THOUGHT L EADE RSHI P
communicate early on with SSDs. “There needs to be communication between theatres and the SSD such that both departments need to work together in partnership to ensure a successful outcome for patient care. When there is a decision to invest in new theatres consideration needs to be given to sterile services at the same time, to bring these units up to standard too,” Jimmy commented. “There are significant issues in units where space is confined and there are too many people to safely distance. As we move from lockdown into a ‘normal’ working environment, units will have to contend with this. SSDs are going to be reprocessing more instruments than ever before, but they are still going to have the same amount of space. This is something that will need to be addressed,” he commented.
COVID-related issues
During the pandemic, PPE also became an important focus area in sterile services, and this raises some interesting areas for further discussion. “We have all grown up with the concept of single-use PPE is always ‘single-use’. However, during the first wave, SSDs were fielding phone calls from organisations, particularly commercial companies, asking for advice on how to reprocess masks and gowns. As hospitals were running out of PPE, they faced a difficult decision. They either faced the prospect of running out of PPE or to look at mitigating the situation by considering the potential for reprocessing these items,” Jimmy explained. Brian Crook from the microbiology team at the HSE Science and Research Centre investigated the potential for reprocessing PPE and his research was presented at the CSC’s virtual study day that is currently available to members on the CSC website. After conducting research on the reuse of FFP3 respirators Dr. Crook and his colleagues concluded that: l Autoclaving was probably too destructive. l Heat treatment was also probably too destructive.
All too often, SSDs can be treated as ‘guinea pigs’ for other new technology. While there was a lot of excitement around theatres implementing robot-assisted surgery, there appeared to be insufficient consideration given to how this new high tech equipment would be decontaminated.
l The best options were fumigation methods.
l Hydrogen peroxide was most promising.
The small scale ‘proof of principle’ study showed: l VHP fumigation effectively eliminated or greatly reduced microbiological contamination on FFP3s.
l FFP3 masks could withstand 10 to 20 cycles of VHP fumigation without any visible deterioration or deleterious effect on filter penetration.
l There was some reduction in fit test values, though no strong evidence of significance.
l There was some damage to FFP3 masks from simulated donning, not through VHP effects.
l There was absorption and off-gassing of hydrogen peroxide from FFP3 masks requiring thorough aeration before re-bagging and return to the user
l Potentially, this VHP approach could be applied using FFP3 masks with rigorous protocol
Dr. Crook concluded that VHP fumigation of single-use FFP3 masks could offer a solution to PPE supply chain issues during emergency and pandemic situations. It could also offer a sustainable environmental alternative to disposal of single-use equipment. However, this would need to be driven by rigorous and validated
protocols and must include selection criteria for reusable masks, as not all mask types were tested and not all will be suitable for reprocessing.
“What has come out of this research are
new departments looking at the sustainability of PPE in the NHS. It has raised awareness that all of this single-use PPE goes to landfill and the health service is beginning to realise that this is no longer appropriate. There is growing interest in reusable PPE and a green revolution is beginning in decontamination. “However, if you are going to reuse PPE, someone has to reprocess it and the facilities and equipment need to be in place. This is where sterile services have come to the fore, enabling the technologies to be tested. It is an interesting area,” commented Jimmy. He added that the issue of sustainability and the NHS will a key focus, going forward, and the CSC hopes to progress green decontamination initiatives as part of its work in the future.
Return to ‘normal’
Jimmy went on to highlight the urgent need to consider how sterile services should return to full flow, in the wake of the pandemic. One issue that has come to the fore, as a result of coronavirus, is ventilation. Speaking at the CSC’s virtual study day on ‘Rising to the challenges of managing COVID-19’, Professor Cath Noakes OBE, from the University of Leeds, highlighted the importance of ventilation to reduce the risk of transmission of the virus. Trusts will need to ensure the appropriate number of air changes for the circumstances, not just within the cleanroom and dirty, areas where instruments are coming into the department, but also in the clinical areas,” Jimmy advised.
In 2016, CSC produced guidance on air quality in endoscopy units. There is obviously keen interest in this area again, in the wake of COVID-19, not just in SSDs but in other areas, and CSC experts are looking at the development of guidance post-COVID. John Prendergast, CSC’s current treasurer, will be leading a technical working group to redraft CSC’s guidance (CSC Working Group – Ventilation Requirements within
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