DECONTAMINATION
the endoscope, to ensure the end result is not just a correctly reprocessed endoscope, but also that this was evidenced with monitoring data.”
At many UK hospitals, endoscope reprocessing has moved away from where the patient is treated to a centralised location. Shifting responsibility away from endoscopy departments and clinical staff, to specialist decontamination teams with infection prevention knowledge, has been a major step forward in terms of quality, in their view. “Previously, the department manager for endoscopy would be responsible for the reprocessing of endoscopes, yet infection control was not their primary profession – their focus was on the treatment of the patient. This change has resulted in greater infection control knowledge in the UK market with closer scrutiny of how scopes are reprocessed,” Ronald commented. He added that, over the past decade, there has also been an increased focus on the logistic processes: “Separation of clean and dirty areas of a reprocessing space is critical to ensure that endoscopes are not re-contaminated after reprocessing. It also means that staff can no longer accidently pick up an endoscope that has not been reprocessed – you cannot simply tell by looking at an endoscope whether it is dirty. “This was a significant step forward in the UK market and we developed technologies to support these changing trends around logistics. A new generation of machines were
Tackling infection
risks in cardiology In 2012, an inquest into the death of a 68-year-old patient subsequently identified that a transoesophageal echocardiogram (TOE) probe used during heart surgery was inadequately decontaminated and caused a cross infection of Hepatitis B. The Coroner found that it was more than likely that Hepatitis B was transferred from another patient because of failures in decontaminating a TOE probe.7 “Used in cardiology, these devices have previously been overlooked from an infection control perspective. Often these are simply cleaned with wipes, but this is not a consistent or safe method of decontamination,” commented Ronald Wassenburg. “We have recently launched a TOE probe feature for our pass-through washer-disinfectors. Existing machines can even be upgraded with this feature, helping hospitals to reprocess this forgotten device.”
introduced around 2006, which delivered increased safety through ‘pass-through’ designs,” he explained. “At this time, the focus shifted away from selling machines from a technical perspective to asking: ‘how can we ensure that the patient receives a safe endoscope?’ By really looking at the logistics, you start to fully understand that there are many small parameters that can influence the whole process. You may have the most advanced endoscope washer on the market, but it doesn’t mean you also deliver the safest endoscope to the patient. After reprocessing, if something goes wrong –
such as somebody touching the endoscope at the wrong moment or without gloves – the benefit of reprocessing with the machine is lost.”
So, what could help improve endoscope safety even further? “The future is data,” continued Ronald. “The EWD itself is just one aspect of the overall ‘flow’ in the reprocessing operation and data is critical to control standards of care. 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. “Our Process Manager software has a function that will determine when there has been long gaps in user activity; the department manager has to evaluate whether there have been any changes in operating procedures and whether extra training is necessary, then they can enable the machine to allow that user again.”
Track and trace
The Health and Social Care Act stipulates that systems must be in place to track endoscopes through decontamination processes, not only to assist with assuring their quality, but also to enable the identification of patients on whom the medical devices have been used. Tracking
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