Endoscope reprocessing
department’s standard operating procedure (SOPs) but highlighted areas for improvement relating to the infrastructure of the department. The report provided the impetus to drive improvement and investment, and Kevin led a project team with the aim of rectifying the concerns raised by HIQA, to deliver the gold standard of decontamination for the nasendoscopes in ENT. It was decided the best model to address the shortfalls within the department would be to move to a pass-through model with an automated high-level disinfection process leading to a sterilised final product. (A detailed insight into the design of the new department is included within this issue.) They established clear separation of clean/ dirty activities by introducing the pass-through system, as this would ensure the safest possible outcomes for the service users of Beaumont. There was also an opportunity to:
l Cease the transportation of contaminated instruments through the clinical treatment area and lessen the risk of cross contamination of the patient treatment area.
l Improve the process to include automated high-level disinfection prior to sterilisation as recommended.
l De-clutter by removing all non-decontamination related equipment from the area.
l Install air systems to give quality control of air in the clean dispatch area.
l Improve quality assurance by introducing a biological indicator to each load sterilised
“Ultimately, it was about giving our patients the safest possible scope that we could,” Kevin commented. He went on to show the final build and explained that extra space was secured to create the fully pass-through room. The build included: l Full rip out of two existing rooms. l Two new Sterrad NX systems installed, alongside a new scope washer and RO system, as well as pipework.
l All floors, walls and ceiling replaced. l New air system, new IT system, new storage, new shelving and new sinks installed.
l Partition wall erected to allow for future development.
“The department looks a lot cleaner, and we now have clear separation. We even went as far as having colour-coded floors, to further mitigate the risk of human error, with a green floor in the clean area and red floor in the dirty area. We have trolleys for the scopes, and they are all transported in hard plastic trays. “The scopes come in; technicians leak test and manually clean them with an enzymatic
detergent; they are rinsed and put into an automated endoscope reprocessor (AER), and then they are put through the Sterrad NX systems. “We also have full electronic traceability;
everything is tracked and flows through the department very nicely,” commented Kevin, adding that the final solution now gives the department the quality assurance it needs, with each load being released upon the successful result of a biological indicator. “Previously, everything was manually
recorded. Our washer disinfectors have their own third-party software programme that tracks every scope, every cycle, who put it in and all of the critical parameters. The Sterrad NX systems have similar capabilities, via ASP Access (an information-sharing technology). They’re great tools to have for mapping out productivity or capacity planning,” he continued. The technology helps to eliminate the need for manual record keeping, minimising the risk of human error, while the automatic production of audit-ready records helps to enhance compliance. Kevin commented: “What we have now ticks
all of the boxes - it’s a really good place to be. All of the issues highlighted [by HIQA] have been dealt with,” he commented. Upon completion of the project, the area was
audited using the decontamination audit tool. The department is now 100% compliant and the gold standard for decontamination of endoscopes is now in place. In 2023, the department sterilised approximately 5400 nasoscopes. Kevin went on to show some slides of ENT endoscopy and patient anatomy, highlighting the importance of minimising infection risk. All scopes will be in contact with mucosal layer tissues in the nasal cavity/oesophagus.
It is worth noting that in cases of epistaxis or during procedures where this mucosal layer is breached, such as biopsy, the endoscope being used may come in contact with the body’s sterile tissues such as the bloodstream. “The closer you are to the brain, the more
likely you might be to find prions,” he warned. “The Spaulding classification is useful to have,
to give us ‘lines that we can work within’, but high-level disinfection is the minimum and, if you can sterilise, you should. I think people have forgotten this. “As decontamination professionals, we have been working to the minimum for 20-30 years, and I’d like to change that. I think sterilisation should be provided for every scope and that is what I have had at the forefront in doing this.”
Sticky trouble: can we get rid of biofilms? Olegs Tucs, Associate Lecturer and Decontamination Programme Coordinator at TU Dublin since 2018, and ASP Application Specialist since 2020, gave an engaging and fascinating presentation on biofilms, including the challenges they present around decontamination and how to stop them. Olegs described how biofilms are “a common
and ancient form of microbial life”, with bacteria dating back billions of years. Both “a living thing” and “an environment”, biofilm can be difficult to detect and eradicate, leading to persistent infections. Microbes in a biofilm are 1000–1500 times more resistant to antibiotics than in their ‘free state’, making them particularly challenging from a healthcare perspective. In addition, bacteria can exchange genetic information (including antibiotic resistance genes) and gain knowledge from each other within a biofilm community.
April 2025 I
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