OPERATING THEATRES
Table 1: Sampling regime Washer
1 2 3 4 5
Niagara
Monday Retractor
Cutting Device Handle
Box Joint Item Top Shelf Tuesday
Dissecting Forceps Retractor
Cutting Device Handle
Dissecting Forceps Box Joint Da Vinci
Da Vinci Item
2nd Shelf We use a random daily sampling process
(see Table 1), where we select instruments that are compatible with the ProReveal system. These are items made entirely of stainless steel as some plastics can fluoresce and this shows as a false positive result. Currently, we are performing around 30 in situ tests per week and we always test any neurology instruments as a priority over other instrument types. Fastrack items are not tested as they require re-washing afterwards and this takes time we often don’t have. To use the ProReveal, we scan the staff ID badge, bottle of ProReveal spray and the tray
Wednesday Box Joint
Dissecting Forceps Retractor
Cutting Device Handle
Da Vinci Item
3rd Shelf Manual wash One item to be sampled each day from the hand wash approved list only.
ID barcode tag and select the instrument type from the menu. Then we select the washer and enter the cycle and wash cart level information and where the tray was positioned. We designate the top level as level 1 and level 5 is the bottom level from our washer-disinfectors. We open the drawer of the ProReveal, insert black paper and place the instrument to be tested on top of the paper and then mist the ProReveal spray evenly over the instrument using five or six sprays. Finally, we close the drawer and the system gives us a reading of how many nanograms are on the instrument by measuring the amount of fluorescence visible which is binding to the proteins on the
surface of the instrument under UV light (Figure 2). We set the ProReveal with a maximum limit of 5000ng (5µg) per instrument side and if instruments are above this they are a fail. If a fail occurs, we investigate to find out what is wrong with the washers, the water or the detergents we are using and the problem is rectified. The results are documented on a ProReveal Daily Log Sheet that is given to SSD Management at the end of the day shift. We are storing the numerical residual protein data we have obtained from our in situ testing in an Excel spreadsheet. As we have only a very basic knowledge of Excel and spreadsheets in our SSD, the most confusing part was the creation of the control chart as specified in HTM 01-01. Fortunately, we have good IT support here
at Coventry & Warwick NHS Trust and they were able to make up the control chart for us – otherwise we would have never achieved it without having to pay an external consultant. We believe the DoH should have produced the control chart as a downloadable template to ensure that all ProReveal users are logging the data in the same way. This would eliminate data collection variation across different Trusts. We also believe the DoH should have written an SOP for the use of the ProReveal so that the method is the same across the different organisations using this device.
Process reassurance
We are now using in situ testing routinely in place of swabbing to confirm the cleanliness of our surgical instrument instruments. This is giving us the assurance that our cleaning equipment is continuing to work as we expect it to. Currently, most of the surgical instruments cleaned with the validated automated process
Implementing in situ testing has not changed theway we reprocess instruments, just the way we test them.
Figure 2: Surgical instrument showing protein contamination hot spots 66 I
WWW.CLINICALSERVICESJOURNAL.COM JUNE 2018
Thursday Handle
Box Joint
Dissecting Forceps Retractor
Cutting Device Da Vinci
Item Bottom shelf
Friday
Cutting Device Handle
Box Joint
Dissecting Forceps Retractor Da Vinci
Item Random Shelf
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