Decontamination
to manual clean properly…I know some people will say that they can do it in three, but they are probably not doing it correctly,” he continued. Other considerations around the manual wash include: the consumption of single use plastics (the syringe may be disposable, for example), chemicals, water consumption, level of PPE and low capital cost. “When it comes to manual cleaning, we’re not
washing some of the small channels properly or effectively. So, what alternatives are on the market or starting to come on the market?” Jim Tinsdeall considered. He highlighted the Pentax AquaTyphoon: “They
are using turbulent flow, mixed air and water under substantial pressure down each of the lumens. Washing of the external surfaces is manual.” Another option is the Steelco EPW 100, which
still requires brushing. Enzymatic detergent is pumped through each channel: “They have done some work on not using the brushes, but because the IFUs are saying you need brushes, they’re sticking with that at the moment – if the market changes, it is likely that they’ll change,” he commented. Other options include the PFE Khamsin:
“You place the endoscope in, connect it up, the distal end goes down into the centre, and it has different washing processes on each element of it, including some silver and manganese dioxide and ultrasonic activity on the distal end. So, this is a different method of cleaning. It cleans the outside as well,” Jim Tinsdeall explained. Finally, there is the Nanosonics Coris – at the time of the CSC conference, this was not yet
available in the UK market but was reported to be in the pipeline. Data is available from each of the suppliers and Jim Tinsdeall was keen to emphasise that he was not promoting any specific technology or approach – it is for sterile services managers to evaluate these solutions with the manufacturers. “If you are interested in going down this route,
there are some questions you might want to consider asking,” he commented. (See table 1) Jim Tinsdeall highlighted the importance of on- site validation, considering ‘risk and revolution’. “Scientific papers are not a substitute for proving their devices work on site,” he pointed out.
In conclusion, Jim Tinsdeall said that “the
desire should be to automate as far as possible, because machines are very good at doing repetitive uninteresting jobs.” These systems move towards automation
and cover more of the endoscope. However, endoscope decontamination departments need to ask questions, ask for demonstrations and ask for trials. Finally, they also need to review the
suggested on-site validation in depth, with advice from their AED.
Implementation of a revolution in pre-cleaning endoscopes Sharon Fox, the Head of Decontamination for University Hospitals Birmingham NHS Foundation Trust (UHB) and Director of Finance for the Institute of Decontamination Sciences (IDSc) continued the discussion with an insight
Key questions
1. Does it clean all the channels? 2. Is it fully automated? 3. What is the cleaning mechanism? 4. Will it detect a partial or full blockage? 5. Will the machine self-disinfect? 6. Is the process linked to track and trace? 7. Have the endoscope manufacturers approved the mechanism and/or the chemistry?
8. Will the manufacturer give written guarantees against scope damage?
9. How will it be validated on site? 10. Have you evidence of technical drawings of the surrogates used?
11. Are the chemicals safe or introducing new risk?
12. Does it wash the outside? 13. What is the capital cost? 14. What is the staff time per endoscope? 15. What is the cost per endoscope for consumables?
16. How much plastic is consumed? Table 1
into a ‘revolution’ in pre-cleaning endoscopes. UHB is the second largest Trust in the country (by turnover) and has 86 operating theatres, 22 endoscopy procedure rooms, 30 ENT OPD treatment rooms and six cardiology treatment rooms. The Central Endoscopy Decontamination Unit
(CEDU) at UHB was BSI accredited in 2018/2024 and the service operates seven days per week. UHB has four decontamination units (one on each site), while sterile services are with a third-party provider. The strategy for UHB is that “any device that requires high-level disinfection needs to go through a central process”. There is a dedicated decontamination manager for each unit, and they are purely decontamination technicians, rather than being from a clinical background. The CEDU has 36 AERs, six UV machines, 26 cabinets, two storage and endsocope transport systems, four vac-packing units, as well as full electronic track and traceability. Sharon Fox gave an overview of the many
When it comes to manual cleaning, we’re not washing some of the small channels properly or effectively. So, what alternatives are on the market or starting to come on the market?
devices that UHB reprocesses, adding that she is “always on the hunt for more”, to ensure that any newly acquired devices can be properly decontaminated. “You’d be surprised what gets purchased,” she commented. “The unit manager will go out and do audits; they will look for these devices and, if we can centralise them [for decontamination], we do.” She highlighted the data from the CEDU’s
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