The Principles of Medical Device Decontamination

There has also been a debate around Alzheimer’s disease 10 and its similar abnormal protein deposition in the brain. While the risks seem remote, we cannot afford to let our guard down. Collins et al 11 demonstrated that surgical procedures were significantly associated with the development of sporadic CJD. Therefore, the cleanliness including protein removal from surgical instruments must remain an important focus, rather than thinking sterilisation will act as a final inactivation step, which it does with all other organism types in Table 1.1

What is infection and healthcare infection?

As Table 1.1 illustrates, there is huge variation in the types and sources of infections that can beset us from the very mild to the very high risk. Infections can be transmitted from person to person through natural routes as we mix in social situations, which can include personal mixing in healthcare premises. Traditionally in a hospital context, community acquired infections are those seen within the first 48 hours of admission to hospital. Anyone acquiring an infection after 48 hours of admission will be considered a hospital acquired infection. However, modern healthcare has moved to a much more fluid state between primary and secondary care that we are now favouring the generic term of healthcare associated infection. By its very nature, all surgery and other invasive medical device use makes the patient vulnerable to infection. As soon as the surgeon’s knife breaches the skin, the wound immediately puts the patient at risk of infection as underlying tissues are exposed to bacteria that do not normally have access to subcutaneous or deeper tissues. Similarly with endoscopies, albeit the risks may be lower but never absent as with the case of Hepatitis B transmission via a trans-oesophageal echocardiograph (TOE) probe. The surgeon however has offered surgery because on balance they have assessed with the patient that the benefits of surgery outweigh the risks of infection. Similarly, antibiotics may be prescribed due to pre-existing infection or as prophylaxis, to support the patient and help the patient’s immune system overcome or prevent infection.

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