Central Sterilising Club
Decontamination: past, present and future
The Central Sterilising Club (CSC) hosts two educational events each year – one in Spring and one in Autumn. In this article, The Clinical Services Journal looks at some of the highlights from the most recent Autumn Study Day.
The theme for CSC’s most recent Autumn Study Day, titled ‘The Generation Game’, sought to explore the past, present and future of decontamination. With constant development of new technologies and the workforce dynamics changing, the speakers discussed and challenged the rationale for current practices, identified gaps that need to be addressed, and considered how the sector can continue to meet the needs of the next generation of decontamination professionals. Opening the Study Day, the CSC’s new Chair,
John Prendergast, invited the audience to share their views on the decontamination sector (using Mentimeter to capture their feedback). A large proportion of the audience agreed that there are other areas in healthcare that need their decontamination resources and focus; a smaller but significant number felt that the sector had lost its focus and standards are dropping; while, in comparison, a much smaller number agreed that decontamination is given the necessary priority today.
The Past: lessons learnt and evolving practice Under the heading of ‘The Past’, sessions included discussion of ‘The Risks with Surgical Screws and Plates’, by Gavin Hughes, a Director at Surgical Material Testing Labs (SMTL) – a medical device and PPE test laboratory that is part of NHS Wales Shared Services Partnership. The focus of Gavin’s presentation was on small orthopaedic single-use implants – such as screws and plates – that are prepared for surgery but are not used and are therefore often reprocessed many times, even though they are categorised as ‘single use.’ There is compelling evidence for the need for National Guidance in this area and the key concerns are: l The legal status of reprocessing unused single-use devices.
l Traceability of devices. l Effects of reprocessing on the quality of the devices.
l Contamination status of the implantable devices.
l Practicalities of switching to pre-packaged, pre-sterilised, single-use (PPS) devices.
The session highlighted that there are genuine clinical risk-management benefits in moving to single-use PPS implants, and this is the only way to achieve full traceability. As NHS Scotland have already implemented this approach, it was felt that many of the logistical and cost implications could be overcome, based on lessons already learnt. Pat Cattini, a Past President of the IPS, and
Corporate Director of Infection Prevention and Control at University Hospitals Sussex, gave her views on decontamination practices over the years and highlighted some examples from the past of inappropriate, localised and unregulated decontamination practices, that took place in a variety of healthcare settings. In the early 2000s, Pat was part of the first national SSD assessments, which later led to centralised services – clamping down on local reprocessing
through improved audits, and a move towards single-use items. Local reprocessing, however, has never really
gone away and Pat provided the example of the use of wipes for non-lumen scopes, which means there is still room for variable results and human error. At the same time, there is a need for more sustainable practices in healthcare. While single use means there are no requirements to clean and decontaminate, the consequences are: l Increased costs. l Increased waste. l The environmental costs. l Human costs in terms of slave labour in non-regulated countries undertaking manufacturing of instruments.
l The potential for ‘single use’ items to not be used as ‘single’ use.
Pat posed the question ‘do we need to go backwards a little, in order to go forward?’ Acknowledging that, today, we have accredited decontamination departments and local
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