DECONTAMINATION
The HTM recommends that instruments are transported to the sterile services department (SSD) immediately after the close of the procedure and processed as soon as is practical. This is a particular priority in preventing the transmission of human prion diseases such as variant Creutzfeldt Jakob disease (vCJD). Prion proteins are described as hydrophobic as once dried onto the surface of an instrument they will adhere strongly and resist procedures designed to decontaminate the item.5
This also means that the proteins are harder to detect through the use of swab tests. Therefore, having capacity to begin reprocessing the items as soon as possible will help reduce the risk to patients and staff.
Testing and maintenance Once the system is installed and operational, it is essential for the final rinse water quality to be sampled and tested to ensure the water continues to comply with the specified parameters. Tests for microbial contamination should be carried out weekly, with the water being sampled from the AER and WD appliances. The results of the total viable count (TVC) should then be recorded and plotted to identify any trends in the findings and to isolate unusual results. Abnormal TVC readings should then be investigated and where the levels rise it is always advisable for more detailed testing to be carried out to identify the species of bacteria. If one AER or WD result is showing higher levels of TVC compared with other units, the source of the contamination could be that unit rather than the water supply. Disinfection of the unit and a retest is recommended. However, human error should not be ruled out as the cause of unusual test results.
The HTM also recommends that a full analysis of all parts of the water treatment and disinfection system is carried out at least once a year. It is also good practice to take additional water samples from the water treatment system outlet either monthly or quarterly so that quality can be corroborated at every stage of the process.
Establishing a maintenance schedule for the system is essential, especially because down time is often not an option. To avoid costly issues, regular planned preventative maintenance should be carried out in line with the manufacturer’s recommendation. Also, where practical, regular sample testing should be conducted at all stages to identify issues as soon as possible. It is important to consider who will be
carrying out these scheduled maintenance checks and servicing. This will primarily depend on the in-house team’s skills and resources. Where it cannot be managed internally, leading water treatment specialists will be able to provide a service package that
MAY 2021
meets the facility’s requirements. Preventing the spread of infections is a central part of managing a healthcare environment and there are many parts that make up the facilities defence against infection. High quality purified water plays a crucial role in the decontamination of surgical equipment and endoscopes but there are a wide range of factors that must be considered when specifying a water treatment system. Partnering with a specialist can help simplify the process and ensure that those involved receive the best possible advice and guidance.
References 1 NICE, Infection prevention and control, Quality standard [QS61], 17 April 2014
https://www.nice.
org.uk/guidance/qs61/chapter/introduction
2 Kings College Hospital, MRSA information for patients and visitors,
https://www.kch.nhs.uk/Doc/pl%20 -%20068.4%20-%20mrsa%20information%20 for%20patients%20and%20visitors.pdf
3 Love, B, MRSA infections in NHS on the rise again in 2016 – while MSSA infections top 10,000 and remain unchecked, The Pharma Letter, 23 August 2016.
https://www.thepharmaletter.com/article/ mrsa-infections-in-nhs-on-the-rise-again-in-2016- while-mssa-infections-top-10-000-and-remain- unchecked
4 NICE, Surgical site infection, Quality standard [QS49] 31 October 2013.
https://www.nice.org.uk/guidance/ qs49/chapter/Introduction
5 Health Technical Memorandum 01-01: Management and decontamination of surgical instruments
About the author
Kalpesh Shah is head of sales, process water, at Veolia Water Technologies UK. He has more than 26 years’ experience working within a variety of roles at VWT UK and has worked for both internal and international sales. His current role has been expanded to include the healthcare sector, which covers renal dialysis applications for water treatment and water treatment services for endoscopy and decontamination applications.
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(medical devices) used in acute care Part D: Washer- disinfectors
https://assets.publishing.service.gov.uk/ government/uploads/system/uploads/attachment_ data/file/545864/HTM0101PartD.pdf
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