBN 13]. 11) A visual indication of plant operation (to include supply and extract) is recommended within the decontamination unit; this can take the form of a simple illumination system, pressure gauges, or more complex control indication. Such information should identify as a minimum if the plant is running or in fault mode. More complex systems can indicate pressure differential across filters and/or variable speed settings. 12) Please refer to HTM 03-01 (2021), Part A. Chapter 8; Table 7, for information on the ventilation requirements.8 13) When determining the room supply and extract, the designer must consider any exhaust requirement for individual EWD machine extraction systems.


Examples of room layouts The line drawings in Figures 1 and 2 are included as illustrations, to show airflows and pathways. (Please consult relevant guidance in national documentation). Additional rooms may be included in any such designs, that may incorporate changing rooms, material transfer, waste disposal, dedicated cleaning cupboards,


36 Health Estate Journal June 2022


office/admin spaces, and storage rooms. It is important, where such rooms are situated, that the ventilation pressure cascade is appropriate for the designated room activity.3


Additional requirements for endoscope decontamination facilities Among the key additional requirements for an endoscopy decontamination facility are: 1) It should be a safe working environment. 2) The environment should be controlled, and access prohibited to unauthorised staff. 3) Door interlocks should be in place to prevent both doors being opened at the same time. 4) Pass-through interlocks – cabinets should be used to move goods in and out of the ‘clean’ area to maintain the environment. 5) Packing systems should be in the ‘clean’ side. 6) There should be segregated cleaning cupboards, appropriately positioned, to ensure that equipment is dedicated for individual dirty/clean area cleaning activities. 7) Endoscopes should be placed into the storage cabinets at the earliest opportunity, not exceeding three hours from completion of the EWD cycle. 8) The surfaces should be ‘wipe clean’ and smooth, as per a standard cleanroom. 9) Flooring should be of the appropriate specified material to aid cleaning. 10) Drain connections from the EWDs must be sealed with appropriate vent


‘‘


fittings, to prevent release of peracetic acid or acetic acid into the workplace. 11) Peracetic acid sensors need to be positioned strategically, to include repeater panels outside the decontamination room to warn of safe/ unsafe conditions within. 12) Lighting should be of appropriate design, and flush-mounted to the ceiling. 13) Systems should be available to ensure that technicians check critical parameters as part of product release, and confirm they have been achieved as part of the decontamination process. 14) Hand cleaning stations and personal protective equipment should be available at strategic points (consult the local Water Safety Group and Infection Prevention and Control team). 15) The ventilation plant serving the clean area should be commissioned, maintained, and performance verified, at least once annually.8 16) Where required, medical gas supply for the cabinets and for general use should be available in the clean side (discuss with AP(MG)/AE(MG) responsible). Note: In the UK there are a variety of legislative responsibilities that directly relate to discrimination and equality; these require appropriate consideration.


Essential tips for ventilation in endoscopy decontamination areas Some essential tips for ventilation in endoscopy decontamination areas are: 1) Ventilation within the decontamination environment should comply with all relevant building notes and national standards. 2) Ventilation requirements should include consideration of the thermal load for staff comfort within the decontamination room. 3) Where there is a single room, the flow is from clean side to dirty side, and should include low-level extraction for vapours at the dirty end. 4) The temperature and relative humidity within the decontamination area should allow users to work with all doors and windows closed. 5) There is a local method of checking both incoming air and extraction (i.e. magnahelic gauges). 6) Ventilation requirements are assessed/ reassessed when there are any changes in room use, including installation of new EWDs. Ventilation plant serving the Endoscopy area should be tested annually to verify operational performance, in line with HTM 01-06 and HTM 03-01.2,8


Peracetic acid releases vapour, but any vapour coming from the short period of a bottle change is usually minimal. The exposure during a spill is likely to be much higher, due to the volume spilled, and the surface area covered – more vapour is present


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