DECONTAMINATION


retain separate sets of neuroendoscopes or reusable surgical instruments used on high risk tissues for people born after 1996. However, a sobering development has been the report that a French laboratory researcher died in 2019 from vCJD, which was acquired seven and a half years earlier in a laboratory incident involving a puncture wound during a procedure. In 2021, there were reports of the tragic death of a second laboratory worker in France who contracted vCJD via occupational exposure. As a consequence, France has since introduced a moratorium on prion research. Also following the reports in Europe of the incidents of transmission of vCJD, involving laboratory workers, guidance has been updated for those handling 1) high risk tissues that contain high concentrations of PrP prions that need to be managed in specialised laboratories; 2) low risk biofluids from patients suspected to have CJD with no or very low concentrations of PrP prions managed in high throughput laboratories. There are now also considerations for laboratory work involving other proteopathic seeds such as those in Alzheimer’s disease where there is a theoretical risk of exposure.


Decontamination engineering: skills gaps? At CSC’s Autumn Study Day, John Prendergast, AE(D), the senior decontamination engineer at NHS Wales, highlighted the fact decontamination equipment has become increasingly complex. This equipment requires maintenance and validation to precise standards, yet the sector faces significant skill shortages. There is significant variance in the standards of engineers appearing within decontamination departments. According to Prendergast, this may be due to a number of possible issues: l A lack of training, out of date training or not enough ongoing training (CPD).


l Engineers taking job opportunities outside their skills matrix, often with no apprenticeship to support the basic theories of engineering.


l The training structure within the decontamination industry may not be aligned to current demands and equipment.


l There is a lack of supervision or competency assessment by facility management. Often this is because of lack of an AP(D) or no communication with the AE(D).


l Organisations may be seeking the cheapest solution, without considering quality or consistency of service, as well as changing providers each year, without the thought of consistency or developing the skills from within the organisation.


In general, he pointed out that the engineering industry does not promote technical


JANUARY 2022


OPINION Increasing demands from robotic surgery


CSJ asked Nicola Thurston, sales and marketing manager, Schülke & Mayr UK, ‘what will be the top decontamination challenges in 2022?’ “For hospital Trusts, one of the main challenges in 2022 is likely to be finding a balance between the constant drive to cut costs, while purchasing


decontamination products which work effectively and do not damage equipment or people.


During the pandemic, many new manufacturers of wipes and hand sanitising gels entered the clinical market. Subsequently, some of these products have since been withdrawn from supply. An ABHR was withdrawn from use in Ireland when some batches were found to contain methanol rather than ethanol. A health warning was issued that ‘prolonged use of the product may cause skin problems, eye and respiratory irritation and headaches.


When selecting detergents or


disinfectants to use in washer disinfectors, there is another balance to be found between material compatibility, efficacy and staff safety. There have been reports of visible contamination on instruments after cleaning, when it was mandated that a neutral detergent had to be used. Input from an AED is essential when selecting the most appropriate cleaning products. An additional challenge will be the focus on non-COVID related pathogens, which are emerging with the potential to cause healthcare associated infections. For almost two years, SARS-CoV-2 has been the main pathogen of concern, but bacteria like Burkholderia (B.) cepacian are easily transmitted, difficult to detect, able to survive in harsh conditions and may cause lethal infections in susceptible patients. They remain – for now – very much under the radar.


The NHS drive for sustainability will prove to be key in 2022 and beyond, when decontamination choices are being


apprenticeships as it once did. While there has been a drive to address this, in recent years, Prendergast questioned whether this was sufficient to develop the core technical skills required for the decontamination sector. He asked: ‘should the decontamination industry look to develop these skills itself?’


made. To become the world’s first carbon net zero national health system by 2040 will require big changes for the NHS and for NHS Supply Chain. Reducing the use of single-use plastics and using reusable instruments means that there will be increased demands on reprocessing. Also, the use of robotic


surgery looks set to increase


as the benefits include increased operative precision and less time in hospital. This means that highly effective decontamination products will be needed for cleaning this sensitive, high value equipment, which will not damage the instruments over time. Reliability of supply is likely to be


another key theme in 2022, with Trusts needing suppliers who not only deliver decontamination products to the highest standards but are also able to ensure constant and reliable supplies. There are a number of key priorities for suppliers of decontamination solutions in 2022. It is essential for suppliers to have considerable experience of the complex needs of hospital infection prevention and control teams; and to work in partnership with these teams to deliver the solutions they are looking for. Decontamination product ranges need to be highly effective, be material compatible and be trusted to deliver on performance and safety. This should be underpinned by the provision of high quality, regularly updated and where appropriate accredited education for both the purchasers and the end users of the products. It is no longer acceptable for suppliers to simply manufacture and supply products, without a genuine understanding of the market and NHS needs. In addition, with the NHS drive towards sustainability, there will be an increased focus on the value of manufacturers being ISO 9000 accredited. ISO 9000 is a set of standards that helps organisations ensure they meet customer and other stakeholder needs within statutory and regulatory requirements related to a product or service.”


New guidance and manuals The continued development of guidance will also be vital to help support units in maintaining high standards of infection prevention, and CSC and HIS will be focusing their attention on the quality of rinse water in endoscopy in 2022. New guidance is


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