INFECTION PREVENTION AND CONTROL
included the following: 1. Linen processors who process infectious laundry should adopt bag handling and opening procedures that: n Do not use liquid permeable bags. n Minimise manual handling/opening of infectious linen and any other exposure to staff to the linen prior to decontamination.
n Are fully automated for washer loading (once the technology has been developed to allow this).
n Are capable of being adequately disinfected.
2. It is envisaged that easy-emptying impermeable bags combined with step conveyor type systems could be implemented which may, if installed and operated correctly, provide an alternative to using water-soluble bags in CTWs.
3. Any systems adopted should not expose the laundry staff to any greater risk than that posed by the use of water-soluble bags.
He pointed out that the HTM guidance was a ‘starting point to raise awareness’, but further work is required. He suggested that it may be time to include a test method and conduct research into threshold limits. This will help with effectively identifying and managing infectious laundry risks.
Semi-critical reusable devices John Prendergast, NHS Wales Shared Services Partnership/Specialist Estates, challenged whether over estimation of risk was better than under estimation for semi-critical reusable devices. He revisited Spaulding’s criteria, and highlighted that investigations have shown there is a risk of infection transmission from equipment to patients. He cited a number of high-profile reports where patients have contracted infections (in some cases leading to fatalities), which involved reusable equipment such as transoesophageal echocardiography probes and laryngoscope handles. He also highlighted the findings of a key study concerning ultrasound probes.
Patient records from the Electronic
Communication of Surveillance in Scotland and the Prescribing Information System were linked with the Scottish Morbidity Records for cases in Scotland, between 2010 and 2016. The analysis sought to quantify the association between semi- invasive ultrasound probe procedures and the risk of positive microbiological reports and community antibiotic prescribing in the 30-day period following this procedure. The study demonstrated a greater risk of infection within 30 days of undergoing semi-invasive ultrasound procedures, and estimated that up to 7% of ultrasound probes were contaminated with HPV. In order to reduce infection risks, he
suggested we consider the following: n Transmission of infection as a result of inadequate decontamination – can we improve systems?
n Can the service be transferred to a more appropriate setting?
n Can we use automated high-level disinfection (HLD) systems? Are we using the most effective wipes (compatible)? Is the environment safe for staff (exposure to chemicals/ ventilation etc)?
n IPC team to audit routinely (i.e. IPC staff with knowledge).
n Routine training of staff, annual refreshers/induction training (decontamination principles).
n Correct use of sheaths/ultrasound gel. n Utilise/develop guidance. n Utilise expert help available (Decontamination Lead, IPC, AE(D) etc) to advise on and support improvement.
Integration of services Finally, the study day concluded with a presentation by Robbie Cormie, Trust Decontamination Lead, Liverpool University Hospitals NHS Foundation Trust, who provided an overview of his journey in the integration of decontamination services across Liverpool, Cheshire, and Merseyside. Integration proved to be a challenging and complex process, involving the
standardisation of equipment and systems, but it also provided opportunities for cost savings, joint venture working, sharing of best practice, and the repatriation of outsourced sterile services. He reported that there was a £100k underspend, by taking instrument decontamination back in house, and instrument repairs and replacements are now completed usually within seven days. He concluded his talk with a quote from Charles Darwin: “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” Ultimately, the study day highlighted
some excellent examples of ‘thinking outside of the box’, while encouraging discussion of some key challenges in decontamination. The thought-provoking content invited delegates to consider ‘what can we do differently?”, to defy the dogma, and to implement positive change back at their respective organisations.
n Acknowledgement
This article, titled ‘Dare to defy the dogma in decontamination’, first appeared in a ‘Decontamination & Sterilisation’ supplement as part of the April 2024 issue of The Clinical Services Journal (‘CSJ’). HEJ thanks the magazine’s editor for allowing its reproduction here.
The CSC
The CSC is a club with a driving passion for the continuous improvement of standards related to the decontamination of medical devices and infection control. Its Autumn Study Day and Annual Scientific Meeting provide the opportunity to hear from and network with multi-disciplinary decontamination practitioners and experts. For further information, and to access videos from previous events, visit:
www.centralsterilisingclub.org
May 2024 Health Estate Journal 37
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