Decontamination
good intentions is often poorly complied with. So, what happens if we don’t reuse? An
estimated 2% of global plastics are used in healthcare. Microplastics in the operating theatre are 3x the background level, while toxic levels of plasticiser DEHP have been found in hospitals’ waste water. He added that there is an issue with resilience in the supply chain – 19% of operations have issues with availability of equipment and NHS supplies have been disrupted. Reuse overcomes this and helps to ensure resilience. In addition, with a free market, ‘disposable
economy’ and ‘global value chains’ comes labour rights risks.
“When we mapped country of origin for suppliers, we found that half of products were being manufactured in countries with high risk of labour abuse. This is not just theoretical, it is a reality of our throw-away culture,” Mahmood asserted. The perception of infection risk, rather than
the reality, can drive questionable practices such as inappropriate glove use, which saw significant increases (of 200%) during the pandemic. “This is germophobia…we need to measure risk and take a sensible approach to it,” he continued, pointing out that 60% of glove use is inappropriate. A new oil refinery in Malaysia (where 70% of the world’s gloves are manufactured) is under construction to produce 7.7 million tonnes per annum of synthetic rubbers and polymers, to meet our demand for PPE. It is importing up to 300,000 barrels of oil per day from Saudia Arabia. “This is not part of a sustainable future,” Mahmood commented. He added that when you “go behind the scenes” many workers are immigrant workers from desperately poor countries and 40% have paid illegal recruitment fees – sometimes up to $5,000. They typically work for three months without a single day off,
working 13 hours per day, and often live in poor conditions – including shipping containers – to produce items that NHS staff simply throw away. He showed some disturbing video footage of the terrible living and working conditions in the supply chain. Gloves used in the NHS have also been found to be manufactured using forced labour. Mahmood further highlighted issues with drapes and gowns – 60-75% the 93 million used in the UK are single use. He questioned why decontamination is considered good enough for medical devices and yet often we do not consider it good enough for textiles. In addition, 52 million single use metal instruments are used in England and >70% are made in high-risk countries. “Even instruments used for the removal
of sutures are simply thrown away,” he commented.
Mahmood concluded that there needs
to be: a change in incentives and barriers through discussions at a national level with IPS and other professional bodies to overcome misconceptions regarding ‘infections’; we need to look at different economic models; improve the design of products, using materials of manufacture that are resilient to sterilisation processes, and to expand decontamination and sterilisation services. The session prompted great questions and discussions. Both Mike and Mahmood fundamentally agreed that sustainability is necessary, and the solutions are multi-layered. Many of the ‘problems’ to infections are related to human error, either due to not following processes consistently or misunderstanding. Therefore, wherever there is a possibility to automate the process, it was felt that we should be looking at this. There was also a feeling that there is a lack of education, and it is essential for decontamination professionals to be part of the clinicians’ decision-making processes when it comes to procurement, use and reuse of their specialty medical devices. The audience voted for Mahmood’s argument against the motion – albeit, in reality, both parties were aligned in their views.
References 1. Amber A. et al, Patient preferences for disposable and reusable vaginal specula and their willingness to compromise in the era of climate change: A cross-sectional study. BJOG. First published: 10 December 2023 https://doi. org/10.1111/1471-0528.17733.
2.
https://www.theboltonnews.co.uk/ news/
9197063.coroner-calls-for-national- review-after-death-of-patient/
3.
https://www.ecri.org/Resources/ Whitepapers_and_reports/Haz_18.pdf
4.
https://www.thefreelibrary.com/ Infected+hospital+probe+led+to+
death+of+patient.-a0301581929
5. Drayton, Rachel & Smith, Honey & Ratnappuli, Ayoma. (2023). Sustainable practice: Switching to reusable vaginal speculums. BMJ. 383. e075779. 10.1136/bmj-2023-075779.
Other sessions...
The programme was packed with thought- provoking presentations - too many to include within this edition. However, other topics included: l Innovative decontamination – saves 115 swimming pools, per year! Paul Chivers on behalf of Mackwell Health
l Manual cleaning of endoscopes: Looking ahead to the next gold standard; Ellie Wishart on behalf of Nanosonics
l The Future of Robotic Cardiac Surgery; Fraser Sutherland
l Challenges of reprocessing robotic instruments; Stuart White
l The underlying problem with dry surface biofilms on ‘healthcare surfaces’;Isabella Centeleghe
l AI and its future in decontamination; Doros Polydorou
l Low Temperature Sterilisation technologies benefits and challenges; Graham Cottam on behalf of Steris
l Education and Training: what to look out for next; Patrick Dunn
l Understanding each other – why using the correct terminology matters; Lena Cordie-Bancroft
l An introduction to the principles of decontamination document; Val O’Brien
l Probe decontamination: the importance of training and education; Jincy Jerry
l Innovations in digital auditing; Paul Kaye l Introduction of the decontamination experience to the ‘unsuspecting’ clinician; Samantha Murray
CSJ About the CSC
The CSC is a club with a driving passion for the continuous improvement of standards related to the decontamination of medical devices and infection control. Its Autumn Study Day and Annual Scientific Meeting provide the opportunity to hear from and network with multi-disciplinary decontamination practitioners and experts. For further information, visit:
www.centralsterilisingclub.org
September 2024 I
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