Endoscope reprocessing
know how many patients contract infections following an endoscope procedure. It is easy to have a false sense of security, therefore. “How long does it take from the procedure
to the infection developing? It’s not going to be instant. If somebody comes in for a colonoscopy and, five days later, they get a stomach bug, are they going to relate it back to that endoscopy that they had five or six days ago or even seven days ago? Probably not,” she pointed out. Helen added that the patient is unlikely to be in hospital when they present with symptoms, unless it’s a hospital procedure, so who will treat that infection? “Will they go back to the hospital and say, ‘I’ve
got this throat infection, and I had a gastroscope 10 days ago and I’ve now got tonsillitis’? Will the GP link it to a procedure that the patient has had? Furthermore, if they did link it to the procedure, how would they report it to the hospital?” she continued “It’s a concern that we are asking people to
process scopes on their own, after just three days, and they are being taught how to do them by somebody who hasn’t got a levelled qualification,” she continued. She looked at what is meant by ‘a levelled qualification’ – explaining that GCSEs can be compared to ‘level two’, A’ Levels ‘level three’ and degrees’ level six’. “Are we expecting our senior staff who are qualified in nursing and endoscopy procedures to know how to decontaminate things? It’s a big ask for people.” Helen commented. She went on to add that when someone new is trained on the department, how do we know that that the person giving the training is competent? Issues raised around the training and
competency of decontamination staff, by the Health Services Safety Investigations Body (HSSIB), has led to the development of the new NHS Estates Technical Bulletin NETB/2024/1 - Competency framework for staff working in Sterile Services and Decontamination Departments. The bulletin covers central reprocessing of
the following: l Surgical instruments l Endoscopes l Nasendoscopes l Transoesophageal echocardiogram (TOE) probes
l Transrectal (TR) and transvaginal (TV) probes l Dental instruments l Cutting-edge medical devices that utilise recent innovations (such as robotic surgical instruments and minimally invasive devices)
Helen asked the audience for a show of hands to see who was aware of the document and the responses suggested that it was around half the delegates. “How many of you have nasendoscopes
that are processed in a centralised controlled environment by qualified staff?” (There was just one department.) Lots of delegates said that wipes are used to clean the scopes between patients, then they are sent to the Central Sterilisation Services Department (CSSD) at the end of the day for reprocessing. “Would you want to be first on the list?
Because I wouldn’t want anyone just to wipe a scope being used on me. Are the people that are cleaning the scopes trained?” said Helen. “What about transoesophageal
echocardiogram (TOE) probes? There was an
alert, some years ago, that somebody died of hepatitis B because the TOE probe wasn’t cleaned effectively. I got heavily involved in this and we changed the way that the probes were cleaned. What about transrectal and transvaginal probes? What is the risk of passing on human papillomavirus (HPV)?” Helen Campbell further questioned. “How are your transvaginal probes used? Are
they sheathed? Are they high level disinfected? Are they wiped and, if they are, is it with a wipe that kills HPV? Are they put into a UVC machine or hydrogen peroxide? Have they been cleaned first? How have they been cleaned?...What about cutting-edge devices? There is a lot of robotic surgery technology coming in. Have we got the instructions? Can the instruments be processed within the department?”
Apprenticeships She went on to explain the decontamination qualifications currently available, including the apprenticeship scheme, paid for by the Apprenticeship Levy. (The ‘Levy’ is a UK tax on employers that is used to fund apprenticeship training.) “For endoscopy, you have the level two qualification – there is no reason why staff couldn’t do this. It is a basic qualification that staff should have before they are allowed to process endoscopes on their own. So, do people know about this qualification?” she asked. Around 40% of the room said they were aware. She urged the audience to talk to their healthcare science education leads to find out if they can fund some qualifications for their staff. She explained that the level two apprenticeship qualification takes a year to complete. “You are not asking a huge amount from staff. Once they have completed the modules, they go on to have an endpoint assessment. An assessor conducts three observations and gives the member of staff some scenarios. For example, they may be doing five colonoscopies in the morning and only have two scopes. The washer takes 20 minutes - can they just manually wash the endoscope and give it to the endoscopy team? What are the reasons for their decision? Then the assessor will look through their portfolio, which will include observations and witness testimonies. In total, the endpoint assessment lasts about three hours,” Helen explained. The qualification – which is overseen by
Health Education England and run through the Healthcare Science School – is awarded by Pearsons, one of the leading accrediting companies within the UK. “From the level two apprenticeship, you can go straight to level four, but the level four
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