The Institute of Decontamination Sciences' annual conference recently took place at the Hilton Birmingham Metropole Hotel, bringing together decontamination scientists and experts from across the UK. IDSc Chair, Trevor Garcia, emphasised the vital need for education for the decontamination sector and the importance of attending events such as the annual conference, in order to update knowledge and share experiences.
In the wake of the findings of the HSSIB report on a serious failure in decontamination, continuous professional development to ensure competency has been identified as an essential requirement for the sector. With this in mind, Trevor revealed that the organisation had been tasked with the development and introduction of NETB/2024/1 version 2.0 – the new competency framework for staff working in sterile services and decontamination departments, which was issued in May 2024.
Sadly, in 2024, the decontamination sector lost some high profile and well-respected individuals who were well known for their contributions to promoting learning, and professionalism within the sector. Trevor Garcia paid tribute to Graham Stanton, Wayne Spencer, John Harrison, and Gillian Sills – who all made their mark on the world of decontamination with a shared passion for raising standards. Each of these individuals left behind an impressive legacy, through their contributions to ensuring patient safety, and will be sadly missed.
“In 2024, we have lost so much experience and knowledge,” Trevor commented. “It is a timely reminder to us, that we need to work hard to develop and encourage the new generation – we need to ensure they are competent, that they have the skills and knowledge to take over the running of decontamination services, and that they can keep these services safe,” he continued.
Helen Campbell, Director of Education for IDSc, provided an insight into the new Endoscopy Technical Certificate, which will be available in the first quarter of 2025. Following a recall of 3,000 patients, the Hine Report revealed that decontamination staff were unaware of how many channels some scopes had – resulting in a channel not being cleaned. The report consequently recommended that there should be competency-based training of all staff.
With this in mind, the new qualification will help staff understand: the basic microbiology, infection prevention and control, the design of the endoscopes, the composition of chemistries used in the manual decontamination process, the potential problems that may occur during cleaning, the importance of IFUs, aspects of health and safety; receipt, tracing and traceability (including the requirements and the use of documentation upon receipts of endoscopes); the limitations of the 3-hour rule, the validation required on the storage systems, and the effects of pathogens on humans.
Some of the hot topics explored at the event included discussion of whether it is time to review the Spaulding classification. Dr. Gerald McDonnell, Vice President, Microbiological Quality and Sterility Assurance at Johnson & Johnson, has produced a number of papers on the topic in recent years, which he highlighted during his session. During his discussion, he highlighted ‘Kremer’s cleaning classification’ - a risk-based approach based on device features.
Maximal cleaning is required for high-risk scenarios where the device has complex features and there is a high risk of soil or microbial retention; moderate cleaning is required for intermediate risk, where the device features require a specific intervention (e.g. lumens and mated surfaces); and minimal cleaning is required for low-risk devices, where all surfaces are exposed for cleaning.
The Spaulding classification, which most sterile services staff will already be familiar with, is a patient exposure risk-based approach used in decontamination. Dr. McDonnell suggested that the Kremer classification could complement the Spaulding classification and enable clearer guidance for manufacturers’ instructions for use.
Another hot topic raised at the event was the problem of biofilms in flexible endoscopes – discussed by Rob Warburton, Group Decontamination Lead at Manchester University NHS Foundation Trust. He gave an overview of the current literature on endoscope processing challenges, biofilm accumulation in new flexible gastroscope channels in clinical use, and endoscope sampling and culturing methods. The literature shows that methods of improving endoscope reprocessing, screening for contamination and evaluating endoscope damage are vital to preventing future infections and outbreaks.
The latest research by Pineau et al (2024) says that background contamination rates in studies vary from 0.4% to 49%. Sampling and culturing methods vary widely. Bioburden extraction efficacy varied from 1%-39% using different culturing methods – hence, they recommended a harmonised and standardised sampling and culturing method for flexible endoscopes.
Biofilms are extremely challenging, once established, and Rob pointed out that high level disinfection may not be effective. Chemical disinfection may even make the biofilm ‘more robust’, according to the findings of research by Sheffield University.
He pointed out that we also need to review manual cleaning processes – brushing may not always be effective. It has been suggested that automated pre-cleaning devices could provide a possible solution to the ongoing challenge of biofilm. Currently, these automated pre-cleaning devices include technologies that use nano particles/ nano metals or high-pressure air and water.
We also know that residual moisture stimulates bacterial replication and can lead to biofilm formation. The 3-hour rule for scope drying may need to be reviewed and he questioned: should we be getting the scope dried immediately?
Rob concluded that more research into biofilms and identification methods is required. There is also a need for a standardised process for accurate and practical biofilm sampling. Currently, biofilm testing is not routine, and he pointed out that the accuracy of tests is not confirmed. A new ISO is currently under development and is being researched now.
Instructions for Use (IFUs) also proved to be the subject of lively discussion at the conference, prompting an engaging Q&A with delegates. Stuart White, Decontamination Lead for East Suffolk and North Essex NHS Foundation Trust, reviewed the current challenges facing decontamination units related to the design of medical devices and IFUs and discussed ‘risk, liability and mitigation’. He gave some examples of some ‘hard to clean devices’ and encouraged delegates to take an active role in challenging the procurement of devices that cannot be cleaned effectively.
If IFUs are not fit for purpose and devices cannot be safely reprocessed, “we have got to be strong and push back!” he warned.
Alongside the conference was an exhibition of the latest state-of-the-art innovations that are helping the sector to tackle key challenges in sterile services – from washer disinfectors, sterile services digital solutions, to the latest RFID track and trace solutions and much more.
CSJ will be providing in depth coverage of the conference sessions in the Decontamination Supplement – watch out for this special edition in April…
For more details on the IDSc, visit: https://idsc-uk.co.uk/
