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Hi Patricia, I can add a few things from the reprocessing part of your question. I would say that the manufacturer’s statement refers to providing validated instructions for use that include information required for safe reprocessing, including;
* The state in which the RMD is provided (should be fully processed on receipt into the facility even if manufactured using clean processes)
* The intended state of reprocessing in which the RMD is to be used – refer Spaulding classification
* The methods of cleaning, disinfection and/or sterilisation required to deliver the RMD in its intended state, including any specific minimum settings that were determined in validating the methods
* Limiting Values i.e. the range for each process variable such as temperature, pressure and chemical exposure, outside of which the device will be adversely affected
* Information on the maintenance, lifecycle or checking of the RMD or componentsAS/NZS4187 also specifies normative references for processes and equipment, so for an IFU to meet the standard it would need to instruct the user in a way that meets those too e.g. the type of washer-disinfector listed.
I have found that the above information can be presented in very wide a variety of ways despite a supplier claiming that it “meets AS4187”, and that a careful check by the CSSD manager or person responsible for reprocessing is vital prior to purchase. IFUs can range from a highly specific set of instructions that allows no deviation from the manufacturer’s validated steps, to a generalised set of processes telling the user to consult local standards in their jurisdiction. Getting more information from the manufacturer and/or vendor can be very fraught so it pays to interrogate before you buy.
Regards,
Andrew Ellis
State Coordinator, Sterilisation & Reprocessing
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 13 | 25 Grenfell Street | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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Good Morning
Please accept my apologies if this has been a previous discussion point, however I was unable to locate a discussion
Our Neonatal Intensive Care unit is hoping to change the supplier of their bottles to a more sustainable option. The current manufacturer provides a sterile, single use, individually wrapped bottle. The new supplier will provide a “clean by manufacture” that they state meets AS4187. on reading their documentation i was unable to find evidence of what this statement is based on.
Could you please advise what is happening in your facility?
And if you are using a “clean by Manufacture” bottle can you please advise what guidelines you used to base this decision on.Kind regards
Patricia Knight
CNC | Infection Prevention Service
John Hunter Hospital Campus
Lookout rd, New Lambton
Tel 02 49855452 | 0447 574606 patricia.knight@health.nsw.gov.au
Please visit http://intranet.hne.health.nsw.gov.au/hne_infection_prevention__and__control
For Infection Prevention resources
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Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
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Hi Lalith,
Anodised aluminium and other alloys used for rigid sterilisation containers, instrument graphic trays and some coloured anodised RMDs themselves are susceptible to extremes of pH. Some titanium compounds are used to give a matte dark finish on RMDS and these can be affected too. Washer-disinfectors that use a high alkaline detergent with corresponding acidic neutraliser, or an acidic rinse aid, can cause a number of surface changes including loss of colour, a sort of multicoloured, opalescent pattern and in the case of aluminium, a powdery feel to the finish. These tend to be beyond recovery.
It’s possible that a chemical product from the W-D has pooled or been allowed to stay on the tins for an abnormal time or that rinsing was impeded in some way, perhaps by the other contents in the load. Patterns of the discolouration may point you towards a particular cause. A service of the W-D and a review of loading patterns and practices may help.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 13 | 25 Grenfell Street | Adelaide SA 5000
Ph: (08) 7425 7152 | Mobile: 0435 389 541 | Email: andrew.ellis@sa.gov.au
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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From: ACIPC Infexion Connexion On Behalf Of Lalith Ramachandra
Sent: Friday, 16 September 2022 3:24 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Staining on the Inside of Genesis ContainersGday all
I was wondering if anyone has had an issue with staining of the Genesis steriliser containers as below:
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Any thoughts on whats causing it would be much appreciated.
They go through the WD first then packed and sterilised in the autoclave.
Thank you
Regards
Lalith Ramachandra
LR consulting Engineers
PO Box 40968 Casuarina NT 0811
P 0401117423Sent from LR Consulting Engineers
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Hi Cathi,
SA Health have a page on Food Safety obligations for businesses at the following link, which endorses the Victorian program as well as providing some other links about training and skills:
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 13 | 25 Grenfell Street | Adelaide SA 5000
Ph: (08) 7425 7152 | Mobile: 0435 389 541 | Email: andrew.ellis@sa.gov.au
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
General public: http://www.sahealth.sa.gov.au/hospitalinfectionsThis email may contain confidential information, which also may be legally privileged. Only the intended recipient(s) may access, use, distribute or copy this email. If this email is received in error, please inform the sender by return email and delete the original. If there are doubts about the validity of this message, please contact the sender by telephone. It is the recipients responsibility to check the email and any attached files for viruses.
From: ACIPC Infexion Connexion On Behalf Of Susan Wyatt
Sent: Wednesday, 13 July 2022 4:34 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Food handling safety requirementsHi Cathi,
I am not aware of any specific official requirements for education in the scenario you speak of, however it is always a good thing.
I note that you are in South Australia. The Victorian Government has a site that talks about food safety and gives access to some free education that may be of use.
The site specifies:Food handlers refers to anyone who is involved in any activity that involves food or surfaces likely to come in contact with food, including those in:
* preparing such as chopping, cooking, thawing
* delivering and transporting
* packing
* serving
* cleaning tableware or equipment that comes in contact with food.Food handlers need to have the skills and knowledge required to keep food safe for the jobs they carry out for your fundraiser. For example, a volunteer required to transport sausages to your barbeque will need particular skills and knowledge in food safety and food hygiene, such as the correct temperature to keep the meat at during transportation, how to test that the correct temperature is maintained, not to transport the meat in a dirty vehicle or with the family dog.
The site that I speak of can be found at the link below:
https://www.health.vic.gov.au/food-safety/food-handler-training
And the free Do Food Safely Course can be found at the following link:
https://dofoodsafely.health.vic.gov.au/index.php/en/
I hope this is of some assistance.
cheers
Susan Wyatt
Infection Prevention Consultant
SWIPE
Susan Wyatt Infection Prevention and Education.
Email: susanwyattic@gmail.comOn Wed, Jul 13, 2022 at 12:28 PM Montague, Cathryn (Health) <Cathryn.Montague@sa.gov.au> wrote:
Good morning IPC knowledge community,In the context of a non-hospital setting, do you know if there is any requirements for staff to undertake specific food safety training who are:
handling or distributing pre-packaged food for provision to patients / residents (not any food preparation)
stocking and storing foods for clients in e.g. bulk refrigerators / freezers for subsequent distribution to patients / residents
Thankyou,
Kind regards,
CathiCathi Montague
Nurse Consultant Infection Prevention and Control
Drug and Alcohol Services South Australia
Email: Cathryn.Montague@sa,gov.au
#GetFullyVaccinated #DontShareTheAir #HandHygiene #StayHomeIfSick #GetTested #BeKindThis email may contain confidential information, which also may be legally privileged. Only the intended recipient(s) may access, use, distribute or copy this email. If this email is received in error, please inform the sender by return email and delete the original. If there are doubts about the validity of this message, please contact the sender by telephone. It is the recipients responsibility to check the email and any attached files for viruses
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Hi Kylie,
Hollow Type A and B are still design considerations for small steam sterilisers and are relevant while AS4815 is still in play. The design and requirements of these sterilisers are covered by ISO13060, which will continue to apply as a normative standard, even if the overarching reprocessing standard in Australia were to change. With a beaver handle, the blind ended hollow is similar to a number of other challenging little nooks and crannies. There are plenty of RMDs that may not even conform to the ideal picture of lumens or hollows but have (either hidden or obvious) close mating or narrow gaps and spaces.
ISO13060 contains the definitions and diagrams of simple hollow items (from which Type A and B are derived) and how to assign them based on the ratio of length to diameter of the cavity. This was inserted verbatim into AS4815.
Annex A of ISO13060 has a further graph to illustrate the way RMD structures are defined for the purposes of testing and classifying the load contents of small steam sterilisers, which is interesting and worth a look. The axes are the diameter and length of the RMD’s feature, and lines representing the length:diameter ratios that define Type A and B Hollow items are used to describe three plot areas into which you could place your RMD – these being non-hollow, simple hollow and narrow lumen areas. The l:d of double ended and single ended lumens are also differentiated in this. I haven’t measured up the screw hole of a beaver handle but it looks like it would come under “narrow lumen” field on that chart.S Type sterilisers include cycles for which the manufacturer has specified the load type and limitations, so those cycles have to be followed according to the manufacturer’s instructions, including testing requirements. That aside, if I were considering the beaver handle as having a blind, narrow lumen then air removal testing would be warranted.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 13 | 25 Grenfell Street | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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Hi everyone,
I wanted to ask the group about reprocessing a specific podiatry instrument.
The instrument is a beaver chuck blade/handle. This item is hollow but capped at the end and when in use the blade holder is screwed into the handle and the blade attached.
It’s getting reprocessed (handle separated from the blade holder) in a S Type benchtop steriliser in a AS/NZS4815 environment.See attached image of the instrument.
Anyway, would this item be considered as a hollow type A or type B and is that even a thing anymore?
Essentially, I am wondering about having to conduct air removal steam penetration tests (ARSPT) for these S Type benchtop sterilisers because of these items. Looking at 4815 it says that if it’s a hollow A or B item then the steriliser needs an air removal steam penetration test anyway. I guess my question is would the ARSPT for this S Type steriliser each day be required because the item is a Type A Hollow or Type B Hollow and why. I’d like to know the rationale for decision making I suppose.
I have been reflecting on this and I think that because the item is hollow, it doesn’t make a difference whether it’s hollow A or B because it’s, well, hollow – and the Standard says if the item is hollow (A or B) then it needs an ARSPT. I just want some more insights about the A and B hollow situation for my own interest.
Thanks for considering this one. I would welcome any offline comments and, of course, through the forum.
Kylie
Kylie Robb
MHSM, GradCert InfecPrev&Cont, CICP-A, MAICD, FACIPC
ADA NSW Head of Practice Services
Advanced Credentialed Infection Control Professional (CICP-A)
Adjunct Lecturer – University of Newcastle – Oral Health School of Health Sciences
ACIPC Board DirectorAustralian Dental Association NSW Branch
1 Atchison Street, St Leonards NSW 2065
t: 02 8436 9936 m: 0438628664
E: kylie.robb@adansw.com.au | W: https://www.adansw.com.au[cid:image002.png@01D88D2F.F378F700] [cid:image003.png@01D88D2F.F378F700] [cid:image004.png@01D88D2F.F378F700]
ADA NSW acknowledge the Traditional Custodians of the land on which we work; the Cammeraygal people of the Eora Nation, and pay respects to Elders past, present and emerging.
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Hi Carol,
AS/NZS4187:2014 A2.4.3.1 is the current reference to this:
“Colour-coded identification systems, including coloured instrument tape, silicon rings,
adhesive labels, can detach from a RMD during surgery, thereby compromising patient
safety. In addition, microorganisms can become trapped beneath the adhesive layer of these
systems, thereby compromising the ability of the RMD to be reprocessed effectively.”Even if you take off tape that has been on an instrument for a long time, the surface beneath rarely recovers and tends to be physically compromised.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 13 | 25 Grenfell Street | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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Hi Carol
Coloured id tape poses 2 key issues* the tape itself and adhesive compromise cleaning and can provide a surface for colonisation
* the tape, certainly use to, became brittle post repeated sterilization. I have seen firsthand, many years ago, brittle tape flushed from a bladder.While I understand that a highly visible marking system can appear attractive especially to keep sets together, there are much better instrument marking systems available.
Kind regards
Ken Chapman
Infection Prevention and Control Clinical Coordinator
Cabrini Health________________________________
[Posted on behalf of member – Moderator]
Dear Brains Trust
I recall years ago that AS/NZS4187:1995 didn’t recommend the use of coloured tape to identify instruments.
Does this still hold true? Is there a document I can refer to?
Cheers
Carol
Carol Bradley
Bradley Infection Prevention and Control Services
Infection Preventionist in Veterinary Practice
Melbourne, Australia
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Hi Brigid,
As others have pointed out, it is commonplace to fully reprocess RMDs on arrival at the destination facility. For RMDs on loan from another facility this is straightforward. There are a couple of other situations I have encountered where this may not necessarily be as simple;
In a business continuity mode, facilities may have a reciprocal arrangement to perform some or all of the reprocessing at a companion site. AS/NZS4187 notes that “Where any activities encompassed by this Standard are undertaken by an external contractor, HSOs shall ensure that an agreement is in place that identifies the responsibilities of each party, including the requirement to comply with this Standard”. Assuming that agreement covers the chain of custody of the RMDs adequately, it is not out of the question. I’ve made use of this in the short term when I managed a couple of metropolitan hospitals and we ran into temporary contingencies. Of course, the triggers for activating the plan have to be suitably risk managed and accepted by the organisation ahead of time, and documentation has to ensure the process is robust throughout. In such a case, transport conditions, manifests and so on should be considered. It would have been acceptable as a routine practice.
Some day surgeries use commercial sterilisation providers for relatively low volume, low complexity RMDs. In my capacity with the private health regulator in SA, we sometime evaluate facilities which entirely outsource their reprocessing to such an agency and only have dispatch and receipt areas. In other states I know that there are vehicles which are advertised as “4187 compliant” when this option is taken.
Finally, I have visited a number of regional health networks in which the low volume of RMD turnover and the cost of refurbishment of individual, isolated CSSDs has driven a hub-and-spoke model. In this case and the one above, outsourcing has removed the capacity to reprocess RMDs on arrival, and is of course the point. A great deal of work has been undertaken by one region to risk manage transport and turnover of RMDs versus non-compliant facilities and understaffing.
The first example is different in that a hospital with a normally functioning CSSD should reprocess RMDs coming in on loan as a matter of course. However the other examples show that when taking into account transport conditions, contractual arrangements and risk management, there may be some circumstances in which it is possible or necessary.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
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Hello Brains truss,
Could someone please point me in the right direction for standards for transporting instrument trays and RMD’s between hospitals? I understand they must be reprocessed prior to use in the next hospital as sterility cannot be guaranteed. Though some staff members are saying if transported in sealed plastic dust covers it is ok to use. I disagree, though the 4187 standards are a bit generic in this aspect.
My belief was that if to be transported from one hospital to another, many factors needed to be taken into account including , transport vehicle, humidity etc. The hospitals are about 30mins apart.
Thanks
Brigid Robertson
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Hi Mandy,
I think that your interpretation re CJD is correct, as the example given in the Note about “high risk tissues” is meant to relate to “individual patient use”. It’s reasonable to take that use to mean something other than normal use of a RMD on one patient between reprocessing (which would go without saying). Traceability of semi-critical and critical RMDs is already well covered throughout the Standard within the normative clauses too, so it would be an odd thing to tack on just as an extra reference to the definition of critical devices.
The Standard itself excludes specific requirements for CJD from its scope, per clause 1.2(b) so perhaps this was an acknowledgement that HSOs may wish to consider such risks, without going so far as to advise explicitly.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 13 | 25 Grenfell Street | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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Good morning “Brains Trust”
I am seeking clarification around my interpretation of some wording in AS/NZS 4187:2014
Under 2.4.3 Identification and traceability of product
There are 3 NOTES; number 1 states ” in certain circumstances, traceability of an RMD to an individual patient might be required (e.g. those used on high risk tissues)
I am seeking clarification on the term “high risk tissues”
* Is this referring to High-infectivity or medium-infectivity tissues associated with CJD risk?
* Or more broad, as in the DEFINITIONS 1.5.18 the Critical medical device NOTE: a critical medical device contaminated with microorganisms confers a high risk of transmission of infectious agents.
* There is no specific definition for high risk tissues (that I could find).I might be reading too much into it. Any clarification would be appreciated.
Kind regards
Mandy Davidson
RN; GCert Inf Pre & Cont; MPHTM; Cert III Sterilisation; Cert IV TAE; Immunisation cred; CICP-A
Clinical Nurse Consultant – 4187 compliance & PPE Stores
Infection Prevention & Control
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Well said Kate.
I won’t rehash the sentiment at length here but I have also taken this approach with RMDs at a local network and wider level, including requiring vendors to provide supplementary IFUs, where the original IFU was either arbitrary/unrealistic, or was limited to international cycles which don’t prevail in Australia and would require additional validation to perform here (see: steriliser cycle parameters).
One of the most common problems I have run into when resolving IFU conflicts is obtaining a reliable statement of compliance from the vendor e.g. “we can confirm that the process you have proposed will deliver a product compliant versus national standards” etc, and not a statement like “while this may decrease the life of the device, we confirm that it will not affect warranty replacement” – which is a very different offering and often conflated in the procurement process.
A conflict between the supplier’s IFU and the organisation’s reprocessing resources is a risk which has to be held or eliminated by one of the parties. If the supplier cannot or will not resolve it at the product realisation stage then that is a consideration for the organisation going ahead.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 13 | 25 Grenfell Street | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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Hi Cate,
I am not going to be helpful in suggesting a solution for you! What I would like to do is use your example to encourage everyone needing to meet the needs of AS/NZ 4187 to push back on medical devices manufacturers and suppliers to ensure there are cleaning/disinfection/sterilisation options provided that are available in Australia and are TGA approved.Since I started in my role a year ago, I have been contacting many companies to request that they provide a suitable Australian reprocessing option when none is given in the IFU. For the most part they have been particularly helpful, and have gone on to provide me with letters of approval to use the products we have in our hospital, or they have gone as far as doing proper compatibility testing and updating their IFUs as a result.
For those few that are unwilling to engage in the conversation, we have informed them that we will not be using their product in future once the existing requires replacement, or if a new product, that we will not be able to purchase from them at all. At the same time I am in the process of tightening up our purchasing policy to ensure that RMDs, and reprocessing equipment can’t be purchased unless they meet strict criteria, namely that they can be reprocessed using the products/equipment we have available.
If we all start pushing back on industry to do their part to enable safe and effective reprocessing, we might start to make change. So I would suggest that you go back to the dialysis supplier and suggest that it is their role to provide an option as per section 3 of AS/NZ 4187, and that alcohol is not a TGA approved product for RMDs.
Kind regards
Kate Ryan
RMD Program Officer
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HI everyone
Our healthcare service recently installed new dialysis machines across a wide area. Unfortunately there was no consultation with infection prevention and control for advice on managing the infection risk of the machines, in particular cleaning and disinfection.
The manufactures instruction for use (IFU) recommend Ethanol (60% to 70%) Isopropanol 60% . There is a further large warning in the IFU stating clearly that only these 2 disinfectants are to be used to clean the touch screen. The rest of the machine maybe cleaned and disinfected with 2 in 1 wipe used in most hospitals .
The IFU do not provide sufficient information or guidance on cleaning the Touch Screen to prevent damage and voiding warranty. The Touch Screen is the most frequently touched area of equipment and likely to become highly contaminated with pathogens from healthcare worker hands. Therefore cleaning and disinfection between patients to prevent healthcare associated infections in this vulnerable high risk group is vital. The IFU describes the disinfection process but not the cleaning process.
The Australian Guidelines for the Prevention and Control of Infection in Healthcare NHMRC 2019 – Page 59 which states:
Physical (mechanical or manual) cleaning is the most important step in cleaning. Sole reliance
on a disinfectant without physical cleaning is therefore not recommended
Given that these machines are currently installed and in use and the company representatives maintain that only alcohol is to be used to clean the touch screen, I was wondering if anyone else had a similar experience and would share with me how you managed the situation.
After all we all know cleaning and disinfection is vital in preventing the transmission of pathogens ,no more so during this COVID-19 Pandemic.
Thanks very much
Cate Coffey
RN BaAScN MPH&TM Grad Cert Infection Control Nursing
Clinical Nurse Manager
Central Australia Health Service
Department of Health
Northern Territory Government
Infection Prevention and Control Unit
Alice Springs Hospital
PO Box 2234, Alice Springs, NT 0871t. 08 8951 7737
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Hi Liz,
The Australasian Health Facility guidelines specify in HPU B.0190 Sterilizing Services Unit under the section on loading and unloading areas of sterilisers that:
“A duct enclosure can also minimise heat build-up within the Workroom. An exhaust over the front of the sterilizer/s should also be considered, to extract both heat (cabinet) and steam (opening door)”. The AusHFG are the standard for facility design and this would be the likely reason.
AS/NZS4187:2014 5.6.1 also states “[The physical environment] shall include requirements for environmental control in areas that can impact the bioburden of an RMD, e.g. control of temperature, humidity, traffic flow, and reprocessing, ventilation and air flow”. If the sterilisers open onto a storage area then excess heat may impact on clause A9.5 (f) “The temperature within the storage area should be controlled within the range of 18C to 25C”.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 13 | 25 Grenfell Street | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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Good Morning One and All
During a recent audit we had a recommendation regarding the placement of outlet vents in the ceiling above the Steriliser doors.
Temperatures in our CSSD Department become quite warm so looking for a reference that supports this
Can anyone assist pleaseMost appreciated.
Liz Vanderlinde
Infection Prevention Control Co-ordinator
North West Private Hospital
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Hi Barbara,
I managed two Adelaide hospital CSSDs in recent years, prior to my current role. Their practice is as follows:
Hospital 1
Hospital 2
Power and air tools
Mostly air tools. Test with medical air prior to packing.
Almost exclusively battery powered tools. Do not check.
Inchecks
Class 4 in all trays.
Class 6 in all trays.
Routine monitoring of RMDs
No post-cleaning tests.
ATP bioluminescence is currently being set up.
As you can see, they differ in each regard despite being located within the same Network.
The ideal combination for me would be; that air and battery tools are quality checked at packing per their mode of operation, that Class 4 inchecks are used in all packs and that routine monitoring of cleaned RMDs (as well as environmental surfaces) occurs to a schedule.
With regard to inchecks in wrapped trays, these are not mandated in ASNZS4187 but in their absence the only visual indicator is the Class I tape. In the event that the tape has changed following exposure to heat but not a correct sterilisation cycle (there being several rare but not impossible ways this could occur), the clinical staff have no cue on opening. At a minimum, a failed incheck provides an immediate halt to proceedings. My clinical colleagues have always agreed to the value of this measure. I think that Class 4 is sufficient for this task.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 3 | Citi Centre | 11 Hindmarsh Square | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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Hello Brains Trust,
I am on our Local Health District AS/NZS4187:2014 working group to update our procedures in relation to reprocessing reusable medical devices (RMDs).The following topics have been raised and am seeking your expert advice and also interested in what your thoughts/comments/happens at your facility please:
* When reprocessing power & air tools does your CSSD test them prior to packing and sterilising?
* Does your CSSD use internal chemical indicators (type 4 CI) with every reprocessed instrument tray?
* Does your CSSD haemo-check all identified difficult to clean RMDs each time they are reprocessed?
Many thanks in advance,
Kind regards,
BarbBarbara May
CNC Infection Prevention and Control |Port Macquarie Base Hospital |Mid North Coast Local Health District
PO Box 2466, PORT MACQUARIE NSW 2444 | Tel 02 5524 2061| Fax 02 55242568| Mob 0402890677[Description: Description: Copy of MNCLHD logo no background colour – Copy]
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Hi Kylie,
The technician should be using the same physical sensors in all of the cycles used for PQ, and not omitting them after the first cycle.
Appendix F of AS/NZS4815:2006 includes several requirements which would support this;
> PQ must demonstrate heat penetration into the chosen load contents using thermocouples deployed in a specific fashion i.e. to reflect the coolest parts of the chamber identified during OQ, using no fewer thermocouples in PQ than in OQ, and at least one thermocouple placed adjacent the temperature sensor controller. Per F4(e).
> Placement of biological indicators in test loads is recommended as being “adjacent to the temperature sensors within the chamber and packages”, indicating that the thermocouples would be expected to be present. This is stated in the same section which cites the need for “three consecutive replicate cycles” so that supports their use for the entire process.
Clauses F5(a-h) specify the required content of the PQ report and this includes the placement of the thermocouples per F4(d).
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 3 | Citi Centre | 11 Hindmarsh Square | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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Hi everyone,
Office based dental practices primarily utilise small benchtop sterilisers. Under 4815 these sterilisers are subject to an annual validation that requires successful performance qualification (PQ), this includes physical and microbiological qualifications run concurrently over three consecutive tests.
Usually steriliser technicians will conduct this process for dental practices.
I’m interested to know if anyone can provide guidance on whether the steriliser technician should be monitoring each of these three cycles with their testing equipment (in addition to the three x Type 5 indicators) rather than just the first cycle with the indicators and the testing equipment and the other two with just the indicators (and no technician testing equipment).
Thanks everyone, I’d be interested to hear your thoughts.
Kylie
Kylie Robb MHSM (Clinical Leadership), CICP-P
ADA NSW Practice Services Manager
Infection Prevention and Control Professional (CICP-P)
Conjoint Lecturer – University of Newcastle – Oral Health School of Health Sciences – Faculty of Health and Medicine
ACIPC Board Director | SHEA International AmbassadorLevel 1, 1 Atchison Street, St Leonards, New South Wales 2065
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Hi Fiona,
Adding on to Terry’s comment about the difficulty of identifying individual tubing – at a prior CSSD I managed, there was a manual tracking system and a reasonable volume of respiratory items from sleep studies, lung function and other areas. All deliveries of reusable respiratory items had to come with a supply docket from the user area and we recorded key data on it using a custom-made, self-inking stamp. I have to say, it was the largest stamp I have ever seen in order to fit all of this on it.
Key data included:
> Time received in Decon
> Time out of the Washer-Disinfector and signature
> Time into anaesthetic dryer and signature
> Time out of anaesthetic dryer, check for total dryness, check for coolness prior to bagging up, and signature
Tracking to patient was not really feasible but for as long as the delivery was kept together in the clinic, there was a link back to the washer cycle and we at least had a record that we were meeting requirements on an ongoing basis. CSSD retained a copy of these return dockets.
More importantly, I think it allowed us to review a couple of the key risks to proper thermal disinfection; the time between disinfection and drying (items left with residual moisture, cooling down on the unload side of the washer risk becoming recontaminated) and ensuring that adequate time was spent in the dryer as well as cooling down before bagging (either step potentially resulting in condensation and thus recontamination during storage). As thermal disinfection is the final step of reprocessing here, we felt that an explicit record of monitoring those risks added value to the process.
Depending on your existing dryer attachments, an increase in tubing through CSSD may create a processing bottleneck as well.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 3 | Citi Centre | 11 Hindmarsh Square | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
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Hi Fiona,
Going back to ancient times when I was a periop nurse and then a CSSD manager we used reusable anaesthetic circuits.
We would use a new circuit for each patient and theses were provided in clean tubs by CSSD and the used circuit was placed back into the same tub and transported to CSSD.
When viral filters became available, we retained the circuit for the day, much like is practised with disposable circuits.
From a CSSD perspective, the tubing we used to use had a limited number or reuses and from memory this was either 20 or 30 uses before the tubing had to be discarded.
Tracking individual pieces of tubing was challenging, so you may need to identify a suitable system for identification of circuits throughout the reprocessing cycle.
Kind Regards
Terry McAuley
Director
MSc Medical Device DecontaminationPO BOX 2249, Greenvale, VIC Australia 3059
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Hi All,
I posted this query earlier in the month without a response, if anyone is able to provide some insight I would be happy for you to email me personally.
In our facility we have been using disposable anaesthetic circuits for a number of years. However with COVID / Pandemic demand there has been a shortage of disposable circuits and the alternative option has been a reusable circuit. I would be interested to hear from other facilities who use the reusable circuits regarding any identified IPC issues / risks and how these have been overcome.
Also if you have the choice is which type of circuit would you prefer and why?
Kind regards,
Fiona De Sousa CICP-E| Nurse Manager | Infection Prevention & Control Unit
Launceston General Hospital, Level 2, Launceston TAS 7250
phone: 6777 6715 | mobile: 0408 487 197 | fax: 6777 5170 | email: fiona.de.sousa@ths.tas.gov.au |
intranet: http://www.dhhs.tas.gov.au/intranet/thon/infection_controlIPCU – ‘By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms’
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