STERILE SERVICES
such as Disney: “When you look at what motivates staff, patient safety is primary. There is a real motivation for prevention efforts and we need to reinforce this. “The future of infection prevention is about our effectiveness in human factors engineering and culture/behavioural change.” In the next session, Shirley Hoskins, assistant service manager for Clinical Support Services, Abertawe Bro Morgannwg University Health Board, discussed a serious untoward incident investigation, and the lessons that were learned. A woman who had recently had cardiosurgery contracted hepatitis B and an investigation was conducted after a second person contracted the same. In 2011 a patient died and it was discovered that a TOE probe was at fault. “Decontamination is key to eliminating preventable HCAIs,” warned Shirley.
“Guidance is critical, and it’s important to refer to the manufacturers’ instructions. Questions needed to be asked, such as who provided the training and where was the accountability? “As an interim action, a standard operating protocol was produced, staff were trained and a process was identified and agreed. As a short term solution an immersive bath was introduced. Decontamination processes needed to be implemented, so a clinical decontamination manager was implemented, and for the operational process staff were trained. It was also clear that much of the equipment wasn’t fit for purpose.” Five years later, the interim process was still in place so new technology was adopted and a dedicated decontamination area was added. “We’ve learned from a patient’s death and overall improved patient safety,” concluded Shirley. “We now have standardised equipment, automated processes that are WHTM compliant and clear governance in the form of a decontamination executive and a traceability and accountability framework.”
Planning and strategies
Bob Winter, national clinical director, emergency preparedness, resilience and response NHS England, presented a fascinating insight into maintaining the availability of trauma sets in a mass casualty event.
Citing the differences between UK and
French emergency services, Bob explained: “An ambulance in Paris is a military unit under the RAID operational doctorine medical officer. There were 250 empty beds on the day of the Paris attacks – compare that with the UK. In the UK, when response teams are used we don’t deploy doctors at incidents, and– there is a predetermined grid to deploy patients depending on the injury. “For the Westminster attack, terrorists used the camber of the bridge. If you stand at one end you can’t see the other and there is no access to hospitals. As for the media, they were there before the doctors, who were then
stopped for interviews. Sterile supplies are urgently required for incidents such as these. “As for the Manchester attack, Borough Market attack and Grenfell Tower, there were problems with command and control – and, for the latter, identification.”
Next on stage were Alison Gee and Fiona
Roche from Nottingham University Hospitals (NUH), who shared their experience of closing a sterile services unit without anybody noticing.
The NUH is the UK’s fourth largest acute
teaching Trust and new infrastructure was needed, especially as Queens & City Hall is 110 years old. The need for new infrastructure and to keep sterile services NHS owned and managed, was coupled with the need to improve clinical and scientific credibility, and invest in equipment and instrumentation.
“In 2015 we had to shut down,” said Fiona
Roche. “We had a lot of infrastructure work, it was impossible to work in the department, so moved everyone offsite to Leicester and Sheffield. It took a year of planning. “We chose to do this in summer, which is traditionally less busy. We needed to transfer enough equipment to take off site and also to plan staff transport, along with planning to avoid traffic, reducing downtime and scheduling shifts. We needed to transfer lots of equipment to be taken to the external provider. “I divided staff and sorted out rotas – altered shifts over two sites – splitting staff according to their experience. Annual leave was also restricted. We arranged orientation visits to the interim sites, as staff needed to understand the layout and access areas. Senior management were also on site to troubleshoot, while a process was agreed for the management of sickness and performance. Regular conference calls and face to face meetings took place with the external provider. “For our track & traceability software, we installed Steris barcode scanners on site and trained staff, while for supplies, we had to set up trolleys of consumables and tray
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wrap deliveries - enough for five weeks.” According to Fiona the swap over was
“Traumatic.” “I spent 21/24 hours trying to empty
departments, which required extra staffing and engineering support for the restart, testing autoclaves and so on,” she explained. “The lessons learned, were that it’s
important to be firm about not increasing the workload in the week before shut down. Know your production figures to get staffing for the workload. Be realistic about downtime for staff crossover and, mostly it’s about good communication between organisations, staff, customers, unions, and theatre staff.”
Alison Gee described the challenges of business continuity and contingency arrangements. “We still use Steris in Leicester and Sheffield,” she said. “We have worked to understand our recoverability and gradually tested and established our thresholds, so we now have a better understanding of our position on productivity. “Communication is key and we have a daily briefing with our sterile services team to isolate trays to be sent to theatre staff. We establish how many trays need to be sent and an agreement with Steris, subject to their capacity. Because Steris and NUH IT systems don’t talk to each other, periodic data downloads are often undertaken but manual logs are also kept of trays dispatched, just in case.”
Closing remarks
Val O’Brien, CSC chair, concluded the fascinating conference by thanking the committee, chairman and speakers, and sharing her thoughts on the talks. “Don’t underestimate human factors,” she warned. “Don’t wait for serious incidents to occur, and take a multidisciplinary approach by constantly investigating improvements.” The next event takes place on 1-2 April 2019, at the Marriott, Worsley Park, Manchester.
CSJ NOVEMBER 2018
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