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CSC REVIEW
Endoscopy debate: Cartel or compliance?
The Central Sterilising Club’s Annual Scientific Meeting provided delegates with a unique opportunity to view a discussion on endoscopy decontamination – and whether there is a ‘chemistry cartel’. The Clinical Services Journal now offers you the opportunity to read both sides of the argument and to take part in this debate.
During the Central Sterilising Club conference in Cardiff there was a debate on the use of third party chemicals in the decontamination process. For years this has been seen to be a topic which has not been highlighted enough so it was a great opportunity with so many decontamination managers and healthcare professionals to discuss the topic and have a vote.
Ean Whalley, Serve Medical, represented
the ‘for’ side, and John Pendergrast, NHS Wales Shared Services Partnership/Specialist Estates represented the ‘against’.
For: Ean Whalley
Endoscopy re-processing is a critical stage in the cleaning and disinfection of an endoscope. Automatic Endoscope reprocessors (AERs) have a wash stage and disinfection stage. For each of the stages there are specific chemicals. These chemicals used and predominantly supplied by the manufacturer of the machines. The chemicals have been type tested on the specific machines as set out in the endoscopy guidelines.
The type testing however limits the customer to the chemicals they can use on their machines.
This leads to my question: “Is there a chemistry cartel?”
I believe customers should be able to have more options when looking at the chemicals they use on the AER machines. If an endoscopy department is looking to purchase new machines it should include in the tender that they wish to type test a third party chemical. This may limit the number of people who take part in the process, but at least you will have the option.
If you already have AER machines and are looking to change the process it could be a little rougher but you have to ask yourself the question.
As long as the third party chemical passes all the microbiological/chemical tests in the guidelines, is compatible with the scopes and compatible with the machine, what is
JUNE 2018
stopping the customer using the chemical? Another point to think about is are you using the best chemicals? This is something you will never know without options. We all want to provide the patient with the cleanest/disinfected scope. You may find that the main manufacturer will use scare tactics such as: l What happens if you end up in court? l We won’t be able to provide breakdown support.
These are questions you need to answer with the help of the third party chemical supplier. The main issue I feel will always come down to cost. It has been seen that endoscopy departments can save money by switching chemicals to a third party company. It will be hospital specific about the amount saved but, during the debate at the CSC conference, it was suggested that one Trust had saved more than a quarter of a million in six years.
In conclusion to the debate I would say it
was a ‘Power to the people’ moment. You have to be strong and, at every hurdle you come across on the journey to a third party chemical, have the strength to jump over it and carry on. Companies providing the chemical will help you along this route to and support you all the way.
The debate was won by the argument for
third party chemicals to be an option for hospitals to use on their AER machines, which I feel is a big step in the world of endoscopy reprocessing. Power to the people…
Against: John Pendergrast
Any designated equipment designed to reprocess re-usable flexible endoscopes should be manufactured configured in line with appropriate standards (BS EN ISO 15883 parts 1 and 4), manufacturers type test data and the appropriate operation to function as required.
Decontamination is a combination of processes, including cleaning disinfection and sterilisation, used to make a re-usable medical device safe for further use on patients and handling by staff.
The principle of the decontamination of medical devices is to provide meaningful and concise evidence of process. There are a host of technical standards and guidance that provide generic requirements when designing EWDs. Health Technical Memorandum 01/06 part D, along with other guidance within the devolved administrations (WHTM/SHTM etc), has provided guidance to establish that decontamination practises meet the required specification eg safe endoscope.
As a result of the nature of design (thermal sensitivity), flexible endoscopes cannot be sterilised using traditional steam sterilisation systems. The majority of endoscopes used in a healthcare facility today, are reprocessed to a level classified as high level disinfection. This includes manual cleaning, automated washing and disinfection using chemicals appropriate for purpose. For this article, we concentrate on chemicals used within automated endoscope washer disinfectors, primarily detergents and a validated disinfection solution. Key requirements of such chemicals used are: l Concentration of chemical product within each phase of the reprocessing cycle – dilution within rinse water
l Exposure – Minimum contact time of the diluted chemical to achieve the intended purpose
l Evidence of Microbicidal Activity – ensure the diluted dose achieves the intended decontamination status at each phase
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