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#20370 16/11/02 6:28 AM
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Wow dudes, this is getting heavy man, I agree with Dave, Ged and Louis, If you soil the goods, clean them up yourself man, Richard you seriously need to chill guy as you is putting stress on yourself and might trip out and maybe end up on some of this equipment yourself dude.

Floyd cool


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#20371 16/11/02 10:36 AM
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Never a truer word spoken Floyd my bong toking fellow functional, never a truer word spoken my friend

Louis


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#20372 16/11/02 2:51 PM
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The views expressed (some of which just seem to be having a go for the sake of it) apparently confirm that generally my views and opinions are particularly unpopular - it seems that I'm really out of touch with what is really going on out there. Hmmm. frown

This aside; from the comments made concerning contaminated equipment, in this thread, there are probably others who take this even more seriously than I do - to their credit. I do think it's really important for EBME managers to take reasonable precautions to ensure the health and safety of EBME staff and others. After all it is their statutory duty. I am not citicising John Sandham, Mark. E, Louis L or Dave.H in this respect - they are trying to meet (meeting or possibly exceeding) their obligations, no doubt. I do wonder though, at which point where EBMEs lose control of this process and should not realistically be expected to "police" the use (and abuse) of equipment and cannot possibly ensure its decontamination status (for example, outside the EBME, in clinical areas). A few questions:

Do you carry out planned-maintnenance on-site, in clinical and ward areas?

When you come into contact with equpment in these areas, how do you ensure that equipment has been decontaminated or that it is clean and that you can work on it? If it appears to be contaminated, how do you deal with this in the clinical area? For example, if you think it's dirty do you immediately ask a member of staff to clean it - will they? Do you then insist on a certificate to ensure it is clean, there and then? Do you do this for everything, down to a SpO2 probe or a PC used in a clinical area? Do you walk away and ignore it?

Does your hospital have a scheme or policy of ensuring that all equipment is cleaned between patients?

Should always be the case - then why does equipment come down to EBME dirty? Who does this cleaning? Who monitors it? Who enforces the policy? Should there be a certificate to ensure this or can we rely on the word of the clinical staff to ensure that equipment is not only clean for other staff but patients as well (or vice-versa)? Is the trust and cooperation always there?

My view is that it is vital for EBME department managers to ensure that EBME staff are not exposed to contaminated or even dirty equipment and I'm certain a lot of departments do this very well as stuff comes into the department - I'm not knocking that, since this issue is important. It is also my view that it is for managers in clinical areas to ensure that their staff ensure the safety of others.......yes, that the clinical areas ensure the cleanliness of their equipment (or clean-up after themselves as someone put it).

Ged Swinton's comments were very good, I think. Unfortunately, unless the equipment belongs in a high-care area where the staff are quite highly motivated (usually), well trained and experienced then, in my own experience, the equipment doesn't necessarily even get a wipe-down before being put on the next patient or being delivered to EBME for repair. Equipment on wards that "does the rounds" is usually kept in a poorer state than stuff in a high-care environment. We have all had instances of "sticky" and blood-stained equipment haven't we? To his credit; Ged is interested enough to give some input and sees the problem is relevent to him - input from nursing staff is to be encouraged - hence my initial comments about our (yes, me included) patronising attitudes to other groups of NHS staff, aimed at Dave H. We should encourage, rather than discourage, other groups like porters, nurses, etc, etc to contribute on the site. When I say qualifications, Dave, I don't just mean academic ones - I mean academic, courses, training and experience - which is ultimately what qualifies anybody to do their job effectively.

The idea of EBMEs managing the equipment within some kind of equipment store or library is a really good one, I think, particularly if it means that dedicated staff can be employed to clean, decontaminate or sterilize equipment before it is reused or repaired. This would also allow EBMEs to pick up on damage, functional-problems and assist in scheduling for maintenance and more effectively manage cleaning, decontamination and sterilization of equipment, perhaps. John Sandham's department and others are probably more developed than other departments in this respect. Sadly, other trusts do not give their EBMEs as free a reign to be proactive, as John puts it.......

Unfortunately, when there is no central equipment store and EBME staff are "out there" in clinical areas, I am wondering how vulnerable they are to picking up infections off equipment and how far the paper-authority (i.e. certificates of decontamination status) applies in practice. There are also the associated problems of cross-infection to be considered when equipment moves around a hospital in an uncontrolled fashion.

Yes Floyd, I do think this is important and perhaps I do need to chill out - you're welcome to that opinion (what was the point of your posting again, other than to try humiliating me?). At least Dave H. and Mercury man are quite funny with it. :p

I have worked for managers in the past who have not taken this seriously and when the issue of decontamination has been raised have shrugged it off. Wait until you have picked up a nasty skin infection or respiratory problem and you're not sure how it came about or just get an inkling that you have been exposed to something nasty at work and you will take your own welfare a bit more seriously, maybe. Maybe not. In the meantime, your manager is hopefully doing this for you.

It is a fact that I have also worked off-site in hospitals where the clinical staff have not informed engineers working in certain areas that the areas have been rife with MRSA, S&D, etc. they've not even insisted on handwashing. It is a fact that I have observed sandwich-eating in anaesthetics rooms and in the theatre itself, between cases - possibly a consequence of the sandwich and coke-dispensers that we see in "dirty-areas" of theatres; we have all seen the theatre staff on the trawl to the canteen in their blues and greens haven't we? Sometimes with white-coats and some times without......it does happen. Training will not sort out this problem, in my opinion. mad

Does anybody share the same views or have similar experiences? Am I that far out of touch with what actually goes on in your hospital?

Poor facilities for adequate cleaning, no backup, no globally enforced on-site policy for decontamination of equipment, etc, etc. No coordinated control, across the board. It all gets very messy (if you pardon the pun). It is a fact that I, myself, have contracted respiratory problems which, after subsequent swabbing, have been confirmed to be MRSA related. Two weeks of applying a topical antibiotic every 4 hours up my nose was not particularly fun. In the same hospital, it is a fact, I was exposed to body-fluids from used plastic-ware, which was inappropriately packaged and not labelled, piled in a stores to be delivered to another hospital for sterilization, on top of faulty equipment - stored on the floor, incidentally. Although as far as the Trust H&S manager was concerned in the it wasn't an incident, if you get my drift......

The bags had been placed on top of equipment for repair and the contents had leaked onto the equipment. The hospital also had cockroach infestation at this time, as well. Don't tell me I take things too seriously, please. I have returned equipment to clinical areas whereupon I have watched the nurse who has received it subsequently use it to wedge-open a fire door so that a trolley could be wheeled out of a store. It is a fact that I've seen 5000 multiparameter monitors left ouside in the rain because the R&D stores was closed for lunch and the Nursing assistant that delivered the equipment didn't know what to do about it.

The problem is not about EBMEs and the efforts of those working there to do their job. It is about people "out there" not taking equipment issues seriously and being less-interested if a problem is not patient-centered, I think. If infection isn't a problem in hospitals then why are infection control nurses coming out of the woodwork? Should this issue be an EBME problem or should it be tackled by the experts? Where are the experts?

The point of this rambling (not paperwork-centered, standard-bashing or spouting requirements but based on experiences and I hope relevent) monologue is that attitudes to equipment usage and its decontamination need to change. I will make my apologies now if this posting offends (or bores) anyone wink

#20373 16/11/02 9:45 PM
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I have empathy with Richard.

Yes, this subject is like a round-about,as someone has already said, and I've now got off it.

cheers

#20374 17/11/02 6:58 AM
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Yo Richard dude, I was not trying to humiliate you at all guy. I was merely trying to suggest that you take the vibe to seriously man. Chill out dude. cool

Floyd


A problem is a gift to be unwrapped :rolleyes:
#20375 17/11/02 7:28 AM
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Gentlemen, are we not all on the same ship here. Richard, you make excellent point's, How do you know that an item is “clinically clean”, simple, you don't. You take care. If Louis is performing a simple functional PPM and NOT a service, Louis will usually wear some protection ,i.e. gloves, as most items only require simple functional/calibratory procedures NOT INVOLVING THE APPLIED PART.
However, You employed a SPO2 probe in your analysis, that is an applied part, surely that probe was ready for the next patient. Louis would say this for all items in clinical areas, they are simply going to be used on the next patient, therefore they should be clean, If not then we have a serious problem on our hands.
wink


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#20376 17/11/02 2:28 PM
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I agree with you Louis but we have a problem on our hands; it's not ours in the making and it can't be solved because other groups are responsible for it. We should do our bit and be able to trust others to do theirs, perhaps but this will not happen, until somebody picks up some really nasty infection in EBME and it's traced back to a piece of contaminated equipment that should have been cleaned.

Ok Louis, you wear gloves but what do you then do with the equipment after you've done your bit - shove it back on a shelf without anyone knowing its decontamination-status? I wouldn't blame you, since the response from some clinical-staff would be less than enthusiastic if you raised the issue but if you didn't raise the issue, wouldn't this be perpetuating the merry-go-round? The "Magic Roundabout", so to speak, where Florence is never seen wielding an azowipe.

That also brings me on to another issue - what is the status of the equipment after the "grubby little maintenance man" has finished with the kit? How do EBMEs fayre in this respect? Do you clean or decontaminate the internal (and user-inaccessible) circuit of anaesthetics systems during routine maintenance, as the MDA seems to suggest in its recent guidance, published on the internet? What handover arrangements do you have?

In my opinion, patients (you and me on occasion) should be examined and treated using clean equipment, they should expect no less. For example; I wouldn't want to be the next patient to have my bladder or heart imaged after somebody with raging skin-complaint or infection has been scanned unless the doppler-probe has had a bit more than a wipe with blue-roll - irrespective of whether my concerns are "evidence based" or unfounded in scientific terms - would you? Just in the same way you would not be particularly happy with wearing a BP-cuff that stinks of urine, faeces and vomit, or an oral or tympanic thermometer that is being used without probe covers stuffed in your orifices, Eh? We have all come across this and it is shameful.

Unfortunately, because of the culture we're in, if clinical staff - usually infection control, can justify to moaning EBME staff that equipment that's not regularly cleaned presents minimal risk to others it becomes acceptable to clinical staff that equipment cleanliness is low-priority, so they don't spend time an effort doing the housekeeping.

There is a wide range of general equipment out there which, may or may not, have had direct patient-contact but the common factor is that it's all used by clinical staff and it should be cleaned. These clinical staff take precautions by wearing the relevent PPE, etc, etc which protects them and they should ensure the equipment is cleaned every time it is used, to protect others. When they're finished with the kit it seems that there's no time to clean it (or it's not their job) before it's rushed off to another ward, used to treat another patient or just returned to a storage area. Not always the case but a fairly common occurrance, I think. The kit sits there, festers and just gets stickier each time it's used.

What I would like to know (perhaps John Sandham has already condsidered this) is how do we deal with this sort of problem when we're out there actually doing the job, rather than processing nice little "certificates of conformity", in the comfort of the EBME department? It's great making references to standards, etc, etc and ticking off "to do" lists and how well CA is being implemented and having meetings but sometimes I think we forget the reasons why all this is important. I doubt that new-starters fully appreciate it when they first walk through the door into a Hospital.

Anyhow, it's annoying that the people appointed to do their bit on the management-side (in clinical and non-clinical areas) can't seem to get anywhere close to solving this problem once and for all. In all my dealings with infection control and H&S, in the past, I have never come away from a problem satisfied that steps have been taken to avoid a reocurrance of the same problem. It is always a "I'll take it away and clean it" response - "problem solved" (for today). It's as if the H&S issues affecting other NHS staff don't matter in the scheme of things, when there's a "poorly-patient" or "overbearing consultant" to consider.

Time for lunch; I hope it's served-up on a clean plate........

#20377 17/11/02 2:54 PM
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Wow man, I really dig the magic roundabout.
Richard Dude, your last posting contained 756 words consisting of 3,623 letters, Man you have a serious gripe dude, chill out babe.


A problem is a gift to be unwrapped :rolleyes:
#20378 17/11/02 3:49 PM
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Yeah, that's right - I can type pretty fast.

#20379 17/11/02 6:40 PM
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Who's rattled your cage then " Dick" ?

As always your very articulate; and thorough.

I would have too agree with you on all your points. shocked eek

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