DECONTAMINATION
Progressing safety in scope decontamination
UK hospitals have come a long way in improving endoscope reprocessing over the past 20 years, but could artificial intelligence drive further improvements in the future? Ronald and Arno Wassenburg believe that data will be the key to improving patient safety.
In 2018, a study by John Hopkins researchers in the US found that rates of infections after endoscopic procedures were much higher than previous estimates. Infections were thought to occur at a rate of around 1 in 1 million endoscopic procedures. However, the rate was found to be slightly higher than 1 in 1000 for screening colonoscopy, around 1.6 in 1000 for non- screening colonoscopy, and more than 3 in 1000 for oesophagogastroduodenoscopy.1 The study followed in the wake of a number of well-publicised infections linked to duodenoscopes.2
These findings have highlighted the need
for: l Further investment in training to ensure staff are fully competent.
l The use of automated reprocessing, monitoring and traceability systems.
l A greater appreciation of the reprocessing challenges in endoscope design.
The Health Technical Memorandum (HTM) 01-06 provides essential guidance on the management and decontamination of flexible endoscopes3
British Society of Gastroenterology4
, along with guidelines from the , while
the MHRA has also previously issued its ‘top 10 tips’ on endoscope decontamination.5 In the UK, JAG accreditation provides
A safe scope for every patient Thorough manual cleaning with a CE marked detergent which is compatible with the disinfectant, including the brushing and flushing of all accessible endoscope channels, must be undertaken before automated endoscope disinfection within an endoscope washer disinfector (EWD). EWDs improve standardisation of the reprocessing steps, reduce personnel exposure to high-level disinfectants and infectious material, while lowering the possibility of human errors.6
In addition to compliance with guidance and initiatives such as JAG, technologies that provide assurances that the reprocessing,
It is already possible to use data to understand whether the user needs extra training. For example, if the user has been working in another department for a period of months (such as in the case of COVID-19, where staff were unable to work in the endoscopy department), they may need additional training when returning to work.
OCTOBER 2020
storage and transportation of endoscopes have been performed correctly, also have an important role to play. Increasing automation and intelligent data in endoscope decontamination have the potential to drive improvement even further.
Ronald and Arno Wassenburg
independent and impartial recognition that a service demonstrates high levels of quality.
At the same time, where the endoscope is reprocessed is also important. In many countries, reprocessing continues to be the responsibility of clinical personnel, rather than staff trained in decontamination science. One of the major changes that has driven improvement in countries such as the UK, Ireland and the Netherlands, has been a move towards the centralisation of endoscope reprocessing in departments managed by specialist staff.
Joint CEOs of endoscope reprocessing specialists, Wassenburg Medical, Ronald and Arno Wassenburg believe the UK’s trend for centralisation – coupled with advances in automated technology – have been crucial in driving improvement across the sector. “Every patient deserves a safe endoscope,” Ronald commented. “This has been our mantra since the company developed its first automated endoscope washer-disinfector in 1987. During this time, the healthcare sector in the UK has come a long way.” When Wassenburg first entered the UK market in 1999, the HTM guidelines were in their early stages of implementation. “The Netherlands had already implemented stringent regulation around the requirement for measuring systems to control the decontamination process. Using this information, Wassenburg was keen to develop new opportunities in the UK,” Ronald continued. “Hospitals started to move from an automatic or semi-automatic process to a controlled and monitored process – we began to understand the importance of measuring what is happening in and around
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