CSC REVIEW Conference highlights
The Central Sterilising Club Annual Scientific Meeting took place on 16 and 17 April at the Cardiff Marriott hotel.
Val O’Brien, CSC chair, made the introductions and welcomed the first speaker Marion Lyons OBE, senior medical officer, Welsh Government. Marion Lyons provides expert advice on vaccination and immunisation, healthcare associated infection, antimicrobial usage and resistance, blood borne viruses, sexual health and communicable disease issues to Welsh Government. She has presented at cross party debates at the House of Lords and House of Commons on prison health, hepatitis C and point of care testing. Marion Lyons highlighted the need to work collaboratively, but realistically to address hygiene issues. “The Welsh Government has taken a zero tolerance stance - we’ve set targets to reduce infections and we must focus on keeping all our instruments clean. It’s vital to remain mindful all the time of new risks, and we want to get policy and guidance right.” The Kelsey Lecture was dedicated to the
memory of Professor Graham Ayliffe, entitled “Historical perspectives of testing the efficacy of hand antiseptics.” Professor Manfred Rotter is professor emeritus for hygiene and microbiology. Consultant for specific prophylaxis and tropical hygiene, and head of the medical microbiology department of the general hospital, Medical University, Vienna, Manfred has approximately 450 publications in clinical microbiology, hospital and environmental hygiene, disinfection and aerobiology. Prof Rotter discussed his work on testing disinfectant, referring to Ignaz
Semmelweis, a Hungarian physician whose work demonstrated that hand washing could drastically reduce the number of women dying after childbirth. Prof Rotter compared today’s work with the work Semmelweis undertook in the 1840s, while he was director of the maternity clinic at the Vienna General Hospital in Austria.
Corporate presentations
A number of corporate presentations highlighted the range of products and services available to UK Trusts. Jim Baldwin, technical & development director at Westfield Medical described the benefits of Humipak, a product designed and manufactured to maintain surgical instruments in a moist atmosphere post operatively - preventing the drying of bio-contamination on the instrument. On completion of the procedure the contaminated instruments are placed into the Humipak pouch where they will remain
until they are presented for cleaning. Water is applied to the Humipak pouch viscose material, which quickly disperses generating a moist, humid environment that is ready to accept the soiled instruments and prevent them from drying. Tests have shown that the self seal pouches retain their humidity for up to seven days. “24 Trusts regularly use Humopak for scopes and instrument sets,” Jim noted. At 10 minutes per set, the Trusts saved 1550 hours per month. Thomas Vanzieleghem from OneLife discussed the company’s OneLife Detect system, which is designed to optimise the cleaning process of surgical instruments. Thomas explained: “In a bid to avoid transmission of pathogens and organic material from patient to patient, OneLife Detect can qualify the area and the intensity by using a colour scale to identify how bad the contamination is.” According to Thomas, this enables four
baskets of surgical equipment to be tested within 20 minutes. Representing Aseptium, Pawel de Sternberg focused on the cleaning of hollow instruments, verification and PCDs, while David Jones, Alphasonics (Ultrasonic Cleaning Systems) shared his thoughts on cleaning and validation to meet the requirements of HTM 0101.
Hygiene and inspection
‘Endoscope reprocessing – from the washer to the patient’ was the title of Wayne Spencer’s talk. Wayne, from Spencer Nickson, asserted: “It’s fundamental that endoscopes are inspected. On a surface level they may appear to be okay, but the concern is what is inside the scope? “35% of endoscopes showed damage in a repeat trial – and that was only on the outside, and despite post-disinfecting. For sterilising packaging we have two well defined standards – the EN 868 series and the EN ISO 11607 series. For post-disinfection systems there are no standards!” Wayne concluded that even basic visual inspection of endoscopes is essential to maintaining a safe process, adding that if sterilising, it’s important to use packaging that meets the EN and ISO standard, while making sure it’s compatible with the process.
“Given the lack of standards, ask your post-disinfection storage system supplier to provide you with evidence of its performance over the time period
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required and for the endoscope types you intend to process,” he warned. “You should also use storage/drying cabinets according to the manufacturer’s instructions, taking note of the drying time. Plan which endoscopes you wish to place in the cabinet in advance – the default position should be to dry if in doubt. And, finally, cabinets and storage systems should be validated regularly.”
Dr Helen Griffiths is a lead assessor for the Joint Advisory Group for Gastroenterology (JAG) and the decontamination advisor for the British Society of Gastroenterology (BSG). “I accredit endoscope units and I’ve seen good and poor practice,” she explained. “I focus on education and training for those who manually clean scopes. Standards are not as they should be because we are taking registered nurses and bringing in technicians who need training. Certificates dating back to 2008 do not mean a thing.” Dr Griffiths questioned where training should focus on groups or individuals on a one to one basis: “Either way, it’s challenging to get endoscopy technicians away from the wards. Experience does not mean competence and if someone has been working in endoscopy for 20 years, they may have trained all subsequent staff incorrectly. There was one incident where a scope was stored over a sink! “We’re working with manufacturers and have created direct observation of practice forms, enabling is to observe and assess their competence. By manufacturers and staff working together, we can go far for those working with endoscopes and decontamination.”
Andrew Bent, senior medical device specialist – decontamination lead at the MHRA, provided a focus on medical device and equipment compatibility, as well as the MHRA’s role in this. For more information on the MHRA’s work turn to page 16. Karen Tweed, Sheffield Teaching Hospital responded to the need for a multi-disciplinary approach, observing: “The role of a decontamination lead is changing. The role is expanding and there’s more to decontamination that CSSD or endoscopy reprocessing.
“In Sheffield we came up with the Decontamination Management Group and we review cleaning and disinfectant products used in the Trust to ensure that they are fit for purpose. If we have any queries we approach the manufacturer and ask for a statement of compatibility. Once we had hundreds of wipes in the hospital – now we just have four or five.”
JUNE 2018
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