Decontamination
medical devices is not always performed optimally. For example, a report on the Top 10 health technology hazards of 2018, ranked “failure to consistently and effectively reprocess flexible endoscopes as one of the biggest threats to healthcare delivery and patient health, second only to threats to cybersecurity.” 3 Biofilm within the channels of scopes can pose a threat, but he pointed out that it isn’t just lumened scopes that present issues. A patient in Wales, Nancy Lane, died as a result of Hepatitis B infection – contracted from an inappropriately decontaminated trans-oesophageal echocardiogram (TOE) probe.4 Further investigation found that four other patients had also been infected. “It is likely that infections are occurring more
often than we realise,” Mike warned, adding that with “small bores come large problems” – including biofilm risks. Statements like ‘The virus is exquisitely sensitive’ are meaningless if the virus is deep in a biofilm, he continued. “Decontamination is a science, undertaken by
scientists, under a controlled set of conditions and guidelines. We need to ensure systems are developed and led by decontamination scientists, aiming to foresee where patients could be put at risk and plan out those risks,” he asserted. So, what is the way forward? Drayton et al
were keen to consider introducing reusable vaginal specula, but recognised the need to look at this carefully.5 They understood that it requires multiple
conversations with multiple people (including patients, sterilisation services and procurement) to consider all of the issues that may arise, Mike pointed out. He emphasised that “partnership working is needed to bring about change”. “We are all invested in this – we have one world, and we are destroying it as a species. But decontamination is a science, and the NHS often
fails to recognise the value of the scientists in all of this. Ultimately, I believe professional decontamination services must be at the forefront of all decontamination decisions and should own and manage all decontamination processes if harm is to be reduced,” he concluded.
Next up on the stage was Mahmood Bhutta,
Inaugural Chair in ENT Surgery, and Professor of Sustainable Healthcare, at Brighton and Sussex Medical School. Mahmood has a longstanding interest in environmental and labour rights harms caused by medical supply chains. He commented that, “It is all about the level
of risk that we are prepared to take. We need to take what is a reasonable and measured risk, and I aim to demonstrate to you that we have perhaps gone too far in throwing things away. “There is no doubt that the Spaulding Classification is useful...But if someone is killed on the road today, do we say immediately that we should stop all cars? We need to look at the root causes of problems.” He highlighted the fact that the NHS in
England is responsible for 24.9 million tonnes of CO2
, 4.4% of national GHG emissions, which is the
equivalent to the whole of Denmark. Ten percent of carbon is from clinical equipment and the NHS purchases over £10bn medical devices per annum (592,000 different types). An estimated 73% of products are single use, contributing to 240,000 tonnes per annum of clinical waste (96% hospitals/3% primary care). He highlighted data on the carbon footprint of
different approaches to hysterectomy, which is influenced by anaesthetic gases that contribute to greenhouse emissions, and single use waste. Robotic hysterectomy had the greatest carbon footprint compared to vaginal hysterectomy (which had the lowest), followed by abdominal hysterectomy and then laparoscopic hysterectomy (which had the second highest carbon footprint). “As we have moved to these modern
approaches, we have seen more and more single use equipment,” he observed. “I wonder what is driving that – is it actually a risk of infection?”
He questioned whether there was a “single use culture” as 68% of carbon footprint, for common surgical procedures, is due to single use products.
182 kg CO2
In the UK, a cataract operation creates (the equivalent of driving from the
conference at Gerrard’s Cross to Edinburgh). In India, a cataract operating at a centre of excellence creates 6 kg CO2
. “They use highly efficient systems. They
reuse virtually all of their equipment, yet they have lower rates of infective endophthalmitis than in the UK,” he pointed out. “Although we may have theoretical concerns, the ‘proof is in the pudding’ and there is no increased risk to patients,” he commented. Mahmood said that we need to reduce, reuse
and recycle. Surgeons need to stop using items that they do not need; reuse can reduce carbon by 38-56%, compared to 3-4% for recycling. The latter is complex and challenging, and despite
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www.clinicalservicesjournal.com I September 2024
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