DECONTAMINATION
Reprocessing high value, sensitive equipment
Dr. Frank Bakker discusses the key factors that must be considered to ensure the reprocessing of sensitive instruments is performed safely, efficiently and without compromising the integrity of the devices. Selection of appropriate chemicals must be made a priority, he explains.
Minimal Access Surgery (MAS) via laparoscopy has become the gold standard for some common surgical procedures across multiple surgical subspecialties.1
It has been
shown to be as effective as open surgery, but is associated with decreased operative times, smaller incisions, reduced postoperative pain, shorter hospital stays and improved patient satisfaction1
A 2018 report by the
Office of Health Economics found that a shift to MAS led to a reduction in the average length of stays for gynaecology patients from 5.5 days to just 1.5 days in 95% of cases.2 However, the utilisation of MAS techniques is highly variable across the United Kingdom (UK), and remains low for many procedures (for example in England less than 25% of hysterectomies are performed using MAS).2 A further innovative development of MAS has been robotic-assisted surgery. Both use small incisions, a camera and surgical instruments. The first robotic procedure was performed in 1985 to conduct a neurosurgical procedure requiring delicate precision. With its success, the first robotic-assisted laparoscopic cholecystectomy was then performed in 1987. Despite these early successes, robotic surgery did not enter the mainstream until 2000 when da Vinci (developed by Intuitive Surgical) was first approved for use by the US Food and Drug Administration (FDA).1 Guidance from the National Institute for Health and Care Excellence (NICE) supports MAS, yet uptake remains limited and unequal between settings. Beyond patient benefits alone, business cases are required to initiate technology adoption decisions, and the increasingly financially constrained NHS means that there is a growing focus on costs rather than value.2
Although the initial investment in laparoscopic instruments and visualisation systems may seem high, the savings associated with high quality and cost- effective care do outweigh these financial
FEBRUARY 2021
costs.2
It is possible to derive value from
MAS and robotic surgery in a variety of ways including lowering costs by increasing the volume of procedures performed this way.1
The increased costs of robotic surgery
are partly related to the high fixed costs of equipment. If these fixed costs can be spread across higher volume, robotic surgery can potentially be cost effective.1
Reprocessing sensitive equipment If the volume of MAS and robotic surgery increases, there will be additional pressures on decontaminating highly sensitive and expensive instruments. The complexity of robotic instruments for minimally invasive surgery places high demands on the safe and reliable reprocessing of these instruments.
New reprocessing systems have been developed and overseen by instrument manufacturers. For example, the Miele
RobotVario X·tra system is designed specifically for the reprocessing of da Vinci robotic instruments. The process was validated using 0.5% thermosept X·tra, a mildly alkaline enzymatic detergent (Schülke & Mayr GmbH), both for manual pre-cleaning as well as for automated reprocessing. The robotic instruments are manually primed and soaked for 30 minutes with 0.5% thermosept X·tra to degrade organic residues, followed by automated reprocessing in a Miele PG 8528 washer disinfector using a newly developed reprocessing programme which lasts just over one hour.
Selecting a chemical for reprocessing
There are a number of key considerations when selecting the most appropriate chemicals. Major advances in technology have seen significant improvements in cleaning agents. They have progressed from
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