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Decontamination


A great debate: sustainable decontamination


Does passionate idealism for sustainable decontamination threaten patient safety, or do we need to rethink the culture of single use? These were some of the questions debated at The Central Sterilising Club’s Annual Meeting.


Once again, the CSC Annual Meeting hosted a thought-provoking discussion, as part of the Great Debate, which saw passions run high. Chaired by Pat Cattini, this lively session considered whether: “Passionate idealism for sustainable decontamination threatens patient safety”. Arguing for the motion was Mike Simmons and against was Mahmood Bhutta. Before the debate, a show of hands showed that the room was split virtually 50/50 in terms of the motion (with a very slight majority against). First to speak, in support of the motion,


was Mike Simmons – a Consultant Medical Microbiologist who previously worked for the Public Health Laboratory Service. He joined the NHS in 1990 before working for the CMO in Wales in 2000. From 2010, he returned to Carmarthen as the Clinical Lead for Microbiology for the Hywel Dda University Health Board Microbiology Service, provided by Public Health Wales. While working for the Welsh Government, he chaired the decontamination project that


led to all HSDUs in Wales achieving Medical Device Directive accreditation. Since that time, he has chaired the All Wales Sterilisation and Decontamination Group. Mike gave a quick history tour of decontamination, describing Lister as the ‘surgical father of asepsis and sterilisation’. Fast-forward back to today and he pointed out that robot-assisted surgery is going to present increasing complexity and challenges around decontamination. He recognised that sustainability has come


to the fore with attention being drawn by David Attenborough to the pollution of our oceans. “The National consciousness has not been


slow in realising that we have a responsibility,” he commented. In Wales, it has now become law that businesses and organisations must segregate waste, Mike pointed out, adding that the NHS has already started on this journey. There is also an increasing emphasis on composting which may have implications for where the health


service is heading, he asserted. Mike praised Mahmood for his work on sustainability and for raising awareness of the amount of plastic waste in theatres, agreeing that “we need to do something about this” and that “the issue is not going to go away”. “It will require new thinking, as we look for ways of dealing with this,” he continued. Mike pointed out that clinical teams currently feel the need to respond and often decide to target single use items. There are companies that will offer support, but he expressed that he had “fears around this”. One medical device that is often talked about,


with regards to moving from single use plastic to resusable metal, is the vaginal speculum. However, the patient perspective is an important factor and studies suggest that metal specula “fail the most in terms of patient comfort”.1 Bioplastic specula have been put forward as an ‘eco-alternative’, yet these would still be disposed of via incineration. Obviously, this would not make sense from an environmental perspective. “People are starting to question ‘why are we using single use laryngoscopes?’ There is a history here that you must be made aware of,” he warned. Mike went on to highlight the tragic case


of Jacqueline Thomason who died as a result of exposure to a contaminated reusable laryngoscope.2 “We learnt, from this, that it wasn’t just one patient’s life that was put at risk…other patients also acquired Group A Strep, due to failures to decontaminate laryngoscope handles. As a result, the coroner called for the NHS to make changes and one of the solutions that was adopted was single use. Often the policy makers are seen as the ‘bogey men’ in all of this,” he commented. In Wales, advice was reissued stating that


reusable is acceptable, as long as it is managed safely to ensure devices are appropriately decontaminated between patients. However, he pointed out that decontamination of reusable


September 2024 I www.clinicalservicesjournal.com 49


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