DECONTAMINATION
present issues around decontamination. A before and after disinfection study of neonatal incubators, by Butin et al (2019),5 for example, found that (62%) of incubators remained colonised with methicillin-resistant clone Staphylococcus capitis NRCS-A after the disinfection procedure. The reality is that decontamination is often performed in crowded facilities, with little worktop space, in one sink/drainer, so it is impossible to have a defined ‘dirty to clean’ flow. There are lots of other problematic items throughout healthcare too – including pulse oximeters, BP cuffs, physio equipment, thermostat knobs on splint pans, seating in showers, mattresses, pillows, clipper handles, blood glucose monitors, hoists, baby scales, EBM kit, bodies of tympanic thermometers, doppler probes, ultrasound keypads/rollerballs, IT tablets, IT mice, burns hydrotherapy baths, supports for single- use bedpans, theatre gel limb supports, commodes, over-bed tables, wheelchairs, ice machines, calculators, laryngoscope bodies, privacy screens, patient trollies and many more...
The problem, he explained, is that items
are often designed for function – all too often, decontamination is an afterthought. He warned that decontamination of equipment on the wards is currently inadequate – often taking place in poor local facilities, rather
than specialist units. Training is also variable. Ward staff do not receive good training on decontamination.
The future “The question is: how much of this equipment could be reprocessed by specialists? A few years ago, it was unheard of for an endoscope to leave the endoscopy unit; now they are sent to a unit for specialist decontamination,” Hoffman commented. He added that there may even be the potential
for an SSD outreach on the wards. “We need to start thinking about where the problems are and how decontamination experts can contribute to solving those problems,” Hoffman continued. He called for manufacturers to have a role in developing devices that are easier to decontaminate but added that the UK is a small player in the global market, so it is difficult to exert influence on the sector. In his closing comments, he said that decontamination of medical devices and the environment remains problematic – most of the easy problems have been addressed. “We must maintain vigilance on sterilisation, but we must continue to look for where the problems are,” he concluded.
Do we need independent AE(D)s? The event also debated whether hospitals lack the expertise to function safely without an independent Authorised Engineer (Decontamination) [AE(D)]. Sulisti Holmes, the strategic lead for medical device safety for NHS Scotland, argued that hospitals do need an independent AE(D) to safely function, while Wayne Spencer, AE(D) and convenor of the ISO TC 198 working group 12 (responsible for ISO 17664 for reprocessing instructions), argued that hospitals do not need independent AE(D)s to safely function.
During the light-hearted duel between the
two experts, Holmes joked that the AE(D) is like the “Mary Berry of the decontamination world”. Both carry out inspections, ensuring a good quality product with “no soggy bottoms”. She argued that AE(D)s are mentioned frequently in the decontamination guidance – in the event of an incident, you will be asked: “why didn’t you follow the guidance and listen to the expertise of the AE(D)?” she pointed out. In addition, AE(D)s can have an
important role to play in learning from incidents – after all, as the philosopher,
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