DECONTAMINATION
Balancing efficacy with material compatibility
As decontamination units and SSDs restart services after the initial COVID crisis, decontamination consultant, Trevor Garcia, looks at some of the issues impacting on the selection of detergents and disinfectants for use in washer-disinfectors (WDs).
Surgical and diagnostic procedures SARS-CoV-2, the virus causing COVID-19, is likely to continue having an impact for the foreseeable future. As public health advice is relaxed, infection rates may fluctuate. While the future progression of the virus is unknown, there is little doubt about the significant backlog of surgical and investigative procedures which has been created during the lockdown period. This is in addition to the large numbers of patients who were on waiting lists pre-COVID. Early in the COVID-19 pandemic, the British Society of Gastroenterologists (BSG) advised a pause in endoscopic services for all but emergency and essential procedures. This was to protect patients and the workforce, as well as to allow time to plan service reconfiguration. The Joint Advisory Group on GI Endoscopy (JAG) National Endoscopy Database (NED) has shown large reductions in procedures, with the number of procedures across the UK falling in April to just 5% of pre-COVID levels.
Many units have now begun the process
of restarting services for non-emergency patients requiring endoscopy procedures and JAG has released guidance ‘Principles for restoration of endoscopy services following the COVID-19 pandemic’ to support units as they restart. Likewise, the Royal College of Surgeons has issued Guidance on the ‘Recovery of surgical services during and after COVID-19’ (updated 5th June 2020). The resumption of elective surgical and diagnostic procedures means that Decontamination Units and Sterile Services Departments (SSDs) will start seeing an increased demand for surgical instrument and endoscope reprocessing services. Robust infection prevention measures will need to be in place. The NHS in ‘Operating framework for urgent and planned services in hospital settings during COVID-19’ has stressed that ‘Excellent
implementation of Infection Prevention and Control (IPC) procedures is paramount in reducing healthcare-associated infections, including nosocomial transmission of COVID-19.’ Likewise, the British Society of Gastroenterology has specified the need for ‘strict infection control measures to reduce spread of the infection’1
Pre-COVID contamination issues Even before the additional infection prevention challenges posed by COVID-19, the issue of post-reprocessed contaminated endoscopes and surgical instruments has been raised. Since the late 1970s there have been sporadic reports of nosocomial infections linked to endoscopic procedures. The majority of documented cases were attributed to non-compliance with national and international guidelines (including inadequate reprocessing, drying, or storage of endoscopes and endoscopic accessories). Damage, design limitations, contaminated water, and contaminated endoscope washer- disinfectors (EWDs) have also been reported. 2 A 2018 study found that organic matter
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from previous patients was still present on a significant number of duodenoscopes after reprocessing. The contamination was found to be of gastrointestinal or oral origin.3 Post-sterilisation contamination of sets containing surgical instruments has also been reported. A study in 2012 found this was linked to an increased rate of deep surgical site infections in orthopaedic and ophthalmic patients.4
Transmission of SARS-CoV-2 SARS-CoV-2 has added an extra layer of complexity to the reprocessing of instruments in the hospital setting. Before considering reprocessing, it is worth examining what is so far known about the transmission of SARS-CoV-2. The two key routes are thought to occur mainly through respiratory droplets generated by coughing and sneezing, and through contact with contaminated surfaces. It is known that SARS-CoV-2 may remain on uncleaned surfaces for many days. It has been found to remain on plastic and stainless steel for up to 72 hours, on copper for 4 hours and cardboard up to 24
OCTOBER 2020
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