INFECTION PREVENTION & CONTROL
maker and team player where necessary. You ensure you get to each milestone no matter what.”
Endoscope decontamination management
Authorising engineer decontamination, Wayne Spencer, took to the stage to discuss the importance of management in endoscope decontamination. Wayne addressed the risks of the decontamination processes, noting: “There are many factors that create risk: failure to clean and disinfect properly; incorrect connectors; failure to irrigate channels; no leak testing; rinsing with poor quality water – and so on. ERCP scopes are a particular problem. Traditionally, we take the cap off a duodenoscope – but now the newer designs are fixed. Some of these new designs are hampering our ability to decontaminate.” Citing an Advisory Committee meeting,
Wayne focused on the broad range of the infection mitigation strategies it suggested, noting that several specific supplemental measures have been implemented in individual healthcare facilities. He explained: “Combined with strict adherence to the duodenoscope manufacturer’s reprocessing instructions, the following supplemental measures may further help reduce the risk of infection transmission associated with the use of duodenoscopes: Microbiological culturing; Ethylene Oxide sterilisation; Use of a liquid chemical sterilant processing system; and high level disinfection.” “Ultimately, the user has the following responsibilities: to certify that the decontamination equipment is fit for use; to hold all documentation relating to the decontamination equipment, including the names of other key personnel; and to ensure that decontamination equipment is subject to periodic testing and maintenance. “The user must also appoint operators where required and ensure that they are adequately trained – as well as to maintain production records. Additionally, the user needs to have documented training records demonstrating that they are competent to undertake responsibilities; to establish
procedures for product release in line with the quality management system; and to ensure that procedures for production, quality control and safe working are documented and adhered to. “It’s important to ensure that staff receive comprehensive training, and are assessed for competency on an annual basis. We must also ensure that cleaning takes place, prior to disinfection or sterilisation – and that all surfaces of an endoscope are exposed to the chemicals during the decontamination procedure. “An effective disinfectant should always be used at the correct concentration, and the final rinse must not decontaminate the endoscope. Drying should be completed if prolonged storage is used, and we must ensure that testing – in accordance with national guidance – takes place, and is audited.
“Ultimately, the responsibility for management lies with the user, so get yourself trained.”
Technician empowerment
Helen Campbell, decontamination manager at Portsmouth Hospitals NHS Trust, shared
her insight into ensuring safe practice through technician empowerment. Helen began by describing the ethos of an endoscopy technician as, “someone who understands why things are done in a certain way.”
She continued: “More importantly, an endoscopy technician is able to identify a problem and act on this information. Having the knowledge of the problem, action needed to be taken ie: the reporting mechanism and escalation process. They should then be able to put this into practice. “So, what is important about an endoscopy technician? They can process scopes and have them ready when required – but is that all?
“Communication is crucial when reporting information to others, so it’s important to remember that this is passed on in a way that can be understood. After two weeks, we tend to remember 10% of what we read, 20% of what we hear, 30% of what we see, and 50% of what we see and hear. “The most effective means of communication is to take an active role – perhaps participating in a discussion, or giving a talk. The most effective measure of all is through providing an interactive presentation, enabling the endoscopy technician to use this empowerment, and ensure the safest possible environment.”
Microbiology: The basics
Wayne Spencer, Authorising engineer decontamination.
Helen Campbell, decontamination manager at Portsmouth Hospitals NHS Trust.
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Karen Egan, decontamination lead at Mid Cheshire Hospital, provided an overview of basic microbiology and the routes of transmission. This, she explained, was vital in order to understand the risks associated with endoscopy. “It’s so important to understand the significance of organisms,” Karen asserted. “For example, commensal - living in a relationship in which one organism derives food or other benefits from another organism without hurting or helping it. Commensal bacteria are part of the normal flora in the
SEPTEMBER 2019
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