Reducing Healthcare Associated Infections

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Reducing Healthcare Associated Infections
Reality or Fantasy
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Advances In Decontamination
Mark Lavery Trust Decontamination Lead Neil
Lamb Decontamination Implementation Officer
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Definition of Decontamination

• Decontamination - Decontamination is a process,
  which removes or destroys contamination and
  thereby prevents microorganisms or other
  contaminants reaching a susceptible site in
  sufficient quantities to initiate infection or
  any other harmful response.

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Three processes of decontamination are commonly
used

• Cleaning
• Disinfection
• Sterilization

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Protocols

• Decontamination Policy.
• Manufacturers Instructions.
• Work Instructions.
• Defect Reporting.
• New Equipment.

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Medical Device Decontamination
Surgical Instruments Endoscopes Medical
Equipment Accessories
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Surgical Instruments
Processing History Recent Past Local
Decontamination Centralised Decontamination CSSD
/TSSU/HSDU Workflow Facility Design (HBN13
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The challenge
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Challenges
CJD Resistant to traditional means of
Decontamination. Difficult to
diagnose. Patient screening. Determination of
risk. Quarantine arrangements.
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vCJD
May be present in tissue not previously
associated with CJD. Greater potential for cross
contamination, possibly across specialties. Scree
ning more complex. Extremely difficult to
inactivate. Suitability of SSD processes
questioned. National audits undertaken in UK.
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SSD Facilities

• Strict environmental controls
• Washing processes critically evaluated with
  emphasis on removal of soil.
• Use of RO water in final rinse.
• Fully controlled clean rooms.
• Use of clean steam
• Stainless steel pipework and sterilizer / washer
  disinfector construction

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SSD
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Track and Trace

• Instrument and set lifetime history.
• Instrument Marking.
• Instrument management (repairs / replacements).
• Instrument migration.
• Process monitoring.
• Cycle identification.
• Staff training and identification.
• Huge costs to NHS of achieving compliance.
• Concept of Decontamination Super Centres.

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ENDOSCOPY

• Rigid Endoscopes
• Flexible Endoscopes with Lumens
• Flexible solid bore Endoscopes (e.g. Naso
  endoscopes).

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Where we were !

• Endoscope wiping
• Automatic Endoscope Re-processors (AERs)
• Varied standards
• Water testing
• Facility design
• Audits / Role of JAG.

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Where we are now!

• WCH
• RCH Endoscopy
• RCH Urology
• Drying cabinet advances
• RCH / SMH OPD
• RO water
• Machine service and maintenance

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Endoscopy Reprocessing

• Manual washing of scopes followed by automated
  (AER)
• Clean water for rinse (RO)
• Vital for scope channels to be monitored whilst
  in AER

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Reprocessing in ENT

• Endoscopes without channels
• Reduced risk to patients
• Still require high level disinfection
• Limited resources mean adapting to availability

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Where we are going!

• RCH central endoscope decontamination facility.
• Experience gained from WCH
• Role of AED
• Staff Training
• Role of DIO
• Timescale

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Ward Equipment

• Concept of Equipment Library.
• Problems encountered.
• Cleaning standards.
• Decontamination Environment.
• Staff Training
• SOPs
• Harmonisation

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The Future

• Options for Developments
• Centralised Equipment Cleaning
• Skilled Staff
• Track and Trace systems/RF
• Reductions in Healthcare Associated Infections.
• Reality or Fantasy?