The Future for Sterlisation of Surgical Equipment

The effective cleaning and sterlisation of reusable surgical instruments between operations is essential in reducing the risk of cross infection. A key component of high quality surgical care is attaining safe and high standards of decontamination of this equipment. In any one year approximately 6.5 million* surgical procedures take place and this figure is growing. However, it is a worrying fact that almost three times as many people are now killed by hospital infections as are killed on the roads each year. Reused surgical instruments from such procedures have been a huge problem in transmitting infection. However, a few hospitals are beginning to combat this growing trend.

In September 1999, following concerns surrounding the theoretical transmission of vCJD, the Department of Health commissioned a snapshot survey of the decontamination of surgical instruments in a range of NHS hospitals, private and voluntary organisations and general medical practices in England. This was the first of its kind for over 40 years and the survey was implemented to investigate the application of decontamination standards. The survey found instances where decontamination processes fell short of current standards and in some cases, practice was poor. Many hospitals were not segregating clean and dirty items which could lead to recontamination of sterile equipment. Also many facilities to clean equipment were not up to standard.

The survey identified that substantial improvements could be achieved by ensuring effective management of decontamination services. However, many of the buildings and equipment used in Sterile Services Departments (SSDs) needed refurbishment or replacement.

Significant investment has been allocated for upgrading decontamination facilities and for purchasing additional surgical instruments and tracking systems to facilitate centralisation of instrument processing from clinical areas to SSDs.

The Healthcare Commission, who are responsible for reviewing complaints about the NHS, was one of the drivers to advise many hospitals to reduce death and illness from healthcare-associated infections (HCAIs) whilst improving the experience of patients in hospital and increasing public confidence in the NHS. The Healthcare Commission exists to promote improvement in health and healthcare.

It is estimated that between 15% and 30% of HCAIs can be prevented by better application of existing knowledge and realistic infection control practices. The aim of decontamination is to make re-usable medical devices safe for use on patients and for staff to handle without presenting an infection hazard.

Deaths from the hospital infection Clostridium Difficile jumped by 28%** last year to more than 8,000, according to official figures published recently from the Office for National Statistics. Other infections, such as MRSA, have also caused huge problems in hospitals.

To enable continuous improvement and access to services of the highest standard, a “National Decontamination Strategy for Modernising the Provision of Decontamination Services” was launched. The development and implementation of the Decontamination Programme was aimed at improving the quality of surgical instrument reprocessing across the healthcare sectors in England. It was felt that the decision to centralise decontamination services (CDS) for many hospitals would bring huge benefits for patients and staff. These centralised facilities would be completely responsible for cleaning and sterilising all the re-usable instruments and equipment used in the operating department and wards, and were located of the hospital site.

To undertake decontamination effectively the centralised decontamination centres needed to be strategically located within easy reach of many hospitals so that equipment could be sanitised and returned in the shortest amount of time. Additionally, the quantity of the stock of devices requiring processing must be factored in to ensure that no hospitals were without equipment.

As some NHS hospitals begin to develop centralise decontamination services (CDS), Nuffield Hospital, the largest network of charitable, independent hospitals in the UK, started strategically placing CDS around the country within key radius of its hospitals.

Nuffield implemented a surgical instrument tracking and management system and revised design guidance for upgrading and building new centralised decontamination facilities. Such specialist decontamination construction work called for experts within the industry, Nuffield contacted cfes Ltd, a market leading turnkey medical construction contractor for assistance. After a tendering process, cfes became the preferred supplier and were awarded the contract.

cfes Medical Construction is a division of cfes Ltd, the company has over 23 year experience within this field and with their clear understanding of medical construction, cfes is currently completing their sixth CDS. These state of the art decontamination units utilise the latest design and innovation features, ensuring that the sterlisation service delivery meets the ever-changing demands of the hospitals.

cfes has built five centralised decontamination sites in Stoke, Warwick, Cambridge, Tiverton, Wetherby and is currently completing work in Eastleigh, near Southampton. The company has been working in close partnership with Nuffield Hospitals ensuring that these hospitals provide the most up to date modern services for its patients.

cfes has transformed many sites including development of a former industrial shed into a state of the art 18,000 sq ft supercentre that will process millions of instruments each year. As a specialist contractor cfes has supplied a full turnkey service including element in the design of the facility, and provision of all necessary M&E and utilities, including purified water, steam, gas and medical air specification.

cfes have supplied a full turnkey packages to their clients; carrying out design, installation, project management and co-ordination of specialist decontamination equipment providers. Services are designed and installed to HBN 13 (2004) and all related HTM’s and good practice guidelines. Services include full fresh air ventilation systems, dry steam boiler plant and steam distribution with condensate recovery, cooling and heating circuits, compressed air, process and domestic water systems, and LV distribution fully backed by standby generator.

Rob Doubtfire, Contracts Director of cfes Ltd comments, By working closely with Nuffield hospital we have provided six new sites that underpin the hospitals objective to reduce infection transmission from surgical devices. Nuffield’s new centralised decontamination centres ensure that surgical equipment is cleaned and sterilised to the highest standards possible to protect patients from cross infection. We believe that upgrading facilities by the CDS or refurbishment of existing sites is the way forward to ensure patients safety”.

Rob concludes, “Very few companies would be able to undertake the scope of the engineering work that we have undertaken. There are a host of specialist consultants who create a bespoke project team comprising representatives from different companies, but cfes strength is that all this expertise falls under one roof with a strong emphasis on liaison and co-ordination. The development is a real success story, not only has cfes been able to build practical and high quality buildings but all the work has been within budget and on schedule.”

For more information about centralised decontamination services and all related construction and building work please call 01420 544224.

References:
* The Operating Theatre Journal
** The Department of Health 2008

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