Central Sterilising Club
questioned. “We have to have proper capacity for reprocessing, and this will be an issue.” Professionals are expected to act reasonably and logically based on the evidence at the time and we are starting to get some evidence in relation to Alzheimer’s, Jim pointed out. “It is a very small study, but we need to be looking for further guidance from the government or NHS England/NHS Scotland,” he commented. Highlighting further pics of lumened devices
showing evidence of pitting, corrosion and congealed blood, after being cleaned and reprocessed, he explained that the main reason for failures in these instances was ‘communication’. He listed nine key issues: l Immediate after use flush not carried out (IFUs).
l Saline used in the surgical process. l Long off-site turnaround time possibly drying.
l Wrapping not necessarily keeping it moist. l IFUs could be interpreted in different ways. l IFUs manual wash only option followed. l Training may have been insufficient. l IFUs offer ultrasonic and connection to the washer disinfector but not instigated as optional.
l Internal inspection by sterile service provider not considered normal nor in the IFUs.
Manual cleaning results for lumened devices are variable due to human factors, but they are also reliant on the brush “flicking down and clearing the blood”, he pointed out. He added that “the blood would not have been there, to the degree shown in the photos, had the device been rinsed by theatres.” It is not normal procedure to inspect the lumened device – as SSDs do not usually have a boroscope that is small enough, and it’s not in the IFUs. “We need duplicate or triplicate methods of cleaning this kind of complex device, so that we can be certain that it is going to be clean,” he asserted. So, what resolves the issue?
l Immediate after use flush. l Wrapping for moisture retention. l Focus on reprocessing time. l Manual wash followed by ultrasonic wash in alignment with IFU options, connection in the WD could be added.
l Inspection using boroscope. l Discolouration reduced but not gone – still being reviewed, with lab sampling etc.
Jim pointed out that when things go wrong, everyone blames everyone else. Ultimately, there needs to be a move away from this blame culture: “We have got to take ownership of the issues, whatever our position within the decontamination process,” he concluded.
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www.clinicalservicesjournal.com I April 2025
The Future: training to raise standards Training is another significant issue highlighted by the Health Services Safety Investigations Body (HSSIB) and this was a focus of the afternoon session, focused on ‘The Future’. IDSc Chair, Trevor Garcia has been a key contributor to the recently published NHS Estates Technical Bulletin (NETB/2024/1 competency framework for staff working within decontamination).3
48 He
began by giving some background to the release of the NETB, which was developed in response to an investigation by the HSSIB (May 2022), following an incident in which a contaminated instrument was used on a patient. One of the concerns highlighted in the HSSIB
report related to ‘training and training standards for decontamination.’ It stated: “Training and training standards for decontamination are set locally by individual sterile services departments rather than set out in a national framework”. The HSSIB pointed out that this “creates challenges for regulators, SSDs and NHS Trusts as, currently, the system of safety relies on trained and experienced staff carrying out decontamination tasks. If the standard of training varies across the country, then the standard of decontamination may also vary.” Trevor pointed out that everyone who works
in sterile services will be aware of an incident where a dirty instrument has been supplied to theatres at some point during their career – the HSSIB reference case is not an isolated incident. To tackle the issue, HSSIB set out a number
of key recommendations – including the need for NHS England and NHS Improvement to develop a competency framework (stating skills, qualifications and professional registration as required) for all sterile services staff and include it in the Health Technical Memorandum (HTM) 01-01.
Other findings of the document included:
l Implementing standardised job profiles and descriptions
l Enhancing CPD programmes l Clarifying of Decontamination Lead role and responsibilities.
l Defining minimum qualifications and IDSc membership for senior roles.
l Increasing board level oversight, governance and accountability.
l Expand apprenticeship training routes and IDSc to work towards accredited professional registration for staff via the Academy for Healthcare Science (AHCS).
l Board level involvement in external certification audits and assurance processes for incidents related to decontamination.
In May 2023, NHS England approached the IDSc
requesting them to develop the NETB document which was issued in April 2024. It is now on version 2. (There has been an amendment and Spaulding classification has been removed for clarity). It covers job role, experience, HTM role alignment, qualifications and banding. It provides a clear career pathway and competencies for the core workforce. Trevor highlighted that a key purpose of this document was to enable decontamination services managers to take it to the higher levels within their respective organisations, and use it as a reference document to highlight the requirements for staff training and allow time for these training and development activities to take place. Trevor reinforced the reasons for ‘why train staff?’ and reiterated that the Health and Social Care Act states that staff should have the qualifications, competency, skills and experience necessary for their job role. Staff must be “trained in cleaning and decontamination processes and the safe use of decontamination equipment and hold appropriate competencies for their roles.” HTM 01-01 also describes the requirement for
staff training, while the NHS Long Term Workforce Plan (2024) recognises that the retention of staff can be increased through supporting individual career development and training. Trevor went on to explain that there is an important difference between training and competency. The Health and Safety Executive states that: “Competence can be described as the combination of training, skills, experience and knowledge that a person has and their ability to apply them to perform a task safely. Other factors such as attitude and physical ability can also affect someone’s competence.” The dictionary definition of training, on the
other hand, is: “The process of learning the skills you need to do a particular job or activity.” (Cambridge Dictionary). Trevor gave an overview of the experience,
professional registration requirements and qualifications for the various job roles within decontamination – from Apprentices/Trainees and Technicians/Band 2/Operators; right the way through to Decontamination Managers/ Head of Decontamination Services/Band 8 A-C, and Decontamination Leads. He revealed that IDSc is currently working with a university on the development of a BSc qualification, planned for September 2025, which is targeted at decontamination managers. Decontamination leads should have direct
access to the organisation’s Board Executives; they must be an IDSc member, and they need to have undertaken a decontamination lead course. To round up his presentation, Trevor highlighted some points that decontamination
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