Vanzieleghem, head of research and development at OneLife, a biomedical company specialising in decontamination solutions for medical devices and the hospital environment. A bioengineer, Thomas did his PhD thesis in the field of microbiology, in particular, biofilms. Since 2015, he has focused on the development of tools to detect biofilms on medical devices and enzymatic detergents to dissolve them. “Biofilms are groups - or communities - of microorganisms that develop on surfaces,” said Dr Vanzieleghem. “A protective matrix composed of polymers is produced by the microorganisms and enables aggregation and adhesion to surfaces. In the hospital environment, biofilms have often been found to protect pathogens such as Staphylococcus aureus, Escherichia coli, or Klebsiella. “The highly-structured polymicrobial communities embedded in a matrix adherent to surfaces, consist mainly of polysaccharides, proteins, DNA and lipids. Biofilms enable bacteria to survive in a wider range of conditions, and bacteria in biofilms are up to 1000 times more tolerant of biocides and disinfectants. “Antibiotics-resistance is favoured inside biofilms through cell-to-cell signalling mechanism, and, over time, progressive accumulation leads to a build up of resistant biofilm over time. If the detergent action is not efficient against a biofilm matrix, bacterial biofilm can resist high level disinfection.” Dr Vanzieleghem explained that biofilms form a protective barrier around infectious microorganisms and enhance the survival of exposure to antimicrobials. He continued: “Prevention starts with good cleaning practices. It’s important to identify which factors prevail and which are not easy to apply – such as non-brushable channels. Effective disinfection can only be achieved when all the soil is removed during cleaning, but we must remember that disinfectants do not clean, they kill what is accessible. Germs in a biofilm are not accessible to biocides, and killing is not cleaning.

He concluded: “Monitor your endoscopes.

Currently, there is no standard way to do this, but I suggest proceeding with endoscope sampling, analysing the results, and comparing these to existing guidelines. The surface of a medical device can become contaminated with a biofilm if adequate reprocessing is not performed after every cycle – a threat to patient safety. “Disinfection and sterilisation methods are not intended for – and will not remove – organic soil or biofilm from medical devices. The only way to achieve this is with good cleaning.”

Surface disinfection and the role of a principal engineer

Bill Keevil is a professor of environmental healthcare and head of the microbiology group at the University of Southampton. A member of the Department of Health Decontamination Group, Prof Keevil researches microbiology

CSC chair, Val O’Brien, presenting Margreet C. Vos with the Kelsey Plate as a thank you for her presentation


Disinfection and sterilisation methods are not intended for – and will not remove – organic soil or biofilm from medical devices. The only

way to achieve this is with good cleaning. Dr Thomas Vanzieleghem, OneLife

and biofilms, as well as decontamination of vCJD prion from surgical instruments and endoscopes. Prof Keevil defined contamination sources and highlighted how a duodenoscope under the microscope revealed how many biofilms were present. Two talks followed - firstly, Mike Ralph, from NHS Improvement, who discussed the role of a principal engineer. Mike was employed by the NHS for 27 years after a military apprenticeship serving with the army and MoD. His last post in the NHS was as director of estates/redevelopment at Ipswich Hospital, and he has recently become the principal engineer for NHSI England. Secondly, John Campbell from Nottingham University Hospitals Trust, presented his talk, “Cardio-pulmonary bypass and mycobacterium chimaera endocarditis: a perfusionist’s perspective.” John’s cardiac surgery career commenced at Harefield Hospital in 1992, working in the cardiac transplant team. He then worked at King’s College Hospital in both the cardiac surgery and hepatic transplant programmes. In 1996 he joined the cardiac team in Nottingham where he is currently in the post of chief perfusion scientist and governance lead for cardiac surgery. Looking to the future, John warned: “It’s an ongoing battle to protect patients – a battle between machine and microbes. Unfortunately, at present, the microbe is winning.”

Sustainability and the NHS

Rose Gallagher MBE is the professional lead for infection prevention and control at the Royal College of Nursing. Based in the nursing department, she provides strategic leadership and specialist professional advice to the Royal College, its members and key stakeholders across the UK on infection prevention and antimicrobial resistance – as well as the implications for nurses and nursing. Addressing sustainability, Rose revealed

a worrying statistic: “The environment is key. Socio-economic growth has an impact on the earth and in the UK we estimate that we have little more than 100 harvests left until the soil is no longer healthy.

“Exponential health and standard of living improvements of the great acceleration have come at a huge cost to the stability of the natural systems that sustain us. The healthcare system is committed to reducing its carbon emissions in line with the UK Climate Change Act of 2008. Issues include road travel, the use of anaesthetic gases – which represent 5% of acute hospitals’ CO2


emissions – and respiratory inhalers – which represent 4.3% of the healthcare sector’s carbon footprint.”

An additional consideration Rose cited was pharmaceutical and medical instruments, which are the two largest CO2

producers. She

continued: “In terms of The Climate Change Act (2008), the UK is required to cut its carbon emissions by 80% by 2050. This target is set against a 1990 baseline and will create a low carbon economy. “The NHS is the largest public emitter of carbon emissions. It will be required to achieve 34% reduction in CO2

e emissions

by 2020 and 50% by 2025.” Rose encouraged a discussion about glove use, in particular improving understanding of, recognition of and management of dermatitis. “We need to engage with other health professionals around these issues,” she continued. “It’s vital that we highlight the sustainability elements of glove use.”

Approximately 1000 healthcare workers develop work-related contact dermatitis of the hands – a painful, debilitating condition which may require nursing staff to be moved out of clinical areas due to the risk of infection. Work-related contact dermatitis can be caused by frequent exposure to water, cleaning agents and inappropriate glove use. Over or under use of gloves can put many at risk of work-related contact dermatitis, while inappropriate glove use can also prevent

MAY 2019

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