Infection Control in Hospitals

The Standard of Standards

We are all aware of the bad press over the last few years on the state of infection control in our hospitals. As a professional in the Healthcare industry, I have first hand experience of the good levels of training, control, and dedication that is put into this area of concern. So why then do we still seem to have problems? Instead of looking at the consequences, we need to look at the overall picture of standards, how we measure current systems effectiveness, and how technology is being developed to further improve Standards overall. Lets take Central Sterile Services Department's (CSSD’s) as an example:

All CSSDs are equal but some are more equal than others

If you went into any UK CSSD they would probably conform to ISO standards and follow the guidance of the previous HTMs or now CFPPs. They would probably all pass the current tests required and most likely other commercially available tests. So one could arguably say; that all the CSSDs are equal. Now our intuition may tell us otherwise when we consider the differences in machinery, personnel, processes, and consumable elements. So why can something so infinitely variable be considered to be equally good? The answer is quite simple – because we are not measuring it adequately. It would be like trying to measure people’s height using a measuring tape marked up in kilometres – everyone would be consider shorter than 1km tall, but that doesn’t tell us how tall we actually are.

This is where we are currently at with monitoring washing efficacy in CSSDs – we are using measuring tape with a scale divided by kilometres to measure something that should be measured in centimetres i.e. our limits of detection for protein are in the micro grams when we should be looking in nano and peco gram range. Until recently this has been the limit of the usable technology, but after years of research new technologies are emerging that will enable CSSDs to start measuring in centimetres and not kilometres.

At the beginning of April a paper was published in the HIS journal about the results of some clinical trials carried out using one of these emerging technologies – tAK Technology. These trials were conducted by the Health Protection Agency (now part of Public Health England) as the inventors of the technology in conjunction with BIOtAK Ltd (www.biotak.net ), the commercial rights holder. The trials took the technology into 7 separate CSSDs (6 in the UK and 1 in The Netherlands). The paper showed that, whilst all the hospitals were fully accredited and passed currently commercial indicator tests, tAK Technology was able to differentiate the CSSDs’ washing performance into three distinct groups, and was able to show significant differences in wash performance within a single chamber and between wash processes.

This is what comes from using a test where appropriate sensitivity, is quantifiable, and gives a result on a scale rather than a pass/fail result. So what does this mean for Standards? It means that CSSD’s can manage processes and equipment objectively and take action before a small issue becomes a major problem. It means engineers, detergent manufactures, and machine manufactures will be able to benchmark processes, equipment, and chemicals. It means CSSDs will be able to take charge of their processes and equipment and drive up standards rather than focusing on just passing standards.

CSSD’s is of course, just one of many areas we need to be applying this strategy other examples are endoscope reprocessing, sterile instrument sealing, washer cross contamination the list goes on. All these and more have great personnel within them, meeting standards to a quantifiable level. Therefore, the conclusion can only be that the ‘Standards’ need refining. Finally it seems there is a wave of technological advancements arising to meet these needs. Lobbying governing bodies to enforce the rising standards will be the next step.

 

Lucina Ridgwell LinkedIn Profile

 

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