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Expert Review

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Summary:
This report provides an update on the progress made towards compliance with best practice following the publication of the “Comprehensive Report: A review of the decontamination of surgical instruments in the NHS in England” (2001) which provided background information relating to the development and implementation of a decontamination programme aimed at improving the quality of surgical instrument reprocessing across the healthcare sector in England. It shows that data collected and analysed between November 2001 and August 2003 demonstrated a significant “step change” occurred with respect to improvement across all aspects of the decontamination life-cycle.A series of assessments of decontamination facilities were undertaken, and the information was used as a focus for future work and investment.The document outlines How and where the data was collected and analysed and what was reviewed e.g. working practices, facilities and equipment and the local actions agreed where immediate work was necessary to improve standards. Where investment was made e.g. replacement of equipment, purchase of additional instruments, upgrading facilities The support provided in expert advice to the NHS and implementation of local medium and long term plans The launch of ‘A National Decontamination Strategy for Modernising the Provision of Decontamination Services’ in July 2003Future work and ongoing initiatives relating to decontamination Revision of existing guidance Surgical instrument tracking and management systems Revised guidance for upgrading and building new decontamination facilities Development of national training schemes The application of national registration schemes to demonstrate compliance The establishment of the Engineering and Science Advisory Committee on the Decontamination of Surgical Instruments including Prion Removal (ESAC-PR)The report provides case studies to illustrate the effects of the investment programme and a chronology of the decontamination development programme from December 2001 to February 2005.
Questions Addressed:
The report provides an update on progress towards compliance with current best practice guidance on decontamination of reusable surgical instruments in the NHS in England
Type of Study:
Review process/statistical analysis and case studies
Methods Valid:
Yes
Methods Valid Detail:

In September 1999, following concerns surrounding the theoretical transmission of vCJD the DH commissioned a snapshot survey of the decontamination of surgical instruments in a range of NHS hospitals, private and voluntary organisations and general medical and dental practices in England. Following the findings of this survey the National Decontamination Programme was launched in October 2000. This document reports on progress made to modernise the service in acute NHS hospitals it does not include any developments in general medical and dental practice or independent sector facilities

Results Reliability:
A systematic evaluation of information was undertaken to identify major risks and in addition to mathematical analysis of the data a risk analysis was undertaken to assess the elements of the life cycle using “Failure Mode Effect Analysis” (FMEA) to identify the key elements of the decontamination cycle which presented the greatest risk
Problems or Biases:

Full detail of the review programme methodology are not included to be able to assess reliability of systems used and analysis of data URLS for references would have been useful

Relevant Studies:
Keywords:
decontamination surgical instruments reprocessing reusable medical devices best practice vCJD survey sterile services departments (SSD)
Reviewer Name:
Sue Wiseman
Reviewer Post:
Nurse Consultant –Infection Control, DH
Reviewer Affiliations:
Member Advisory Committee on Dangerous Pathogens Health Protection Adviser Royal College of Nursing P/T Member Infection Control Nurses Association