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Section 5: Conclusions and Recommendations
5.1 Conclusions
The aim of the study was to produce a structured review to provide assurance to the CMO that the response to HAZ(SC)04/05 had resulted in the necessary actions being taken and to inform him of any concerns about practice. In particular the first objective of the study was to identify any deficiencies in relation to actions required by HAZ(SC)04/05.
HAZ(SC)04/05 required identification of all endoscope channels the results of the review indicate that this has yet to be fully achieved.
The development and application of the tool for endoscope decontamination has highlighted and quantified issues that were not revealed by previous observation and local review. While noting that there were instances of good practice, the overall picture is one of widespread non-compliance with current best practice guidance.
The data obtained during this review have provided an evidence base to indicate that there are sufficient deviations from best practice guidance to require a national initiative to improve endoscopy decontamination.
5.2 Recommendations
HPS recommends to the CMO that the following actions be taken to address the findings of this review:
1. The CMO should write to the service drawing attention to the need to ensure that all actions required under HAZ(SC)04/05 have been fully implemented.
2. Following a review of priorities, the 'Glennie Group' should consider establishing a National Endoscopy Strategy Group, to consider the implications of the review report and plan any action necessary. It is recommended that this group would take responsibility for:
(a) The definition of interim action on the minimum acceptable standards that must be met within existing facilities and with existing equipment. This should include consideration of the means by which assurance may be obtained that:
- endoscopes are correctly identified;
- staff are aware of the channels that are present and require cleaning and disinfection;
- staff are aware of the need for manual pre-cleaning;
- staff are aware understand the use of appropriate connectors;
- staff are trained in the correct use of detergents and disinfectants;
- EWDs are reviewed for compliance with current standards and any shortfall is addressed by appropriate manual procedures;
- All EWDs and their associated water supplies are subject to formal validation, periodic testing and planned preventative maintenance.
(b) The development of a longer term programme to bring facilities and processes up to best practice guidance standards.
3. Strengthen monitoring, reporting and compliance mechanisms to ensure that endoscopy decontamination equipment is procured, validated, tested and maintained in accordance with extant best practice guidance.
4. Priorities in respect of medical device decontamination should be reviewed in light of the review findings.
5. The establishment of a National Endoscopy Forum to promote and share good decontamination practice experience and to contribute to formulating the interim guidance. It is recommended that the Forum would liaise with infection control and decontamination specialists and with manufacturers of endoscopes, endoscope reprocessing equipment and process chemicals. The aim would be to enhance awareness of developments in current best practice and in continuing developments for devices, equipment, detergents and disinfectants.
The guidance document 'Endoscope Reprocessing: Guidance on the Requirements for Decontamination Equipment, Facilities and Management' 25 will inform this process.
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