DECONTAMINATION


the fact that there are more incidents); and ‘critical’ meant ‘lowest risk’ due to the fact that despite the risks being higher, the likelihood is less.


She continued: “Spaulding does not assess the risk of CJD, so should this be included? Do we have the data to quantify the risk? Should an update include hepatitis B or HIV?


“Risks need to be re-evaluated. For example, semi-critical devices are even available on eBay! I would define ‘critical’ as low risk because we manage it so well. For ‘non-critical’ we need more care and attention. If we moved ‘semi-critical’ to ‘critical’ and everything was sterilised that would make more sense. Designers and manufacturers must also play their part, and need to work to make probes easier to clean and decontaminate.”


Decontamination failures


Vanessa MacGregor, communicable disease control consultant at Public Health England, followed Karren, with a talk on the experience of a patient lookback following failures in decontamination at a dental practice.


She explained how, in 2014, a whistle- blower had concerns about a dentist’s failures in infection control, and the death of two patients who’d been treated on the same day. “Public Health England issued a notice and a police investigation was launched,” said Vanessa. “


A panel examined video footage and decontamination records. Around 7000- 8000 patients were seen by two dentists – which equated to approximately 60 patients every day. This was a staggering number of patients, considering that the average is more in the region of 20.


“In 2013, the dentist had been referred to the National Clinical Assessment Service (NCAS). During the assessment, it was notable that the number of patients went down to around 20. He was allowed to continue working.


“Single-use items were being re-used, there weren’t enough gloves and he was re-using them from patient to patient, and between seeing patients, no hand hygiene products were being used.”


In total, 103 issues were identified, with the primary concern that there was no decontamination of surgical instruments between seeing patients. Vanessa continued: “Due to incomplete decontamination records, there was a range of infection risks for patients – including BBV transmission. There were no records of which patient may have had a BBV infection. “A patient notification exercise was


undertaken, to test any infected patients. Because of the large number of patients he had seen, it was difficult to contact them. There were 22,000 records to go through and not enough time. It was at this point we decided to go to the media – and asked them to publicise a message: ‘If you have been


NOVEMBER 2019


mean systematic data collection, estimating and monitoring SSI incidences and rates. We will then interpret and disseminate the findings, evaluate the practice and – the central goal – improve patient care.” Sid explained how the plan is to follow


up every patient to see if they develop signs and symptoms of SSI via micro-records. “Ultimately,” he concluded, “to engage and educate front line staff, you need good leadership. It’s so important to motivate staff to encourage, execute and evaluate.” Following Sid Mookerjee was John


Karren Staniforth, Nottingham University Hospital


treated by this dentist’ and contact details. An advice line was set up and a project implementation group formed. There were 3161 calls to this advice line. “The clinic closed in December 2014 and 55 allegations of malpractice were proven.”


SSI surveillance


The next speaker was Sid Mookerjee, a hospital epidemiologist and surveillance lead for HCAI and SSI at Imperial NHS Trust. He has extensive experience in hospital data analysis, big-data linkage, mining and management, to support service evaluation reporting against national and international surveillance and improvement indicators, to address AMR, bacterial infections and SSIs. Sid’s talk was ‘Understanding the burden of harm: An insight into the importance of surgical site infection surveillance’. “Surveillance is a key part of the Public Health Strategy and SSI is a key healthcare associated infection. But how do we define ‘surveillance’? “This is the ongoing, systematic


collection, analysis and interpretations of outcomes specific data. “The ECDC reports that in acute care hospitals in the EU and EEA, 20% of HCAIs are SSIs. There is clearly a lot to be done. There are significant costs to the NHS – per patient, per SSI equals $20,785 and 11.2 additional length of stay of a contracted patient is another significant cost. What are we going to do about it? “Orthopaedic SSI surveillance is the only


mandatory surgical category. There is guidance available, so it’s important how you plan out and apply this guidance step-by- step. We need surveillance to understand and follow up cases of post-operative infection, to enhance the quality of patient care, and to use the results to change practices. “Long term data enables us to analyse trends, pick up issues and make necessary changes. We’re currently setting up an SSI surveillance group at Imperial, which will


Prendergast, AE(D), senior decontamination engineer, NHS Wales. John provides guidance on decontamination of medical devices to NHS Wales and part of his role involves working closely with Welsh government, developing surveys and national guidance. John provided delegates with his personal experiences reviewing decontamination practices for ENT provision within the NHS.


He asked delegates: “What happens when an incident occurs on your patch? Alarm bells immediately ring. In an exercise in 2014 we identified significant risks in ENT provision, endoscopy departments, and practices cleaning ultrasound probes. Awareness of decontamination was not at a good level. Staff were using non-compliant equipment and, in terms of ENT provision, scopes were being left everywhere! “Sheaths were often used, so some members of staff didn’t feel the need to clean. This was due to a lack of training and guidance. SEAC identified a number of concerns with sheath usage and made recommendations that there should be validated reprocessing of each scope at the end of every working day.


“Based on the Spaulding Classification, improvements were made on the back of our visits. An interim solution was the use of wipes to clean and disinfect.” During 2016, further visits were made and, while methods of decontamination were improving, scopes were still found stored in ineffective storage conditions. John continued: “Wipes were stored with no ‘use by’ dates, and at the end of 2016 we issued a report with recommendations identifying a new route forward. “Wipes are fine if used properly, but the issue is the ‘human factor’ and how to ensure staff competencies’ potential for error. There is also a reluctance to change – precleaning is essential – but this didn’t seem to be recognised by staff.” Turning to today, John noted that five years since the initial visits, there is still a need for training, but the resistance to change remains. In the next issue of The Clinical Services


Journal, further talks will be published, ranging from decontamination of semi-critical ultrasound probes, and quality improvement, to supplier concerns and investigating decontamination failures.


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CSJ 101


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