NHS HDL:
(2001)10

Health Department


 




Dear Colleague

DECONTAMINATION OF MEDICAL DEVICES

Summary

Decontamination is the combination of processes (including cleaning, disinfection and sterilization) used to make a re-usable medical device safe for handling by staff and use on patients. The effective decontamination of re-usable medical devices* is essential in reducing the risk of transmission of infectious agents including the causal agent of vCJD.

"Our National Health A plan for action, a plan for change" indicates that:

  • every healthcare system will be expected to deliver the service standards established by the Clinical Standards Board on food, cleanliness, infection control and other matters

An SEHD Working Group has recently considered current decontamination practice in healthcare premises in Scotland. To aid its considerations, a review was undertaken which found that, whilst there were examples of good practice, many decontamination processes fell below current standards. In some cases practice was unacceptably poor. These findings have implications for the prevention and control of healthcare acquired infection generally, as well as the potential transmission of vCJD. The Working Group therefore drew up a series of recommendations for SEHD. The Report is published at the SEHD Web-site http://www.show.scot.nhs.uk/sehd/. The text of the Report is attached. A bound version of the Report will be sent to you as soon as it is available.

SEHD endorses the Working Group's recommendations. This circular identifies the immediate and medium-term actions required in response to their recommendations.

__________________________

* A medical device is any instrument, apparatus, appliance, material or other article whether used alone or in combination, intended by the manufacturer to be used for human beings for the purpose of: control of conception; diagnosis, prevention, monitoring, treatment or alleviation of disease; diagnosis, monitoring, treatment, alleviation of or compensation for an injury or handicap; investigation, replacement or modification of the anatomy or physiological process.


9th February 2001

______________________________

Addresses

For action
General Managers/Chief Executives,
Health Boards
Chief Executives, NHS Trusts

For information
Chief Executive, Clinical Standards
Board
Chief Executive, Health Education
Board for Scotland
Chief Executive, Common Services
Agency
Executive Director, Scottish Council
for Postgraduate Medical and Dental
Education
General Manager, State Hospital
_________________________


Enquiries to:


Ms Jenni Brooks
2E (South)
St Andrew's House
EDINBURGH EH1 3DG

Tel: 0131-244 2083
Fax: 0131-244 2051
email:
Jenni.Brooks@scotland.gsi.gov.uk _________________________



Action

SEHD has already provided £3million to NHSScotland so that NHS Trusts and Island Health Boards can begin improving decontamination practice. Priority was given to upgrading washer disinfectors. In addition SEHD has undertaken the following actions:

1. Establishing a working group led by Richard Carey, Chief Executive Highland Acute Hospitals NHS Trust, to produce guidance to NHS organisations about assessing and managing the risks to the health of patients, staff and visitors from infectious and related hazards associated with healthcare. This will consider and make recommendations on:

a. how the senior management of NHS organisations should monitor and assess the risks to human health from their healthcare procedures; develop programmes to reduce risks and monitor their effectiveness;

b. the standards which measure whether NHSScotland organisations are discharging the following functions satisfactorily:

- decontamination;

- infection control;


- the management of medical devices and


- cleaning services.


c. The mechanisms for ensuring compliance with these standards.

2. Setting up a working group led by John Glennie, Chief Executive, Borders General Hospital NHS Trust to review the current provision of decontamination services and make recommendations for their future provision in NHSScotland. The review will be underpinned by a detailed survey of current compliance with regulatory standards and current guidance. It will also gather information on equipment.

3. Commissioning the Scottish Centre for Infection and Environmental Health to edit current guidance on decontamination to simplify and make it more accessible to users and to develop a training framework for staff involved in decontamination practice.

Chief Executives of Health Boards should ensure that:

1. This circular is brought to the attention of the Board Infection Control Advisory Committee. Local Infection Control policies must contain a section covering decontamination based on the guidance detailed in the Decontamination Working Group Report;

2. All independent healthcare providers registered by the Board are made aware of the need to improve decontamination practice to the standards detailed in the revised Infection Control Policy;

3. From April 1st 2001, inspection of registered independent healthcare providers incorporates an audit of decontamination practice;

Chief Executives of NHS Trusts should ensure that:

1. A senior manager (i.e. either a member of the Trust Board or directly accountable to a member of the Trust Board) is designated as having overall responsibility for risk assessment and management processes relating to decontamination, infection control, medical devices management and cleaning services. He/she will be responsible for receiving and ensuring the circulation of relevant advice on these matters and working with SEHD, the Clinical Standards Board for Scotland and other agencies on improving practice.

2. By March 31st 2001, the following are undertaken:

- the development of an action plan to ensure that appropriate arrangements are in place to oversee and improve where necessary decontamination processes;

- an audit of decontamination practices to address any issues of potential risk to staff and/or patients;

- an assessment of the age and condition of decontamination facilities and equipment in both central and local decontamination units.

3. Details of the senior manager with overall responsibility for decontamination, infection control, medical devices management and cleaning services are forwarded to Jenni Brooks at SEHD (Jenni.brooks@scotland.gsi.gov.uk or at the address overleaf) so that he/she can be invited to a forthcoming meeting where guidance will be provided on the above actions. This meeting will be held on the afternoon of Tuesday February 20th at the Royal College of Physicians and Surgeons, 232-242 St. Vincent Street, Glasgow. Further details will follow once the names have been received. An Advisory Panel will be established to support Trusts in implementation.

4. This circular is brought to the attention of all relevant personnel including, where applicable, Infection Control Committees, Sterile Service managers, Estates and Facilities managers, Theatre managers.

Yours sincerely



 

TREVOR JONES
Head of Health Department
and Chief Executive, NHSScotland

DR E M ARMSTRONG
Chief Medical Officer