DAS 2024 Review
l Are technicians empowered to raise non- conformances with their supervisors? Are they willing to raise concerns or are we all too busy getting sets from A to B?
l Do staff have access to the quality system, if they want to look something up – such as tracking, for example?
l Do they know how the SOPs relate to the quality system, or is the SOP simply ‘stuck to a wall’ and staff become ‘poster blind’?
Historically, there has been no recognised training programme for decontamination staff - Trusts have been free to train inhouse and to choose their approach, which has led to wide variation in terms of what is deemed ‘an appropriate period of training’ to ensure ‘competency’. A standardised level of qualifications is really important, Helen asserted. “There is little recognition by the NHS or
other organisations of the importance of our role,” she commented. “The misconception is that SSDs just put instruments in big dishwashers and anyone who has loaded a dishwasher at home can effectively do the role. There is little respect for what SSDs do,” she continued. She pointed out that when new theatre
staff are invited to come to the SSD, to see exactly what staff do, they often realise that that the technicians are expected “to know everything” – from orthopaedics, gynae, and every other surgical specialty, to endoscopes and TOE probes. Decontamination covers much more than just invasive medical devices. “So, why aren’t we better recognised for this expertise?” she exclaimed. The HSSIB report says of the technician’s
role, that staff’s ability to decontaminate a large variety of different equipment types, in vast numbers, to a set quality and standard, is: l Purely reliant on individuals following manufacturers’ instructions for use (which they are not required to access).
l Their professionalism. l Integrity. l Training. l Skill. l Competence. (HSIB report 4.6.11)
“We are totally reliant on the technician to get it right and to follow the manufacturer’s instructions. So, do technicians have access to these instructions or are they in the manager’s office on a shelf? Have they been trained on them? We have thousands of instruments. Are they just trained on the complicated instruments? Are they able to identify
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instruments correctly? With needleholders, for example, are they aware of the tungsten inserts? We are expecting a lot from our staff. No one wants to come to work and make a mistake; they want to do a good job. But if we don’t train them, how will they have the skills? How can they be competent? “The HSSIB investigation concluded that staff
are currently the strongest barrier to prevention of incorrectly decontaminated equipment being sent to operating theatres for use. It is our staff that are protecting patients,” Helen commented.
Maintenance and repair of instruments So, why are errors being made and what exactly is the scale of the issue? A report carried out in 2016, by the IHEEM Surgical Instrument Group (SIG), looked at instrument condition. A total of
65 audits were carried out in 48 hospitals over a 2.5 year period and 32,000 instruments were checked. The results were as follows: l 31% needed replacement. l 33% needed repair. l 18% had issues with surface finish such as corrosion, water marks or presence of silicates.
l 18% were acceptable.
“How do we expect our staff to say instruments are fit for use, if we have these figures? Around 70% are in some way damaged. Will this affect how they are washed and sterilised? No wonder staff make errors,” Helen exclaimed. She pointed out that instruments are valuable assets. Using the 48 UK hospitals as an average, they had the following: 735 beds, 18 theatres, 27,000 operations per year, 1,545 surgical
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