Part 4: Visual inspection, maintenance and functional testing of standard atraumatic clamps
Constructional features and intended use
Atraumatic clamps provide for gentle and safe grasping and holding of vessels, tissue and organs without causing any trauma to tissue. Fig. 1 illustrates the constructional features of an atraumatic clamp. The size and design of atraumatic clamps are tailored to the type and size of blood vessel, anatomical landscape (e.g. depth of the surgical field) as well as to the surgical techniques. Vascular clamps are used with a straight, curved, angled or doublebent jaw design (Fig. 2), while the shafts are straight, curved or angled.
Developments in vascular clamps were essentially influenced by the endeavours of US cardiovascular surgeons Michael DeBakey und Denton Cooley. The intention was to exert optimal pressure distribution on the tissue when closing the jaws of the clamps but without damaging the tissue. The standard designs differ essentially in the shape of the jaws. A distinction is made between various types of serration (e.g. DeBakey, Cooley), each with a different number of tooth rows. [...]
Cardiff, 16 – 17 April 2018
The British Central Sterilising Club (CSC) held its annual conference this year in Cardiff, Wales. Some 150 delegates were in attendance to hear the opening keynote speech by Marion Lyons, OBE, from the Welsh Government and the Kelsey Lecture, given by Prof. Manfred Rotter from the Medical University Vienna. He spoked about the historic perspectives of testing hand antiseptics and called to mind the achievements made by Prof. Graham A.J. Ayliffe, with the “Practical Guide on Rationale and Testing Procedures for Disinfection of Hands” published in 1991. He summarized the insights gained by Semmelweis, explaining how these had led to the introduction of hygienic and surgical hand disinfection, initially in the German-speaking countries. Today, these were standard practice worldwide. Rotter went on to describe testing hand disinfectants on subjects according to the “Vienna Model”. He compared the reduction rates achieved with handwashing with water and soap versus the reduction in bacterial contamination on using hand disinfectants. He explained that when testing disinfectants for surgical hand disinfection, the disinfectants were tested on hands that had been previously washed. Rotter demonstrated how the reduction factors continued to rise in line with a longer exposure time – that was essential in cases where any intraoperative contamination of a wound had to be prevented. [...]
NEW: Guideline of DGKH, DGSV and AKI for the validation and routine monitoring of automated cleaning and thermal disinfection processes for medical devices
Validation of the process steps of automated cleaning and disinfecting of medical devices is an elementary requirement of their processing for use to ensure that the requirements of the pertinent effective regulations are met. Since publication of the first edition in 2005, the team of authors has continuously developed the Guideline, building on experience and improvements as they have become available and proven. This revised Guideline also implements the requirements of the current version of EN ISO 15883, “Washer Disinfectors”, providing the organizations involved with these activities with the current state of the art.
T. Suvd-Erdene (1,4), T. Gantumur (1,4), W. Popp (2,4), N. Parohl ( 2,4*), C. Battogtokh (3)
Medclean LLC (1), HyKoMed GmbH (2), Mongolian National University of Medical Science (3), Mongolian Emergency Service Hospital Hygiene Project (MeshHp) (4)
Abstract: The high prevalence of hepatitis B and C in the Mongolian population is imputed not least to inadequate reprocessing of the medical devices used. For the purpose of the current study conducted in 77 healthcare institutions in Mongolia, 105 autoclaves, three ethylene oxide (EO) sterilizers, one formaldehyde (FO) and one plasma (H2O2) sterilizer were investigated with biological indicators. 8 % of the autoclaves and two of the three EO sterilizers showed unsatisfactory performance. The H2O2 and FO sterilizers tested inactivated the biological indicators. Of the autoclaves, the older Russian models produced better results than the modern sterilizers from China and Korea. That may be due to the long experience with the old Russian appliances, which have no pre-vacuum, unlike with the more complex modern sterilizers. Thermologgers were used for the first time (in Mongolia) for measurement of physical parameters such as pressure, holding time and temperature. The findings indicate that inadequate reprocessing of medical devices may impact the high colonization rates with hepatitis viruses in Mongolia.
IDSc Conference, 27 – 29 November 2017 in Blackpool
Like every year at the end of autumn, the members of the Institute of Decontamination Sciences met for their annual conference in Blackpool. This year, however, the event was special, because the IDSc celebrated its 50th anniversary. The keynote lecture, however, on the face of it had nothing to do with decontamination, but with safety aspects of a different technical system, in this case the railway network. However as Pam discussed, there are comparable lessons to be learned in any process that relies on vigilance for safety. Pam Warren, known in the UK as “The woman in the mask”, reported her long journey back to life after she had suffered severe burns during a train accident at Paddington in October 1999. During the rehabilitation phase, in which she had to wear a plastic mask over her face around the clock to promote healing, she became chairman of the “Paddington survivors” group who fought for improved safety measures in rail traffic. After a series of serious railway accidents in the 1990s, the political parties and the railway companies needed to be persuaded to embrace the recommended safety changes, and public opinion also had to be influenced. Warren described how she mastered this often stony path in a similar way to her own rehabilitation: like a river, one must continually move forward, sometimes flow around obstacles, or in individual cases carve a new riverbed, always with the aim to improve safety. At the end of a five-year campaign, 97% of the proposals have been implemented, and the British Rail system is now one of the safest in the world, Warren concluded.
Markus Wehrl*1, Amelie Achten1
(1 wfk-Cleaning Technology Institute e.V., Krefeld)
Background: Process challenge devices (PCDs) according to Annex 9 of the Guideline are used for the process control of the overall reprocessing efficacy for thermolabile endoscopes. The analysis of these PCDs is sophisticated and requires a microbiological laboratory. These PCDs are therefore not appropriate for routine controls in central sterile departments.
Sabine Gleich, Bernarda Lindner
Department of Health and the Environment, City of Munich
Hyg Med 2016; 41(5): E71 - 79.
Background: In 2012, almost 51 million surgeries and medical procedures were carried out on hospital inpatients in Germany. According to national representative prevalence studies on nosocomial infections (NI) in Germany (NIDEP 1 study), postoperative surgical site infections (SSI) accounted for 16% of all NI. With 24.3%, the percentage of SSI in the second national prevalence study was again the highest of all NI. Preventative interventions in order to reduce the rate of postoperative wound infections have been described in scientific literature. In 2011, the Bavarian State Ministry for Health and Long-Term Care issued a joint obligatory concept for the surveillance and monitoring of infection control measures in healthcare institutions by public health authorities. Also in 2011, inspections of all surgery departments of acute care hospitals were prescribed as mandatory. For Bavaria this meant 288 surgical departments in 239 hospitals. In the state capital Munich, 59 surgical departments in 35 hospitals (= 21% of all Bavarian surgical departments) had to be inspected.
Delia Warburg, Sabine Gleich
Department of Health and the Environment, City of Munich
Hyg Med 2016; 41(6): E93 - E103.
Background: Ambulatory surgery has long been established as the third pillar in patient care besides inpatient treatment and conservative outpatient therapy. Facilities for outpatient surgery are especially common in areas of high population density. The supervisory public health authority for the city of Munich is the Department for Health and the Environment (RGU).
Special Issue: Hospital Hygiene in Europe
Infection prevention in Europe – EUNETIPS is celebrating its birthday
In autumn 2018, EUNETIPS (European Network to Promote Infection Prevention for Patient Safety) will celebrate the 10th anniversary of its foundation. This celebration will take place in early December 2018 in its founding city, Berlin. The Network was set up at the initiative of the German Society of Hospital Hygiene (DGKH) which had invited the national hospital hygiene specialist societies to Berlin. Today, there are 30 specialist societies from 21 countries in the Network and they meet twice yearly. Silvio Brusaferro, the Network coordinator, gives an overview of its history and future plans in this issue of the journal. This special edition also features reports on Italy, Spain, Netherlands, France and Sweden. Since the scope of the journal is limited, only a selection of countries could be featured. Therefore, interesting countries such as the United Kingdom (UK) or smaller countries such as Croatia or Greece are missing. The authors were proposed by the journal to focus on certain topics. Some did so, while others tended to give a chronological account of proceedings. This demonstrates that developments and the current situation can vary greatly between countries.
Endoscope reprocessing In his lecture John Mills (Steris) spoke about endoscopy. He pointed out that endoscopic, like minimally invasive surgery, procedures were being used increasingly, with ever smaller more complex instruments containing increasingly more electronic components.
One wondered whether high level disinfection was still adequate since the boundaries were increasingly more blurred between diagnostic and interventional, and as such also between non-critical and invasive, procedures. Mills continued by stating that while the Spaulding classification system was effective, modern surgical techniques were yet to be developed at the time of its formulation. The basic trend pointed towards endoscope sterilization, using a range of low-temperature sterilization processes.
H2O2 sterilizers with and without plasma had become established, largely thanks to their shorter cycle times compared with ethylene oxide or formaldehyde and the fact that they did not present a risk of toxicity to users or the environment. Gary Clarke (IHSS), too, spoke about endoscopy. Outsourcing of endoscope reprocessing (decontamination) to specialist establishments was one alternative to traditional organizational practices and also increased patient safety thanks to more specialized personnel. Besides, obtaining certification was a particular challenge for small reprocessing departments. Another benefit was the investment savings made and the space-saving advantages to the hospital. But one problem could be keeping the endoscopes sufficiently moist, especially with long transport routes, and reprocessing them as prescribed within three hours.