ENDOSCOPE DECONTAMINATION UNITS ‘‘


Single room units do not physically segregate dirty and clean activities, and consequently present a higher risk of inadvertent release of endoscopes not decontaminated to the required standards


7) Staff working within the area must be aware of, and adhere to, all relevant health and safety policies and safe working practices, including on the number of personnel working in the area, wearing of PPE, and control of the environment via door interlocks. 8) There is a documented process in place for dealing promptly with ventilation problems. This can be with use of electronic worksheets, or a manual logbook, available for regular inspection and review. 9) Decontamination audits should include the function, efficiency, and effectiveness, of the room ventilation and gas monitors. 10) Ventilation installation and maintenance are only undertaken by


competent persons, with a working and up-to-date knowledge of the requirements within a decontamination environment, at set frequencies, and should be recorded. 11) Non-conformities or difficulties meeting standards must be escalated through the correct lines of accountability. Such structures will include dedicated groups tasked with Ventilation Safety and Compliance.8 12) Such ventilation safety groups should include dedicated decontamination professionals (AP(D), AE(D), Decontamination Lead etc.) as members, who should attend at appropriate intervals when any ventilation query about a built environment dedicated to medical device decontamination is raised.


Appendix: Dangers of peracetic acid


Peracetic acid, also know as peroxyacetic acid, (PAA) is a highly corrosive chemical used for endoscope decontamination. An organic chemical compound used in a mixture with acetic acid and hydrogen peroxide in water, it is a colourless liquid with a strong vinegar-like odour that can be smelt at very low levels. A strong, highly reactive oxidant, PAA is produced by combining hydrogen peroxide, acetic acid, and water. The more concentrated the solution, the more effective it is antimicrobially, but equally the greater the vapour concentration, and the exposure risk to staff. This highly biocidal oxidiser shows good efficacy against a broad spectrum of pathogens. According to NIOSH, symptoms of


acute exposure to peracetic acid vapour include cough, laboured breathing, and shortness of breath; skin redness, pain and blisters, and severe deep burns to the eyes.20


Concentrations of 15%


or higher also give rise to fire and explosion hazards and reactivity issues. It is thus important to ensure that both training for use, and safety precautions for peracetic acid, are in place.


While formal limits have not been published in the UK, the ACGIH (American Conference of Governmental Industrial Hygienists) in the US proposed a 15-minute Threshold Limit Value of 0.4 ppm, subsequently adopted


by OSHA (Occupational Health and Safety Administration) as the 15-minute Time Weighted Average (TWA).21,22


The


Californian division of OSHA has proposed an eight-hour TWA of 0.2 ppm. These figures are likely to be adopted/reviewed by all agencies at some point, so tend to be the figures suppliers reference in terms of operator exposure.


BSG Guidelines Within the BSG Guidelines (British Society of Gastroenterology), there is reference to COSHH (Section 9: Health, Safety, and Infection Control), feeding back to the Health and Safety at Work Act 1974,7,23


which says that that the risks of


staff exposure to disinfectants should be ‘considered and documented in risk assessments’. Organisations may deem it appropriate to instigate risk assessment/ Occupational Health for those staff


members exposed to peracetic acid, and lung function tests might be carried out periodically. Protective measures required for


spills are typically more robust than during chemical bottle changes. This should be considered during COSHH risk assessments, as room size, number of machines, concentration of chemical (referring to MSDS sheet info), and the room air-handling capabilities etc. should all be considered, plus whether there have been previous issues – spills, or reports from staff of sensitivity to chemical. ‘Engineering’ methods of control are


preferential to controlling exposure (i.e., air-handling units/low level extraction /monitors etc.). Part of the JAG accreditation/certification is an audit which has a section that specifically mentions peracetic acid exposure and monitoring (Section 8, 23, of the IHEEM/ JAG Annual Review of Flexible Endoscope Decontamination Facilities, pictured left).17 The specific gravity of air is 1.0, and of PAA, 1.114; hence it is heavier than air. The principle is to provide an operational extract at a low level where PAA odours are present, to include a boost facility to aid in the event of spillage. You will always find small amounts of routine operational vapours present (from bottles/connections/drains/ machines etc.) as well, which is where the LLE comes into play.


June 2022 Health Estate Journal 37


References 1 Central Sterilising Club. Air Quality for Endoscope Decontamination Facilities. Medical Device Decontamination. 2016; 20:12–7.


2 HTM 01-06. Management and decontamination of flexible endoscopes. Department of Health & Social Care, 30 June 2016. https://tinyurl.com/2v3wtwrh


3 HBN 13. Planning and design of sterile services departments. Department of Health & Social Care, 21 May 2021. https://tinyurl.com/yckkc4re


4 WHTM 01-06. Decontamination of flexible endoscopes. NHS Wales Shared Services Partnership, 2017. https://tinyurl. com/52sfdxr6


5 SHPN 13 Part 2. Decontamination facilities: local decontamination units. Health Facilities Scotland, 2008. https://tinyurl. com/swezwh35


6 The Control of Substances Hazardous to Health Regulations. Approved Code of Practice and guidance. Health & Safety Executive, 2002. https://www.hse.gov.uk/ coshh/


7 Health and Safety at Work etc Act 1974


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