Addressing challenges in sterile services

In the UK, Sterile Services Departments (SSDs) were pioneered and developed in the late 1950s following the successful supply of pre-sterile sets of surgical instruments and dressings by the Royal Army Medical Corps to support the Suez crisis. As part of the early development of the service, superintendents managing the departments formed the Association of Sterile Supplies Managers (ASSM). This was the predecessor to the Institute of Sterile Services Management (ISSM), which evolved in 1984. In November 2004, the ISSM changed its official name to The Institute of Decontamination Sciences (IDSc). This name change was made to reflect, acknowledge and encompass all decontamination professionals, allied professions, clinical services and the challenges of safe healthcare provision. From the inception of the ASSM, the IDSc has continued to develop and grow in strength, and is now recognised as a key professional body in the UK framework, managing all of the risks associated with healthcare-associated infections (HCAI) in medical devices reprocessing. The control and reduction of HCAI is fundamental to effective patient outcomes. Patients have the right, enshrined in UK law, to expect professional competence in the decontamination process, and that the medical devices used in any intervention are fit for purpose and decontaminated to the highest standards. The IDSc embraces the challenges faced in helping to reduce the risks of infection and is committed to ensuring the provision of competent staff that can meet the technical and operational challenges of medical device decontamination. Since the development of Sterile Services Departments in the 1950s, the sector has seen many changes. Following the emergence of Creutzfeldt Jacob Disease, the risks associated with medical device reprocessing have received a high public profile. The requirement for prion deactivation during the decontamination process has led to a major review of traditional standards and practice in all areas of decontamination from acute SSDs to GP practices, endoscopy and dental services. The IDSc remains the biggest UK professional body for medical device reprocessing and at the forefront of this rapidly evolving field.

Understanding the new HTMs

Guidelines on codes of practice for decontamination are also now undergoing change – with the publication of the new Health Technical Memoranda (HTM) – and this will be the subject of intense debate at the forthcoming IDSc conference and exhibition, held at the Hilton Hotel, Blackpool, 23-25 November 2009. Wayne Spencer, senior technical advisor for the National Decontamination Programme, Department of Health, will attempt to unravel the new HTMs at the conference. In addition, decontamination of dental devices is also high on the scientific agenda at present, with the release of the controversial document HTM 01-05 Dentistry in Primary Care. IDSc considers this to be a contradictory standard and believes that it will result in confusion for those who are not fully conversant with the principles of decontamination, as well as those who have worked in decontamination for a number of years. Issues relating to the decontamination principles that are applied to the acute sector appear not to apply in the primary care sector. The association is concerned. In particular, the shelf life of sterile products has suddenly changed from those applied in hospitals – enabling general practice dental devices to be wrapped after sterilisation. The IDSc hopes that Andrew Smith from the Glasgow University Dental School will clarify issues and specify the standard being applied in Scotland which may well be different to those being promoted in England. It will be interesting to compare the standards. The conference programme will also cover a wide variety of other topics – providing answers to difficult and challenging questions in relation to the science of decontamination. David Hurrell, who is well known within the decontamination community, will provide the keynote address. The content of his presentation is expected to be both educational and entertaining, and he never fails to shock, amuse, provoke and challenge his audience. IDSc recognises the need for decontamination sciences personnel to collaborate with other allied professionals to ensure patient safety and to improve efficiency of processes in all its activities. Therefore, the association has invited colleagues from various allied professions to contribute to the programme. Diane Gilmour, president of the Association of Perioperative Practice, will talk about the vital communications between sterile services and theatres and there will also be a presentation by Martin Kiernan, the president of the Infection Prevention Society. Our work is inextricably linked and we have to work together to ensure efficiency and patient safety, in the way we manage surgical instruments. There will also be two presentations from Porton Down. Jimmy Walker will provide a presentation on “Anthrax and African Drums”, which covers emergency preparedness – a topic close to all our hearts, particularly with the potential for difficulties in keeping services running with the latest swine flu outbreak. His presentation has relevance for all decontamination professionals and contains the basic principles everyone faces when presented with a significant risk in service continuity. Thomas Pottage, a colleague of Jimmy Walker, will discuss “outer space problems” in his presentation – which covers the necessity for sterilising spacecraft prior to each trip into the unknown. While delegates will all be familiar with the principles of sterilisation of surgical instruments, this will provide an interesting insight into how larger devices are managed. Rosemary Simpson, a well-known figure within IDSc and other related decontamination services industries, has been involved in standards committees for many years. She will provide an update on cleaning efficacy and EN ISO 15883. Her presentation will tackle issues currently being faced in agreeing a standardised test method for washerdisinfector cleaning efficacy. A review of the 19 test methods is currently underway. There will also be a number of other topical presentations including training issues from Sue Peckham, Eastwood Park, and from Christiaan Meijer, who will provide an update on textile standards. As the current convenor of “EN 13795 – surgical gowns and clean room suits”, Christiaan Meijer is well placed to provide an overview of how the standard is progressing.