This month we bring you a bumper newsletter (as opposed to a ‘Bulletin’) with an overview of the 2024 Annual Scientific Meeting (ASM), held on the 15th and 16th of April at the Crowne Plaza Gerrards Cross, Buckinghamshire.
If you know someone who isn’t a member yet and might find some value in this newsletter, please do pass it along.
Grab a cuppa, sit in a comfy chair and enjoy the reminder of another fantastic event!
CSC Activities
This year saw a few changes to the committee starting with:
Jimmy Walker handing over the Chairpersons role at the Annual General Meeting to John Prendergast. So it was ‘goodbye’ to Jimmy and ‘hello’ to John as Jimmy handed over the ‘Chair’s bell’
Mike Bowden also completed his term in office as Treasurer and handed over the mantle to Jonathan Lintott.
At the end of 2023 the committee sent out an invite to the membership for expressions of interest to fulfil the role of committee member. We had several expressions of interest for our membership to vote on and the majority voted in Sulisti Holmes.
And finally we sadly say goodbye to Graham Stanton a member of the committee and our decontamination community, who unexpectedly passed away on the 10th April.
Graham was a proud, passionate, family man, who was a stalwart within the decontamination field. He strove to raise standards and always put the patient first.
A warm welcome to the incoming committee members and massive Thank You, Good bye and You’ll be missed to our outgoing members. Don’t be strangers to our events and it will be good to see you all attend as delegates in the future.
Look back at ASM 2024 – Never a dull moment!
Kelsey Lecture
Martin Exner, Professor and Chair of Hygiene and Public Health at the University of Bonn in Germany was this years Kelsey lecturer. He was due to be with us in person but unfortunately was not able to board his flight, and with no other flights available to ensure he got to the event on time, it was decided to stream his talk live. Just think, pre the Covid pandemic this wouldn’t have been viable but with video conferencing and live streaming now more common place it was possible to bring Martin in to the room. A big thanks to our AV people James Plummer and Peter Pinnington for their flexibility and helping to make this work.
Martin shared his experience and the German perspective on environmental cleaning practices with updates on research they have undertaken to demonstrate various biocide efficacy on the multiple array of different microorganisms found in the healthcare environment. He also touched on a subject we previously heard about at the Autumn Study Day around the novel introduction of probiotics.
Environmental cleaning is an activity that is taken for granted and has been undervalued for some time. The importance of this activity, it’s consistent application and the rise of antimicrobial resistance has also increased since the pandemic and it’s good to see a number of more current publications being released around the globe comparing cleaning methodologies, chemistries and validation processes.
Here’s a link to one of the papers Martin referred to which acts as recommendations for hospital and healthcare facilities hygiene and cleanliness https://www.egms.de/static/en/journals/dgkh/2024-19/dgkh000468.shtml
Industry speakers
One of the CSC events key differences is the fact that we encourage our industry colleagues to be part of the conference through attending the presentations, and being part of the sharing knowledge process as opposed to manning an exhibition stand whilst presentations are taking place. We hope it creates an environment of inclusion and equality whilst focusing on the continuous learning and innovation. In recognition of our corporate members commitment and our reliance on membership we open four sponsored speaking slots to industry for them to share new technology, techniques or development work.
For the first session Paul Chivers, on behalf of Mackwell Health presented on a trial at Northampton Hospital for a new LED UV technology used for reusable anaesthetics masks in his presentation titled, “Innovative decontamination – saves 115 swimming pools per year.
Ellie Wishart, Senior Medical Affairs Manager for Nanosonics discussed the future of manual cleaning of endoscopes, specifically endoscope channel cleaning. A really informative presentation highlighting the potential for endoscope contamination, that adverse events are on the rise and what’s in store for the future improvements in processes.
Ellie presented a number of studies and literature reviews that demonstrate manual cleaning is complex, challenging for staff to do and is often not done correctly. Here’s a link to one of the papers highlighting the physical stress staff report when undertaking the manual cleaning process https://www.sciencedirect.com/science/article/abs/pii/S0196655322000554
Combine all these elements together and there remains evidence of cross contamination from one patient to another. Concerningly there is evidence of persistent biofilm in all channels and the question raised was how does the decontamination industry improve on what is currently considered the ‘gold standard’ for manual cleaning?
Ellie went on to share a project Nanosonics are working on comparing two endoscope channel cleaning approaches to remove cyclic build up of biofilm, a manual way and an automated way.
Both speakers gave thought provoking sessions and prompted a lively Q&A session from the audience which is what the CSC events are renowned for.
Robotic Surgery
Robotic surgery is on the increase with the number of procedures growing by 17% per year. With this increase comes a new challenge in decontaminating robotic instruments.
This session started with Fraser Sutherland, consultant cardiac surgeon providing a fabulous insight into the future of robotic cardiac surgery and his specialist area of aortic valve replacement.
Fraser described the novel approach he and a colleague took using robotics to successfully install the first-in-man aortic valve replacement.
Here is one of his publications describing the procedure in more detail. https://esmed.org/MRA/mra/article/view/2417/193545818
Fraser showed an amazing video of using a robot whilst undertaking aortic valve replacement and concluded with the advantages of using a robot being:
- Improved dexterity
- Quantum leap in visualisation giving a 3D feeling during surgery
- Easier to perform than open surgery
Such clinical treatment would not have been possible 10 years ago, but rapid technology developments within industry and healthcare innovations result in better patient outcomes. We are eternally grateful to the amazing clinical teams progressing such high-tech surgery.
Following Frasers presentation from the surgeons perspective was Stuart White presenting from the decontamination of reusable instrument specialist perspective.
Stuart opened his talk with getting some audience participation by getting everyone to stand up in a typical position that a surgeon undertaking a laparoscopic surgery would have to do, making the point for the use of robots in minimally invasive surgery.
He then went on to review the instruments and describe a typical anatomy. There are normally some ports for cleaning however, they cannot be dismantled which presents reprocessing challenges. Stuart highlighted that the ‘special requirements’ include:
- Asking the theatres staff to wipe the instruments down, flush them and keep them moist
- The initial manual clean requires they be soaked in enzymatic detergent, brushed and flushed in a sink that is large enough to take the instruments. It may be that the use of an ultrasonic preclean will work better than brushing.
- Once in the automated washer disinfector irrigation of the instruments needs to happen.
- The instruments require lubrication in the clean room prior to packing.
Stuart agreed with Fraser that the use of robotics is increasing and it’s here to stay. He concluded with a question/ answer, “Are robotic instruments difficult to reprocess? No they are not, but are they different and we need to do different things?”
Risks Associated with decontamination in the built environment
Isabella Centeleghe from Cardiff University opened the after break session with her PhD work on dry surface biofilms (DSB). She highlighted that the evidence shows that they are not culturable by normal methods and this paper https://www.sciencedirect.com/science/article/abs/pii/S0195670111003197
Shows that they are present on many surfaces but these could only be seen using scanning electron microscope.
Issy identified the top 10 species found on multiple different surfaces during a previous multicentre study and went on to describe why DSBs are a problem in healthcare and how they could be linked to healthcare associated infections.
Concerningly DSB’s demonstrate a higher resistance to commonly used concentrations of disinfectants in solution and in wipes of less than a Log 2 reduction!
Issy showed the results of the levels of S. aureus and B. subtilis bacteria being removed by a selection of commercial wipes using the ‘wiperator’ at 30 sec and 60 sec contact time, demonstrating that they have very little impact in removing DSB’s!
Her research then went on to ask the questions how long DSB’s remain on healthcare surfaces and whether the bacteria present in DSB’s are viable but not culturable. Looking at the more resistant B Subtilis strains from the previous work showed they remained live for the 6 month period but still not culturable. This led to wondering if DSB’s could go unnoticed even in a lab.
Issy took Klebsiella pneumoniae that had previously been found in a DSB to test capturability, transferability and viability showing the bacterial cells remained viable but not culturable (VBNC) in a long term DSB state.
Leading to recommendations for the healthcare setting to improve hand hygiene, cleaning processes, monitoring of surface contamination and identifying a disinfectant formulated to target DSBs.
Here’s the article Issy published in 2024 highlighting that culture swabs are the most common method used for detecting surface contamination, and the variability in knowledge and understanding of healthcare workers.
https://www.sciencedirect.com/science/article/pii/S2590088924000210
Rounding off the session and day 1, Jimmy Walker followed Issy to talk about the risks of water supplies in the built environment. He reminded us about the mantra CSC have used for many years ‘Cleanliness is next to Godliness’ and yet water remains the elephant in the room. It’s taken for granted every day and yet it is a known contributor to healthcare associated infections.
Jimmy showed many pictures of examples of hospital mains water supplies being held in tanks and pipes contaminated with microorganisms encouraging wet biofilms, highlighting the need for robust management. Such images horrified the engineers within the room, but was a practical example of why water management is essential.
He highlighted the impact of water quality on surgical instruments and why it is necessary to have good strategies to manage water quality. Which is why a system that can produce higher qualities of water is often seen in decontamination units. Jimmy observed from his visit to Japan, a the hospital he visited had built a large reverse osmosis system on the outside of the hospital to provide the whole hospital with high quality water.
Here’s the paper Jimmy referred to https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/abs/investigation-of-healthcare-infection-risks-from-waterrelated-organisms-summary-of-cdc-consultations-20142017/0771439B1D60E697C52B37FC24944CC0
that showed more than 20% of water related outbreaks were from non-legionella bacteria and 33% included pathogens that were multidrug resistant.
Jimmy showed that since surveillance of Legionnaires disease began in 1992 it has been seen to be rising year on year and it’s not just legionella it’s also other water waterborne bacteria as well. Jimmy said it should be the whole ‘sick building’ syndrome that we should be concerned about since water it everywhere.
Looking to the future new hospital programme where there has been a lot of talk about single room hospitals, in a letter to the editor of the Journal of Hospital Infection https://www.journalofhospitalinfection.com/article/S0195-6701(23)00113-5/abstract it was highlighted that from an audit of shower use in one hospital, that on average 86% of the showers were not in daily use by the patients for personal care thereby presenting a water hygiene hazard.
Pictures speak thousands of words and Jimmy showed many other photographs of poorly used and managed areas. In Japan his hosts had a problem with Legionella in their hot pipe system and they came up with a solution to remove all the hot pipe and install local heaters to every sink so during daily use it heats the cold water up to the comfortable temperature of 43oC to wash hands and then it’s pasteurised every night.
Filters are a common management strategy but Jimmy warned it is important that there is no leakage around the filter.
Jimmy highlighted that it is about ‘Controlling the exposure route’ and looking at all areas where water can be found even in a toilet cistern. Additionally there is increasing evidence through publications that drains are a health hazard in their own right.
Jimmy finished his talk with an adverse event at Papworth hospital resulting in a patient death due to mycobacterium waterborne infection. The result of the inquest has been an order for new guidance to be written for HTM 04-01 which will be led by Dr Susanne Surman-Lee. As an interim solution whilst this mammoth task is being undertaken a Technical Bulletin is planned to be released later in the year. Watch this space.
The Annual General Meeting closed proceedings for the first day where it was announced Jimmy would be handing over the Chairs bell to John Prendergast as the next Chair along with the other changes mentioned above. John was honoured to receive such a prestigious position and gave a speech in memory of Graham Stanton as part of handover.
The evening kicked off with the Mike Emmerson drinks reception followed by the Gala dinner and quiz. A good night appeared to be had by all with a fair few staying up to the early hours in the morning (yes the author was one of them so I know – LOL)
Congratulations to the quiz winners, the team led by Sam Murray who was determined not be the recipient of the wooden spoon again! Well done.
The Committee collated a wonderful montage for Mike Bowden and Jimmy Walker as part of their leaving celebrations, we shall cherish the impact made by both to the Club.
Day 2
Day 2 of the ASM began with the second round of Industry presentations and a big thank you to Doros Polydorou for being able to step in at the last minute, presenting as a CSC member, not in his capacity as MD of Steris IMS, due to a short notice change with our industry speakers.
Doros shared another engaging and informative presentation about artificial intelligence (AI) and it’s future use in decontamination services. He made the link between his experience as a football referee and the use of technology and automation very visual and highlighted how technology is driving job loss and job demands.
When looking at the future of AI there is a clear and recognised use for it in decontamination services and we should reframe the term ‘job’ to ‘tasks’ when considering the use of AI.
Doros highlighted that with the rapid evolution of AI it is important that is it used not only to drive efficiencies in the workplace, but to also be applied ethically and effectively.
Picking up on Fraser and Stuart talks from day 1 Doros showed that there are an increasing numbers of robotic platforms for varying surgeries and answering one of the previous questions as to whether there is any evidence of fully autonomous surgery, Doros presented a paper that shows there is. Here is a video link to the John Hopkins reference showing the surgery being done. https://youtu.be/cybRmhsvOss?si=HO-Ordur8VVqZR_B
He then went on to show how technology and AI can be translated across to the various tasks within decontamination services and even theatres to drive improvements in the service.
Doros finished his presentation showing a fully automated sterile services department does exist in Rigshospitalet, Denmark. The challenge is that it requires an investment of 45M Euros!
Next up was Graham Cottam on behalf of Steris Healthcare UK presenting on low temperature sterilisation (LTS) challenges and benefits. Graham introduced the four different methods that achieve LTS:
- Ethylene Oxide
- Vaporised Hydrogen peroxide (with plasma, without plasma, with ozone)
- Low temperature steam – formaldehyde
- Liquid Chemical sterilisation
Graham discussed why there is an increasing need for it, what’s required to ensure patient safety and challenges with instrument and material compatibility.
Education, Training, Competency
The theme for the late morning and early afternoon session centred around ‘learning’ and we started the session with Patrick Dunn from Ufi VocTech laying the foundation with ‘The evolving world of education and what to look out for next’
Patrick introduced his talk by introducing who Ufi VocTech are and what they do for adult education, which is try to cultivate innovative uses of learning technology to teach adults vocational real life skills.
Patrick highlighted that ‘learning technology’ is often thought of as the type of e-learning where you click on a page/slide and take a quiz at the end, but what Patrick was going to talk about was the broader ‘learning technology’
Patrick reviewed the environment that influences / moves the way that learning technology moves. These include the environment, economy, social cultural pressure, technology and work, with artificial intelligence being a theme running through all.
In the current learning climate we are in a period of permanent rapid change, uncertainty of jobs and skills required, rapidly changing technology and lack of clarity as to what is ‘training’ v ‘education.’
Patrick highlighted that the relationship between people and technology has to be symbiotic; without human involvement technology is useless and vice versa. AI confuses that somewhat.
Patrick provided examples of how the separation of humans v technology in learning is over, which led to the six categories we should be looking for in understanding how people are learning strategies:
- Fragmentation: ‘bite size’ learning – apparently 15% of the world’s population uses Youtube to learn from. TikToc is another platform providing small chunks of ‘learning’
- Integration: There are many sources of training and learning and with this awareness many organisations are now trying to pull together to provide an ‘integrated’ approach. For more in here is the Green Paper Patrick referred to.
- Access: The original concept with e-learning was the ‘Martini promise’ – Anytime, Any place, Any where. We now have Zoom/Teams, reference bots, micro learning and now there are systems that provide ‘performance support’ where the idea is that you don’t need to ‘learn’ just perform. Examples like SatNav, you don’t need to know where a place is or learn how to read a map, you just follow; Google Lens, you point your phone at the words and the software will translate from one language to another, you don’t therefore need to learn a language. This ‘performance support’ culture is creating an environment which prompts the question ‘Why would I learn?’
- Simulation: Any type of activity that simulates the real world, examples of VR, Game-like elements, digital twins, AI bots
- Social learning: LinkedIn, Facebook, Youtube, TikTok etc. School in todays culture is considered a form of discipline, learning happens using social media because it is seen to be more credible.
- Personalisation: The idea is that the learner gets what they need, whenever they need it, however they need it. Technology is available today that allows this to be very effective.
Patrick then raised what he described as ‘the elephant in the room’ of AI and explained that the agenda in the learning industry has been on ‘efficiency’ improvements, giving an example of a Ufi VocTech funded AI project called ‘Teachermatics,’ which has saved teachers 4hrs per week in the tasks they need to do, highlighting that this is about doing the same job/set of tasks just more efficiently. However, what is of more interest and evolving is understanding how ‘effective’ AI can be on better learning strategies, new approaches to problems, accurate assessment and solving unpredicted problems.
In conclusion we are living in a fast moving, flexible learning environment where we need courage to ask our younger colleagues what works for them; be brave by recognising what we don’t know and seek to understand through asking and respect the views and ideas of our younger generation to help the older generation engage with the variety of learning technologies and what they can do.
Patrick was followed by Lena Cordie-Bancroft talking on understanding each other addressing some of the communication challenges, terminology and harmonisation in standards.
Lena provided an overview of the role of terms and definitions within a standards document and how standards are structured. Reviewed the two main standards bodies ISO and IEC and the projects being worked on to develop harmonised terms and definitions.
Here’s the link to the ISO online browsing platform tool https://www.iso.org/obp/ui currently used to find definitions of words that are used throughout a standard. These tools are developing and evolving the ‘vocabulary’ helping the standards committees to use the same terms and definitions when developing new standards, to ensure a common understanding across the different committees.
Lena reviewed the development of ISO 11139:2018 Sterilisation of health care products, Vocabulary of terms used in sterilization and related equipment and process standards giving examples of the type of definition i.e. ‘circular definition’ the working party are attempting to remove.
Lena then shared her work with the Kilmer Conference where collaborations teams were assembled from the multidisciplined attendees. Lena was part of the Kilmer Regulatory Innovation Team whose objectives were to identify and promote areas of cooperation and innovation between regulators and manufacturers. One area identified was to create a modern and standardised glossary of terms. See the paper Lena et al published.
Lena wrapped up with a great quote from Warren Buffett, “ Bad terminology is the enemy of good thinking.” Checking our listening skills she gave away a bottle of wine called ‘Definition’ to the person who could answer the question, “What clause or section of a standard can you find terms and definitions in?” Congratulations to Paul Chivers who was the quickest of the mark with the answer ‘3’
Val O’Brien then came to the stage to share a new unique ‘document’ on principles of decontamination that she has been leading on over the last three years. The idea originated from Tina Bradley, recognising the need for a basic reference document covering Decontamination Principles. The intention is for it to be an ‘easy to read’ ‘living’ document for anyone wanting to gain an appreciation of the fundamentals of decontamination.
The collaboration group involvement included CSC, IHEEM Technical Platform, HIS, IDSc, IPS, BSG, JAG and AfFP plus expert authors on specific topics.
There are sixteen chapters, emphasising the principles to support best practice and bringing a practical approach. The aim is for it to be a digital document with links embedded that take the reader to the relevant webpages.
The group are aiming for the document to be available mid to end of year.
Jincy Jerry kicked off the session after lunch with some audience participation to highlight information retention. She showed Ebbinghaus Forgetting Curve which shows how information is lost over time without an effort retain it. Understanding this is important when considering staff training because it demonstrates the need to create training moments/events which have meaning and are memorable.
Although the brain has a much greater capacity for processing information and therefore retaining information than a computer, due to the complexity of being human we still forget.
Jincy explored the ‘learning pyramid’ which demonstrates ‘Active learning methods’ and ‘Passive learning methods’ and asked the audience what type of training they had received from their organisations in the last year. Many fed back that ‘YouTube’ videos had been used, she then went on to identify that people learn differently i.e. Auditory, Visual and Kinaesthetic, overlaying this with the Learning Pyramid, highlighting that how we deliver training matters.
Jincy went on to describe a challenge she had identified in her hospital with the cleaning and decontamination of ultrasound probes. She had identified 24 areas in the hospital where ultrasound probes were being used and asked the question, are these probes “A physicians’ best buddy or a missed IPC opportunity?” She went on to highlight the increasing use of this medical device not only in hospitals but now clinics. This presents the next problem of how many, and which healthcare professionals require training and who is responsible for providing that training.
Jincy highlighted that as the responsibility for staff training can come under many different job roles, this confusion often leads to procrastination, abdication of responsibility and in the end ‘Hopeful’ training is then developed, usually in the form of some e-learning module, with power point slides, printed posters, hoping that people will see and read the guidelines and standard operating procedures. The measure of how successful that ‘hopeful training’ was is usually discovered at an observational audit.
Here’s the study https://pubmed.ncbi.nlm.nih.gov/27778309/ that Jincy presented showing a staggering 29%, 11% and 6% of the 946 practitioners surveyed did not disinfect the probe after each patient! Based on these results the European Society of Radiology Ultrasound Working Group produced these guidelines in 2017.
Jincy then presented a global survey from 2021 which concluded there was a gap in knowledge in basic infection prevention control practices in the ultrasound unit. She then compared the European guidelines with the Australian and American one highlighting that Australia and Europe are aligned but in America the ‘bugs must be highly educated and know not to stick to the ultrasound probe!’ So misleading guidelines leads to outbreaks.
In the Mater hospital Jincy invited sonographers to attend a training session on cleaning and disinfection and they all used ‘time’ as an excuse not to go. To make the training happen Jincy and her team undertook an ultrasound IP audit which identified that only 14% of the critical procedures were processed correctly and 44% of the semi-critical ones. She looked at when the operators received prior training which showed that 55-57% of the primary and secondary operators had received no training at all and only 33% had been trained in the last 2 years. With this evidence she invited staff and the probe provider to come for a ‘lunch time’ training session, where the staff were given a training probe to clean using a colour on – colour off wipe system enabling staff to see areas they missed. Here’s the German study evaluating manual cleaning of probes using a colour wipe system to identify cleaning gaps.
Audits from 2022 and 2023 have shown cleaning and disinfection improvements across all ultrasound probe types.
Jincy concluded we need to make training interesting and accessible, providing education that corrects poor guidelines. Finally as a committee member of the Hospital Infection Society (HIS) she has extended an invite to all CSC members to attend the HIS Conference on 24th – 25th June with a special discount code to get HIS membership pricing.
Following Jincy was Paul Kaye from QuiqSolutions who provide quality assurance and auditing software across the NHS, which was developed on the back of work done in the Social Care sector helping establishments prepare for CQC inspections.
NHS England invested in the software introducing it into all the Integrated Care Boards (ICB) for reporting on continuing healthcare quality.
Wales were looking for an Endoscopy decontamination auditing tool for AE’s and approached Paul to collaborate on developing a framework based on the Interactive Quality Assurance of Aseptic Preparation Services (iQAAPS) tool already used in the specialist pharmacy services area. The tool provides Real-time visibility of compliance for units, Trusts and all NHS Regions, highlights strengths and weaknessesand drives continuous quality improvement.
To give the audience an idea of what the tool looks like and how it works Paul showed a demonstration of the online platform. Graham Stanton was working closely with Paul in the development for this area and was a great advocate of anything that helped demonstrate improvements especially competency of staff working in the decontamination areas.
Sam Murray rounded off this Education, training and competency session. Sam applied for and was subsequently successful in receiving the Hurrell-Simpson award. As part of the award agreement successful applicants are requested to present on how they have used their funding and what they learned from it.
Sam works for Anuerin Bevan University Health Board (ABUHB) as Senior Infection Prevention Nurse and Decontamination manager from a clinical perspective. Sam used her Award to contribute towards the fee required to attend Eastwood Parks Roles and Responsibilities of the Decontamination Lead training course.
This allowed her to review what the organisation should be doing in decontamination practices, the skills required to fulfil the duty of the various roles, an understanding for the dual role of the staff and how to approach the ‘unsuspecting clinicians’.
Sam reviewed two areas within ABUHB:
- Decontamination of high risk devices within Ultrasound
- Decontamination of medium risk devices within Ophthalmology
She identified that clinicians in both areas are not accepting of the WHTM decontamination guidelines and therefore more evidence is required to persuade clinicians to move away from conflicting professional body guidance which is in conflict with cleaning and decontamination principles. Human factors and sustainability also came out of her review leaving Sam to conclude there is a lot of work still to be done, but every little step counts.
Rounding off the conference was our CSC tradition of ‘The Great Debate’ introduced by Pat Cattini, the Moderator for the session. Sustainability is high on the NHS agenda sprouting many ‘green’ groups looking at where reduce, reuse, recycle can be achieved within the different disciplines of healthcare. This has sparked lots of discussion in the infection prevention and decontamination forums and hence the title for the debate was chosen to reflect these discussions. ‘This house believes that “Passionate” idealism for sustainable decontamination threatens patient safety.’
Mike Simmons was the Chief Medical Officer (CMO) for Wales and continues to advise Wales on a part time basis. Mike was first to the podium arguing for the motion and began his presentation reflecting on the history of surgery, disinfection and decontamination. Pre the Germ theory, speed of the surgeon was more important than cleaning and often the surgeons were responsible for their own equipment often not cleaning them between patients. Lister introduced carbolic spray and quickly went from anti-sepsis of the surgical field to developing the first steam steriliser for asepsis which was used to sterilise sutures.
Mike brought the audience back to the topics of the conference, highlighting how things have changed and the present day challenges with the increasing use of robotic surgery and associated surgical instruments, and the increasing use of technology by clinicians which presently rely on manual cleaning and disinfection. In Mike’s view the journey of sustainability has come about from the arguments presented by David Attenborough who began to see and share the impact of what humans were doing on the oceans, forests and planet with our way of living. The UK Government and NHS have recognised they need to play their part in ‘sustainability’ beginning with a law being passed in 2023 where all waste must be segregated into separate waste streams with a big emphasis coming on ‘composting.’
Mike acknowledged that there is a great deal of plastic and other waste seen in the NHS and that it does require a new way of thinking about how we are going to address it whilst keeping patients safe.
Because of the attention that the sustainability agenda is bringing, Mike observed that clinical teams and indeed everyone, are beginning to feel there is an obligation to do something about it. However, Mike’s fear is that there are many companies now in the marketplace offering ‘sustainable’ options going to the clinicians directly who are not sufficiently aware enough of the importance of the cleaning and decontamination processes if we go back to reusable medical devices. Supporting this statement with various studies and reports on the use of vaginal specula, laryngoscopes, lumen and non-lumen endoscopes, also highlighting the ongoing concern of over use of non-sterile gloves when handling medical devices.
Mike introduced research on ‘Complex Adaptive Systems’ which speaks to the behavioural aspects within an organisation, supporting his concern that clinicians alone should not be the ultimate decision makers regarding what’s best for the sustainable agenda. Mike believes that a way to respond to ‘clinical enthusiasm’ for sustainability is to have lots of conversations with multidiscipline people, as highlighted in a paper by Rachel Drayton et al describing the switching to reusable vaginal speculums
In conclusion Mike agreed with the need for the sustainability agenda in healthcare, highlighted that all staff groups need to work in partnership to bring about safe change, with professional decontamination services and the science behind decontamination being put at the forefront of clinicians decision making.
Mahmood Bhutta is the Inaugural Chair in ENT Surgery at Royal Brighton and Sussex NHS and Professor of sustainable healthcare at Brighton and Sussex Medical School. Mahmood followed Mike arguing against the motion and started by bringing the focus on ‘risk’ and the question what is ‘reasonable measured risk.’
Mahmood believes we have gone too far in throwing things away to keep people safe and questioned if someone is killed in a car today would we immediately stop people driving cars. Thus challenging ‘have we in healthcare gone too far’ supporting that will looking at the root cause of the problems.
Mahmood went on to highlight that NHS in England is responsible for 24.9M tonnes of CO2 which is 4.4% of national Green House Gases (GHG) emissions and that’s equivalent to the whole of Denmark! 10% of that 24.9M tonnes is associated with clinical equipment. Presenting more data from USA of different approaches used in hysterectomy on CO2, the two key contributors to were anaesthetic gases and single use equipment.
Mahmood presented compelling data about the single use culture on increasing exposure to micropollutants from plastics; supply chain resilience leads to free market economics, global value chains promoting finding lower cost of manufacture, leading to an endemic abuse on migrant workers.
Mahmood challenged that the throw away culture we are currently in is based on the ‘Perception of Infection’ vs ‘Reality of Infection’ he agreed, “There is risk, let’s measure it and take a sensible approach to it.”
Mahmood concluded that there needs to be a change in incentives and barriers through discussions at national level with IPS and other professional bodies to overcome misconceptions regarding ‘infections’; look at different economic models and servitisation; improve design of products, using materials of manufacture that are resilient to sterilisation processes and expand decontamination and sterilisation services.
The session prompted great questions and discussions. Both Mike and Mahmood fundamentally agree that sustainability is necessary and the solutions are multilayered. Many of the ‘problems’ to infections are related to human error, either not following processes consistently or misunderstanding. Therefore wherever there is a possibility to automate the process it was felt we should be looking at that. There was also a feeling that there is a lack of education across the board from undergraduate level upwards and that it is essential for the decontamination services professionals to be part of the ‘enthusiastic’ clinicians decision making process when it comes to procurement, use and reuse of their speciality medical devices.
The audience voted for Mahmood’s argument against the motion, albeit that in reality both parties were aligned in their views.
Thank You
Many elements need to come together for a successful conference not least of which is the participation from the audience. Thank you to all our speakers, to Pete Pinnington who organised the AV, to James Plummer for the Video recording and live streaming, to Victoria our events partner, to the venue staff for their care and attention, to the corporate speakers from Nanosonics, Steris and Mackwell Health for their sponsored slots and YOU, our members and non-members who attended in person and online.
Remember to give us your feedback by scanning this QR code from your desk top or visiting https://centralsterilisingclub.org/asm-24-feedback/ where you will find feedback survey links for Day 1 and Day 2. Please select the day(s) you attended and let us know your thoughts.
If you would like your CPD certificate please contact Becky through [email protected]
The next CSC event will be the Autumn Study Day, on the 14th October at the Crowne Plaza in Birmingham NEC. Tickets are on sale NOW. We look forward to seeing you there!
What other events are upcoming
Theatres & decontamination Conference 2024, Coventry Building Society Arena, 16th May 2024
HEEM 2024 Wales Regional Conference “Back to the Future”– The Celtic Manor Hotel, 27th – 28th May 2024
Authorising Engineers Conference 2024 – “Driving the Standard”, Epsom Downs Racecourse, 9th July 2024
Infection Prevention Conference 2024 – 16th Annual Conference, 23rd – 25th September 2024, ICC Birmingham
IDSc 18th Annual Conference 2024 – 26th and 27th November, Hilton Birmingham Metropole
The CSC committee would like to dedicate this Newsletter in honour and memory of Graham Stanton. Thank you for all your dedicated service to improving standards in Healthcare.
