INSTRUMENT DECONTAMINATION


Six decades of changing practice and thinking


Leading microbiologists with extensive experience in the field looked back at some of the key developments in surgical instrument decontamination over the past six decades, recalled some of the lessons learned, and recounted a number of the most memorable incidents from their careers, during the Central Sterilising Club’s 60th Anniversary Annual Scientific Meeting in Stratford-Upon-Avon earlier this year. Louise Frampton, editor of HEJ’s sister publication, The Clinical Services Journal, reports.


High on the agenda at the Central Sterilising Club (CSC) Annual Scientific Meeting was the need to drive improvement and learn from the mistakes of the past, while approaching today’s problems with the discipline of a science, informed by guidance and evidence- based practice. At the same time, decontamination professionals must also remain vigilant, scanning the horizon for new threats and challenges – whether it is the next pandemic, difficult-to-reprocess new technologies, or tackling the healthcare sector’s significant contribution to climate change. The first opening sessions – introduced


by CSC chair, Jimmy Walker – were delivered by Robert C Spencer, a retired microbiologist who has occupied senior positions within the NHS, Health Protection Agency and Public Health England; Geoff Ridgway, who was previously a consultant


in clinical microbiology at UCLH, a member of the Committee on CJD incidents (among others), and past chair of the CSC; and Peter Hoffman (Kelsey lecturer), who recently retired from being a consultant clinical scientist with the UK Health Security Agency. Together, they reflected on the origins of the CSC, as well as the historical challenges faced by healthcare – intermingled with personal anecdotes and horror stories from the past 60 years. The discussion included some high-


profile incidents, the lessons learnt, and subsequent evolution of decontamination practice. They painted a picture of how far decontamination had come during this time, but also how far it still needs to go...


The past In 1957, the Nuffield Trust published its report on the planning and organisation


of central syringe services, for example. Syringes were previously boiled and the process decentralised, so it was often poorly supervised. Contaminated equipment would be added to the steriliser just before syringes that were required for use were taken out. The maintenance of syringes was also poor, so needles were often blunt. The report underlined the importance of safe methods of sterilisation, and discussed the move to central sterilisation.1 In 1958, the Trust also published damning findings from its study of sterile supply arrangements in six hospitals – including open windows in decontamination facilities that allowed dust ingress, extreme build-up of scale on stainless steel from the use of hard water in sterilisers, and the cleaning of instruments by simply washing under a tap. The report acted as a catalyst to driving improvement in decontamination practice.2 The ‘Devonport incident’ – one of the


most infamous pharmaceutical disasters – also hit the headlines in the early 1970s, when the release of non-sterile dextrose infusion bottles onto the market resulted in the (known) deaths of at least four patients from endotoxic shock.3


The Peter Hoffman. ‘‘ Jimmy Walker.


The opening session reflected on the origins of the CSC, as well as the historical challenges faced by healthcare – intermingled with personal anecdotes and horror stories from the past 60 years


conclusion of the inquiry into the incident (summarised in the Clothier Report, July 1972) was a sombre lesson to all: “The committee considers that too many people believe that sterilisation of fluids is easily achieved with simple plant operated by men of little skill under minimum supervision, a view of the task which is wrong in every respect.”4 The incident highlighted the importance of quality assurance of processes, as well as traceability. A third of the bottles from the implicated batch had failed to reach sterilising temperature, probably due to the retention of air within the steriliser. The drain to the steriliser was blocked. Steam would enter the steriliser, layer at the top, and would produce locally high temperatures near the sensor


September 2022 Health Estate Journal 27


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112