Decontamination
based on evidence, clinical need and regulatory understanding – not simply cost, convenience, historic practice or assumptions about sustainability.
Key messages for health boards l Wales strongly recommends migration towards pre-packed, sterile, single-use small orthopaedic implants.
l Repeated reprocessing of unused implants raises concerns about cleaning, contamination, traceability, degradation and regulatory liability.
l Clinical practicality, supply chain reliability, cost, storage and sustainability must still be considered.
l Risk acceptance must be informed, deliberate, transparent and agreed by the right stakeholders.
l Where reusable or reprocessed implants continue to be used, executive board-level approval and clear governance are essential.
Why Phaco handpieces need close attention Jim Tinsdeall gave a session on phacoemulsification handpieces reinforcing the importance of cleaning internal channels as well as external surfaces. Delegates reviewed how missed flushing, unconnected lumens, poor orientation and inadequate drying can undermine sterility assurance. The key message was practical: connect lumen devices to automated wash processes where possible, position them to support drainage, and treat drying as a critical safety step rather than a finishing detail. The session began by revisiting a case that brought phacoemulsification handpiece reprocessing into sharp focus: a failed sterility test that revealed a combination of issues across the cleaning, washing, sterilisation and drying stages. The findings showed that the flush process
had not been carried out correctly, lumens had not been connected during automated washing, sterilisation orientation had not supported drainage, and drying time had been insufficient. Together, these factors created conditions where contamination could remain and sterility could not be assured.
Key learning: connect, orientate and dry Phacoemulsification handpieces contain narrow internal channels that are difficult, and sometimes impossible, to clean effectively by manual methods alone. If these lumens are not connected during automated washing, the washer-disinfector cannot reliably clean or disinfect the internal surfaces.
IHEEM guidance discussed during the session
recommended connecting lumen devices to an automated wash process wherever possible and permissible. This helps ensure that cleaning and disinfection reach the internal pathways, not just the external surfaces. Orientation is equally important. Positioning handpieces at approximately 45 to 90 degrees from horizontal supports gravitational drainage, helping water escape from internal channels during sterilisation and drying. Dryness was repeatedly emphasised as a
critical control point. Even where sterilisation has been largely effective, retained moisture can allow microbial growth if bioburden remains. In complex devices, drying is not simply a finishing step; it is central to safe reprocessing.
Instructions for use: minimum standard or best practice? The session also explored the role of Instructions for Use (IFUs). While some IFUs may include manual cleaning options, the speaker reminded delegates that the processor remains responsible for ensuring that reprocessing is effective with the equipment, staff, process and environment actually being used. A sailing analogy was used to make the
point: having “right of way” does not remove the need to act safely. In the same way, choosing the most minimal option within an IFU may not always be the safest practical approach if better risk controls are available.
Learning across surgical services and endoscopy Delegates were encouraged to consider lessons from endoscopy, where connecting channels for automated reprocessing is standard practice. The discussion asked whether a similar mindset should be applied more widely to lumen devices in sterile services departments. Although
cost, time and equipment availability remain practical considerations, many modern washer- disinfectors now include connection points that allow internal channels to be flushed during automated processing. While these systems may not monitor flow in the same way as endoscope reprocessors, connecting devices is still a meaningful improvement over leaving lumens unconnected.
Audience reflections During the session, delegates were asked whether lumen devices should be connected to automated wash processes where possible. The response was overwhelmingly supportive, with the majority agreeing that connection should be the preferred approach. There was also strong support for orientating
items to support gravitational drainage during washing, sterilisation and drying. This reinforced the central message that safe reprocessing depends on how devices are handled throughout the whole cycle, not just on whether they have passed through a steriliser.
Question of ‘sterile but dirty’ instruments One of the strongest themes from the discussion was the ethical and clinical concern around instruments that may be sterile but not clean. Delegates agreed that visible or retained contamination is not acceptable, even if an item has undergone sterilisation. The conversation considered risks associated
with residual debris, complex instruments, implants and long-term patient safety. Particular concern was raised about uncertainty around diseases with long incubation periods, where risks may not become apparent for many years.
Key takeaways for practice l Connect lumen devices to automated wash
October 2026 I
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