INSTRUMENT DECONTAMINATION
in conduct”. In any case, he argued that “independence can be overrated”. He argued that a lack of expertise does not necessarily mean you cannot function safely – people can get expertise from a variety of sources. However, the expertise is in the NHS – people succeed as AE(D)s because of the expertise they gained within the health service. He added that there will always be a struggle for the health service to retain expertise if we do not pay staff enough – decontamination staff can ultimately earn more elsewhere. He further pointed out that the average age of an AE(D) is probably around 60 years old – they will be retiring, and there is already a struggle to find AE(D)s. It is going to get even harder, without succession planning. “The role of a consultant or trainer is
infected, and there were further deaths and infections, linked to the water supply – “causing pain, agony, and sorrow”. “Safety and the lives of our patients are
paramount,” Sulisti Holmes commented. “I hope you don’t need surgery. But if you do, which one will you choose? The one that follows the guidance, that learns from previous incidents, that has gone through
independent review by an independent expert – an AE(D) – or one that doesn’t?”
True independence? Wayne Spencer questioned whether AE(D)s are truly ‘independent’ – i.e. “not subject to control by others, not affiliated with a larger controlling unit, and not looking to others for opinions or guidance
to empower the customer, not to make consulting indispensable. If we make ourselves indispensable, people will never have the expertise they need to manage without an ‘independent’ AE(D). AE(D)s should not be a ‘necessary evil’, but more of a ‘comforting blanket’,” he concluded. One delegate argued that the definition of ‘independent’ used by Wayne Spencer was “too broad”, and we should talk, instead, of being “free from conflicts of interest” – i.e. there is no manipulation of the advice due to commercial pressures.
Response from two senior IHEEM AE(D)s on CSC debate
Dear Editor, We would like to provide some additional comments and discussion in response to the article, titled ‘Decontamination: past, present and future’, which appeared in the June 2022 edition of The Clinical Services Journal,1
and included a report
on a debate at the Central Sterilising Club’s 2022 annual conference on whether hospitals lack the expertise to function safely without an independent Authorised Engineer (Decontamination) [AE(D)]. The article is reproduced in slightly modified form here in the September 2022 HEJ. The debate saw Dr Sulisti Holmes speaking for the motion, and Wayne Spencer speaking against. While the report correctly identifies the key arguments presented by Dr Holmes and Wayne Spencer, and the outcome of the audience vote in favour of his assertions that an independent AE(D) is not needed, the proposition of the debate and issues it raises requires further exploration.
What is meant by independence? The title of the debate, and the arguments presented, directly relate to what is meant by ‘independent’, and its use in describing the services provided by AE(D)s to the UK healthcare sector. Aligned to
30 Health Estate Journal September 2022
this are two further personal attributes – impartiality and integrity, both of which are essential characteristics of an AE(D), and healthcare professionals in general. In common use the word ‘independent’ has many subtly different meanings. A Google search will provide many definitions such as, for example; ‘not influenced or controlled by others in matters of opinion, conduct, etc.; thinking or acting for oneself: an independent thinker. Not subject to another’s authority or jurisdiction; autonomous; free: an independent businessman. not influenced by the thought or action of others’.
Some examples of the concept of independence Any quality management system will embrace the idea of having quality assessment teams who exercise their duties independently of the production teams to avoid conflicts of interest. If there is a question mark about the quality of manufactured product, the performance of a production process, or an operational activity, those responsible for such activities should not influence decisions relating to acceptability. An independent assessment is required. In the field of conformity assessment, EN ISO/IEC 170202
discusses at length
the concept of independence with regard to the requirements for the operation of various bodies performing inspection and audit. As an example, a notified body auditor is independent of the facility he/ she is auditing. The same principles equally apply
to healthcare facilities producing decontaminated (cleaned, disinfected, and sterilised) medical devices. Independent, impartial advice on the procurement, validation, and operational aspects of the decontamination equipment and department will ensure freedom from conflicts of, and vested, interests. The conclusions one can draw from these arguments suggests that any organisation should have access to independent expert advice.
What is meant by organisational independence? The next question raised during the debate and the arguments presented above relates to what is meant by ‘organisational independence’. In this regard it is worthwhile examining some organisational structures which operate both within a healthcare setting, and wider industry. In industrial pharmaceutical manufacturing operations, the quality control and assurance teams
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