DECONTAMINATION
George Santayana, is quoted as saying: ‘those who fail to learn from history are doomed to repeat it’.
The need for earlier engagement of
expertise was highlighted during a public inquiry into an incident involving the contamination of the water supply at the newly built Queen Elizabeth Hospital. A ten- year-old girl tragically died after a Hickman line became infected, and there were further deaths and infections, linked to the water supply – “causing pain, agony and sorrow”. “Safety and the lives of our patients are paramount,” she commented. “I hope you don’t need surgery. But if you do, which one will you choose? The one that follows the guidance, that learns from previous incidents, that has gone through independent review by an independent expert – an AE(D) – or one that doesn’t?” Spencer questioned whether AE(D)s are truly ‘independent’ – i.e. “not subject to control by others, not affiliated with a larger controlling unit, and not looking to others for opinions or guidance in conduct”. In any case, he argued that “independence can be overrated”.
There are 30 registered AE(D)s on the IHEEM website at present – only 27 are actually practising; 35% are not actually ‘independent’ of either the NHS or the public sector bodies that employ them, and only a third of the AE(D)s are actually independent. Spencer commented that a lack of
expertise does not necessarily mean you cannot function safely – people can get expertise from a variety of sources. However, the expertise is in the NHS – people succeed as AE(D)s because of the expertise they gained within the health service. He added that there will always be a struggle for the health service to retain expertise if we do not pay staff enough – decontamination staff can ultimately earn more elsewhere. He further pointed out that the average age of an AE(D) is probably around 60 years old – they will be retiring and there is already a struggle to find AE(D)s. It is going to get even harder, without succession planning. “The role of a consultant or trainer is to empower the customer, not to make consulting indispensable. If we make ourselves indispensable, people will never have the expertise they need to manage without an ‘independent’ AE(D). AE(D)s should not be a ‘necessary evil’ but more of a ‘comforting blanket’,” he concluded. One delegate argued that the definition of ‘independent’ used by Spencer was “too broad” and we should talk, instead, of being “free from conflicts of interest” – i.e. there is no manipulation of the advice due to commercial pressures. Spencer responded that there is a question over how independent some of the AE(D)s are in the devolved administrations from the
NHS. Some may argue there is a conflict of interest as they are working for the same health body, with the same financial ‘pot’. Another delegate pointed out that AE(Ds can bring learning from other hospitals, which is extremely valuable.
She added that actions, that have already been recommended by the infection prevention team, are often subsequently reiterated by the AE(D) – but only then are they taken seriously; suddenly, it becomes “really important to implement them”. Other views put forward by the audience included the fact that AE(D)s can help with culture change – it is easier to hear you are doing something wrong from an outside party. Concluding, Spencer commented that the comparison between Mary Berry and AE(D)s was an interesting one: “Mary Berry inspected the cakes and looked out for soggy bottoms but, ultimately, she left – and the show went on. ‘Bake-off’ didn’t die because Mary Berry left. Hospitals won’t collapse without AE(D)s. They will move to a different way of working. They can function safely, but it may be different.”
The motion was put to the audience vote and the majority sided with Wayne Spencer.
References 1. Nuffield Trust, The planning and organisation of central syringe services, 1957. Accessed at:
https://www.nuffieldtrust.org.uk/research/the- planning-and-organisation-of-central-syringe- services
2. Nuffield Trust, Studies of sterile supply arrangements for hospitals: Present sterilizing practice in six hospitals, 1958. Accessed at:
https://www.nuffieldtrust.org.uk/research/studies- of-sterile-supply-arrangements-for-hospitals- present-sterilizing-practice-in-six-hospitals
3.
https://blog.sciencemuseum.org.uk/remembering- the-devonport-incident-50-years-on/
24 l
WWW.CLINICALSERVICESJOURNAL.COM CSJ
4. The Clothier Report, July 1972. Accessed at:
https://api.parliament.uk/historic-hansard/ commons/1972/jul/12/dextrose-solution
5. Butin, M., Dumont, Y., Monteix, A. et al. Sources and reservoirs of Staphylococcus capitis NRCS-A inside a NICU. Antimicrob Resist Infect Control 8, 157 (2019).
https://doi.org/10.1186/s13756-019- 0616-1
About the CSC
The CSC was formed in 1960 as a result of the enthusiasm of a small group interested in sterilisation processes and the provision of sterile supplies in hospitals, brought together by Professor Michael Damady. As topics discussed at meetings, and indeed the character of the meetings themselves, have changed over the years, the central themes have been maintained: applied and basic research topics; the general interchange of information; and the generation of CSC guidance documents, using multi- disciplinary members. Several successful national groups have emerged from the Club’s membership, including the Institute for Decontamination Sciences (IDSc and formally the ISSM), the Infection Prevention Society (IPS, formally ICNA) and the Healthcare Infection Society (formally Hospital Infection Society). The 60th Anniversary Annual Scientific Meeting took place on 4-5 April 2022, at the Crowne Plaza Hotel, Stratford Upon Avon. The next Annual Scientific Meeting will take place on 3-4 April 2023 in Newcastle Upon Tyne. For further details, visit:
https://centralsterilisingclub.org/ For membership please contact:
membership@centralsterilisingclub.org
JUNE 2022
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