DECONTAMINATION
Role of pure water for effective decontamination
Kalpesh Shah looks at the Health Technical Memoranda (HTM) guidance on sterilising medical equipment. He outlines the issues that need to be considered when implementing a purified water system.
Infection control in hospitals and other healthcare facilities has to be approached on many fronts. This includes ensuring best practice from staff, robust cleaning procedures, good pre-operative preparation, post-operative care and patient education. The National Institute for Health and Care Excellence (NICE) figures show that around 1 in every 16 patients admitted to hospital contracts an infection. The most common of these are respiratory (including pneumonia and lower respiratory tract infections), urinary tract and surgical site infections.1 These infections not only risk the health of the patients and impact their recovery time but also put a strain on hospital resources including staff and bed capacity. Preventing the spread of infections is especially important due to the risk of outbreaks of antimicrobial resistant pathogens. This is one of the most serious issues facing modern healthcare facilities. Among the highest profile of these is Methicillin-Resistant Staphylococcus Aureus (MRSA), which, lives harmlessly on the skin of around 1 in 30 people and only becomes a serious issue when it enters the bloodstream,2
Clostridium
difficile (C. difficile) and Escherichia coli (E. coli). However, there are a number of other resistant pathogens that are a threat in hospitals such as Methicillin Sensitive Staphylococcus aureus (MSSA), which hit a peak Between 2015 to 2016 with 10,586 cases reported across NHS facilities.3
regards to infection control: HTM 01-01, on the design and required standards for the decontamination of surgical instruments and HTM 01-06 on the management and decontamination of flexible endoscopes. The primary approach to decontamination and sterilisation of reusable medical equipment is thermal sanitisation at temperatures above 60˚C. However, there is a range of surgical equipment and other clinical devices that cannot be processed using this method. This can include surgical instruments, bowls, dishes, receivers and glassware and anaesthetic equipment.5
The
most common approach for the treatment of items that cannot be thermally sterilised is to chemically disinfect them and then rinse in purified water. This is usually achieved through the use of Automated Endoscope Reprocessors (AER) or Washer Disinfectors (WD) for sterile surfaces. As such, the HTM along with ISO 15883, specify the general performance requirements for AERs and WDs and the minimum quality of water that should be supplied to them.
10% for large bowel surgery.4 Therefore, Also, in recent years, Vancomycin
Intermediate Staphylococcus Aureus (VISA) and Vancomycin Resistant Staphylococcus Aureus (VRSA) have become more common.
Instrument decontamination Surgical site infections (SSI) account for up to 16% of all healthcare-associated infections (HCAI) although the rate of SSI varies depending on the type of procedure. For example, it can be less than 1% for orthopaedic procedures and as much as
MAY 2021
effective decontamination of medical and surgical devices is an essential element of controlling infections. A fundamental part of any hospital disinfection system is establishing a reliable and consistent source of purified water in line with the Health Technical Memoranda (HTM) that also meets the needs of the facility.
The Health Technical Memoranda provides detailed guidance on a variety of areas relating to the design, installation and operation of both new and existing hospitals and healthcare facilities. The HTM documents cover a range of topics including fire safety, the design of medical gas distribution systems, heating and ventilation, acoustics and energy efficiency. However, there are two key areas with
As it is the final stage of the disinfection process, HTM 01-06 and HTM 01-01 provide strict guidelines for the quality of final rinse-water in particular. The standards provided in the documents cover the appearance, acidity (pH), electrical conductivity, hardness and total viable count (TVC) of microorganisms in a sample. HTM 01-06 also specifies a maximum total organic carbon (TOC) level for final rinse- water used for disinfecting endoscopes, while HTM 01-01 stipulates maximum chloride, lead, iron, phosphate and silicate levels in the final rinse water used for washer disinfectors.
Choosing a purified water system With an array of water quality criteria that need to be met, choosing the correct water treatment solution to supply the AER or WD units is crucial. There are a range of factors that need to be considered to ensure the
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