DECONTAMINATION
Decontamination: past, present and future
The Central Sterilising Club’s 60th anniversary annual scientific meeting finally took place in Stratford Upon Avon, having been delayed by the pandemic. It hosted some lively discussion around the key challenges in decontamination – from difficulties in reprocessing TOE probes and contaminated neonatal incubators, to whether hospitals can function safely without Authorised Engineers (decontamination). Louise Frampton reports.
High on the agenda at the Central Sterilising Club (CSC) annual scientific meeting was the need to drive improvement and learn from the mistakes of the past, while approaching today’s problems with the discipline of a science, informed by guidance and evidence-based practice. At the same time, decontamination professionals must also remain vigilant, scanning the horizon for new threats and challenges – whether it is the next pandemic, difficult to reprocess new technologies, or tackling the healthcare sector’s significant contribution to climate change.
The first opening sessions – introduced by CSC chair, Jimmy Walker – were delivered by Robert C Spencer, a retired microbiologist who has occupied senior positions within the NHS, Health Protection Agency and Public Health England; Geoff Ridgway, who was previously a consultant in clinical microbiology at UCLH, a member of the Committee on CJD incidents (among others) and past chair of the CSC; and Peter Hoffman (Kelsey lecturer), who recently retired from being a consultant clinical scientist with the UK Health Security Agency. Together, they reflected on the origins of the CSC, as well as the historical challenges faced by healthcare – intermingled with personal anecdotes and horror stories from the past 60 years.
The discussion included some high- profile incidents, the lessons learnt, and subsequent evolution of decontamination practice. They painted a picture of how far decontamination had come, during this time, but also how far it still needs to go...
JUNE 2022
Jimmy Walker The past
In 1957, the Nuffield Trust published its report on the planning and organisation of central syringe services, for example. Syringes were previously boiled and the process decentralised, so it was often poorly supervised. Contaminated equipment would be added to the steriliser just before syringes that were required for use were taken out. The maintenance of syringes was also poor, so needles were often blunt. The report underlined the importance of safe methods of sterilisation and discussed the move to central sterilisation.1 In 1958, the Trust also published damning findings from its study of sterile supply arrangements in six hospitals – including open windows in decontamination facilities that allowed dust to ingress, extreme build-up of scale on stainless steel from the use of hard water in sterilisers, and the cleaning of instruments by simply washing under a tap. The report acted as a catalyst to driving improvement in
Peter Hoffman
decontamination practice.2 The ‘Devonport incident’ – one of the most infamous pharmaceutical disasters – also hit the headlines in the early 1970s, when the release of non-sterile dextrose infusion bottles onto the market resulted in the (known) deaths of at least four patients from endotoxic shock.3
The conclusion of
the inquiry into the incident (summarised in the Clothier Report, July 1972) was a sombre lesson to all: “The committee considers that too many people believe that sterilisation of fluids is easily achieved with simple plant operated by men of little skill under minimum supervision, a view of the task which is wrong in every respect.”4
The incident highlighted the importance of quality assurance of processes, as well as traceability. A third of the bottles from the implicated batch had failed to reach sterilising temperature, probably due to the retention of air within the steriliser. The drain to the steriliser was blocked. Steam would enter
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