The Principles of Medical Device Decontamination

Approaches to Analysing Perceived Decontamination Failures

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Decontamination failures come in a vast and variable variety. As such, a checklist approach to their analysis is inherently over-simplistic and unlikely to usefully inform analysis. Failures can be multiple, adding extra layers of analytical complexity. In many occurrences, some parameters of a failure may be unclear when first suspected, but actions cannot all wait until a possibly lengthy investigation has been completed. Given that context, what this chapter will attempt to do is equip investigatory teams with the concepts to facilitate insightful investigation where decontamination failures are suspected. The term “investigatory teams” is also a concept that can vary between investigations or during a single investigation. Such a team could be a single person in a department, more than a single person in a department, people from more than one department in an organisation, as well as people from different organisations. This chapter is written purely about patient safety in the context of transmissible infections. In general, decontamination processes are robust with respect to patient safety; minor failures are unlikely to compromise that. Processes involving microbial inactivation by heat (surgical instrument washer-disinfectors and steam sterilisation) have greater safety margins than those where microbial inactivation is achieved using chemicals (typically endoscope washer-disinfectors).

Let us consider the relevance of the individual stages of decontamination the instruments life cycle as described in chapter 2, “Decontamination Life Cycle ”

Manual pre-cleaning: This step is used to remove gross soiling. It does not always occur but may be used for difficult to clean surgical instruments or surgical instruments where a delay has allowed contamination to dry firmly onto surfaces.

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