Clinical

Guidance for Decontamination of Equipment for Gastrointestinal Endoscopy

Guidance on Decontamination of Equipment for Gastrointestinal Endoscopy: 2014 Edition

The Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee

June 2014

The 2008 guidance has been updated so as to incorporate the following developments:

  • The English Department of Health "Choice Frameworks for Local Policies and Procedures (CFPPs)" and equivalent documents from the devolved administrations.
  • Implications arising from moving decontamination facilities out of endoscopy units to centralised facilities, in some cases outside of the hospital campus; in particular the need to ensure a moist environment for endoscopes following last patient use and before decontamination, and conversely the maintenance of a dry storage state following decontamination and before next patient use.
  • Review of vCJD transmission risks, given that at the time of writing there are no known examples of vCJD arising as a result of endoscopy or surgery; guidance on decontamination of endoscopes following the performance of procedures in at-risk individuals is discussed, and quarantining of endoscopes is now deemed rarely necessary.
  • Some references to newer technologies such as NOTES and cholangioscopy.
  • A move away from enzymatic detergents, which have been linked to occupational dermatitis and asthma.
  • The introduction of audit tools, workforce recommendations and educational frameworks.

It is also acknowledged that there are many "stakeholders" in the field of decontamination. This, together with varying guidance from the devolved administrations, has frequently led to inconsistencies and misunderstandings. Against this background BSG Council has agreed that BSG will no longer co-ordinate revisions of its guidance, but a member of BSG Endoscopy will represent the Society on the Professional Expert Organisation Forum that has been established under the auspices of the Institute of Decontamination Sciences.

Finally Miles Allison would like to acknowledge the help and support of so many colleagues during his 12 years of involvement in this arena, in particular Tina Bradley, Helen Griffiths, Libby Thomson, Geoff Ridgway, Mike Bramble and the late Prof Don Jeffries.

Job Profiles and Training and Education for Decontamination Technicians - July 2014

The MHRA (Regulating medicines and medical devices) recent publication 'Managing Medical devices: Guidance for healthcare and social service organisations' April 2014 states:

 

'All relevant members of staff have been fully trained in decontamination protocols' [pg47]

 

As recommended within the document the Institute of Decontamination Sciences (IDSC) have recommended, accredited training courses for technicians and these can be found on the institutes website at: http://www.idsc-uk.co.uk and following the link on the tab to the education section on the IDSC website.

The IDSC has also developed generic job templates, along with National profiles from which job descriptions for endoscopy technicians can be developed these can also be found by following the link to the education section on the IDSC website.

Over time it is hoped that this will bring endoscopy technicians into the same group as Healthcare Science staff groups with the support and networking that this will provide and consequently raise the overall standards of decontamination within endoscopy.

Dr Helen Griffiths
Advisor Decontamination BSG


Choice Framework for Local Policy and Procedures CFPP 01-06

These documents offer best practice guidance on the management and decontamination of flexible endoscopes. They consist of five documents covering operational management, design and installation, testing methods, validation and verification and policy and management. These are large documents that will be subject to periodic updates and therefore it is recommended that rather than download all or part of the guidance the link is made available on endoscopy desktops. These guidelines are designed to provide information and guidance to those working within endoscopy services in England, please see the link below for relevant guidelines for Scotland, Wales and Northern Ireland.

Audit

Audit is key to understanding and ensuring that the decontamination environment and the processes within it are safe and effective. The MHRA (August 12) talks about the legal implications if there are failures in both understanding and practices in decontamination. The CFPP 0106 reminds us that the Health Act Code of Practice (2006) recommends that healthcare organisations comply with guidance establishing Essential Quality Requirements (EQR) and demonstrate that a plan is in place for progression to Best Practice (BP). There are a number of audit tools available for use within endoscopy to demonstrate compliance with EQR and allow planning to achieve BP. The Infection Prevention society has developed comprehensive audit tools to sit alongside the guidance in CFPP 01-06. These tools are now recommended by the member committees of the Professional Expert Communication Forum (PECF): Decontamination of medical devices as the UK wide audit tool of choice.

Access IPS audit tools here

Access list of member organisations of the Professional Expert Communication Forum (PECF) here

"Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection"

As part of its remit for the whole of the UK the Department of Health ACDP TSE Risk Management Subgroup produces the guidance document Transmissible spongiform encephalopathy agents: safe working and the prevention of infection. The aim of the guidance is the minimisation of the risk of transmission of CJD, and vCJD.

Read the entire updated document on the Department of Health's 'Advisory Bodies' website:

BSG Update to Endoscopy Service on vCJD risk reassessment

In 2012 the Department of Health published the Choice Framework for local Policy and Procedures CFPP 01-06, a technical document that replaces HTM 2030. The vCJD risk reassessment is discussed in this. It is no longer necessary to quarantine endoscopes following procedures in most patients at risk of vCJD (including blood product recipients) provided that national recommendations on decontamination practice are scrupulously adhered to. There has been a further recent update to these guidelines (January 2014). A précis of the documents with their links is found below. It is strongly recommended that endoscopy teams review review these documents, in light of the changes including the identification of a newly described human prior disease, Variably Protease - Sensitive Prionopathy (VPSPr), whose transmissibility characteristics are still under investigation.

MHRA Guidelines

View documentation "Top ten tips" revised 2012 on MHRA website: