THOUGHT L EADE RSHI P
services were put under immense pressure. They were told to reprocess PPE and the views of decontamination managers in some cases were disregarded. Some decontamination managers were more forceful than others in resisting this pressure. At my own Trust, we didn’t reprocess PPE as we didn’t believe it was safe. Other sites took a different view. There wasn’t enough evidence to support it at the time, in my view,” he commented.
He explained that Meredith Smart, the research and development director at IDSc, helped produce vital educational materials to communicate the right messages to staff and provide them with reassurance around a variety of issues relating to COVID-19. Having a good working relationship with Public Health England, Meredith was able to provide valuable expertise to support and advise the membership.
Adapting to change
As theatre activity decreased during the pan- demic, SSDs had to adapt to major changes and staff were redeployed to other depart- ments – helping out on the wards, stores, kitchens – anywhere they were needed. “They have all stepped up to the mark,” commented Tony. “At Durham, where I was recently based (before I moved to North Tees), we went from an average of 18,000 instruments and sets per month to just 4,000, so you can imagine the impact on the staff. “Previously, staff would be handling 6-8 sets an hour, but suddenly they were doing just one. This meant a lot of sitting around and the more people sit around the more scared they get, as they have time to think about what could possibly happen. It has been a challenging time,” he explained. He pointed out that this downtime helped
Trusts to “ramp up education”, however. SSDs are usually faced with constant pressures from theatres and users, but suddenly they had time on their hands. “Trusts that have made the best use of this time have taken the opportunity to go through the decontamination processes with staff.
There may be 100 instruments in a set, when only 40 are needed. Different surgeons like different instruments and there is a tendency to bend to pressure. But SSDs need to work with suppliers and theatres to help rationalise instrumentation.
Over the years, people find shortcuts and can deviate from best practice, so refresher training to ensure everyone is working to the same standard has been one of the positive outcomes of the pandemic. It has also allowed SSDs to catch up on outstanding jobs and upgrades,” commented Tony.
Ongoing challenges
While COVID has presented significant challenges this year, there are other challenges that persist, which will require collaboration between the theatres, decontamination staff and industry, if they are to be addressed. During the past year, experts at IDSc have continued to champion these issues – undertaking research and development and progressing educational programmes to ensure high standards within the sector. A key focus has been the increasing problem of ‘difficult to clean’ instrumentation. “There is a growing influence of the US market in terms of instrumentation and this is presenting problems for SSDs in the UK,” Tony explained. “Their instructions for use (IFUs) aren’t always compatible with UK best practice, so we have to find out whether it is safe to use our processes with their equipment and it can take a long time to obtain answers. IDSc’s R&D team have been working hard to ensure IFUs are fit for purpose. “There are more robotics coming on to the market with a lack of adequate instructions for decontamination. This is presenting significant challenges. The R&D and Education team are looking at how we can take innovation forward. This
work is extremely important as pathogens are becoming increasingly resistant to antibiotics. We need to find a way to combat the risk of HCAIs and constantly progress research. IDSc is therefore working closely with manufacturers to solve these potential infection risks,” he continued. Helen Campbell, IDSc’s director of
education, has been working with various companies to develop research around robotic technologies and decontamination. “Not enough thought goes into how these technologies will be decontaminated. I have witnessed some inappropriate practices in relation to decontaminating robotic instruments. Decontamination is a strict process, but all too often it is overlooked. The science needs to be followed and complied with, and manufacturers need to take more responsibility,” Tony asserted.
Rationalisation and standardisation He added that there also needs to be a change of attitudes to the rationalisation and standardisation of sets – there is still resistance from end users, and it is costing the NHS dearly. “There may be 100 instruments in a set, when only 40 are needed. Different surgeons like different instruments and there is a tendency to bend to pressure. But SSDs need to work with suppliers and theatres to help rationalise instrumentation. Some Trusts have reported savings of up to £200,000 per year and there are millions of pounds worth of savings to be made across the NHS. Policy and effective leadership, from the top down, will be required to change the status quo in theatres,” he commented. He added that flexible endoscopes also need to be designed to be easier to decontaminate, while there is a tendency for manufacturers to develop scopes that can only be reprocessed in their own machines. “This means that if the Trust buys a specific model of endoscope, they often have to invest in a new machine to decontaminate it as the manufacturer won’t provide a guarantee if a competitor’s machine is used. Manufacturers need to work together, although this is unlikely to happen, as it is not in their commercial interest. There is a lot of frustration from a decontamination technician’s perspective. They often ask:
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