DB 2003 (05) management of medical devices prior to repair, service or investigation

I have been asked a number of times in the last month about medical equipment cleaning and decontamination. I have seen numerous pieces of equipment coming to the workshop with decontamination declarations signed by the user. Even when they have been signed, some of these devices are still dirty. My concern is that some staff are willing to sign the declaration, but the equipment is still contaminated/dirty. This then puts the onus on the technician to either clean the equipment themselves, or return it to further cleaning. I tend to leave it to the discretion of the technician as it can sometimes be more hassle taking the equipment back, finding the nurse...etc. This is an area that comes up again and again. It seems to me that the MHRA basically says it is the responsibility of the manufacturer to tell us how a piece of equipment should be cleaned/decontaminated. Has anyone actually documented a generic cleaning process that covers most equipment coming into an ebme dept and is it working well? Is it time that every EBME technician was trained in cleaning and decontamination? or should we trust the users?
See: MHRA DB2003(05)

I feel like this issue is going around in circles and technicians are put at risk.

John
This problem has gone on for more years than I can remember. Our Control of Infection Manual clearly states that all equipment should be accompanied by a Contamination Status Certificate.
However in practice this is rarely the case, although we insist on one being completed for certain types of equipment such as suction etc.
A certificate may well be expected for equipment sent in, but what happens when the techinican
visits a ward and collects an infusion pump due for service. If he waits for a certificate, sure as eggs, somebody will come along and need to use the pump. All our nursing staff are supposed to clean such items between patients and unless the device is obviously dirty we accept it and clean it ourselves. Physically dirty equipment is reurned to the clinical area and appropriate words of admonishment are given.
Graham

Graham,
Most EBME depts would like to have a decontam status form signed by the user that can be trusted. In truth, it is a pipedream. Even if equipment looks clean - it may be hiding all sorts of horrible bugs. I think that techs should be given gloves, cleaning materials, and training in cleaning equipment. (What can/can't be used... how effective different methods are etc) We should (as a minimum) clean equipment before it goes out.
Some depts (with equipment libraries) have a 'dirty room' where equipment arrives, is cleaned and only then goes onto the 'goods in' shelf. I think this is the way to go.

Hi John

As usual, I got battered by the Trust's Audit when our department received yet again its yearly audit.

Certificates of Contamination Status for Medical Devices are insisted upon when requests are reported to EBME. My staff are under no illusions on this one, no certificate, then don't leave the department to attend to the request.

And they don't. No ticket, no shirt!

I am happy to contribute to any scenarios that others may suggest in this topic.

Regards.

Jim

Jim - You are one of the few who seems to have got a handle on this. Was it just sheer persistance? Did you get support from the users?

John.

What about when the workshop is located on the unit ie: Critical Care Techs and i come in on a Monday morning to find a bloody syringe pump on my nice clean workbench sporting a paper towel with the words "fix me" scribbled on it?
This continues despite my best efforts at trying to enforce the requirements with regard to cleaning and labelling U/S equipment.

In Lincoln we have gloves, aprons, sanicloths, anti-bacterial foam sprays provided. However we do expect the users to DECONTAMINATE the equipment ie remove any traces of bodily fluids etc before sending to us. We have a card system whereas the user attach a white ( never contaminated ), yellow ( was contaminated but cleaned ) or red card ( contaminated but still so after cleaning ) to the equipment before sending to us and it works pretty well. Very rarely we have to send equipment back to the user for decontamination before we look at it.

It is useful for the EBME tech to clean the gear before returning it as it will reveal any physical damage to it.

Its very interesting that a third of those that voted have said yes.

We use a tag system that tells us the decontamination status and the fault / repair required as well as the person / dept reporting it. I can email a copy to anyone who would lkie it.
I have to say that since installing the system we have had a great success with minimal "faulty" & "fix me" type reports and we have been able to trace those that are problems via either the tag or the medical equipment management system data.
We also report any problems on the risk management register as training isues for users etc.
The only other comment is that dont we (med eng) all need to know how to clean equipment properly anyway as there will always be instances such as blood splashes getting past a ventilator cover inside the main case, which the user doesnt remove. Or the possibility of secretion build up bloking airways and so forth which we would have to deal with.

Here at this trust we also have a decontaminated section on our reported fault form. Not that it is always filled in correctly, signed, blah blah.

I like to give the equipment i'm about to work on a quick once over, just for my own peace of mind.
I also give it a clean once i have finished a repair.

If i consider the equipment too dirty or what i think is a contaminant then i return it to the user and tell them its needs a clean.

I have on a couple of occasions informed infection control because i felt it neccessary.

Some equipment is such a pain in the hello to clean with all the grooves/nooks n cranies. I understand that ward based staff dont have access to some parts of the equipment to clean.

The bottom line is: will this ever change with staff shortages, inproper training and general poor standards of house keeping???

I dont think so... its life!

John,
Like most of the replies you have had, we have a decontamination/ permit to work form which must be completed before we will collect the equipment. The equipment is checked when it is collected and if it looks contaminated, we ask the staff to clean the outside. But this system is not perfect, often the form is filled in by the ward clerk (sorry, administrator) who doesn't know what they are signing.

I agree that it is right and proper that any equipment is cleaned and/or decontaminated beforehand. However, the reality is that this can never fully deal with all scenarios - as indicated by others.

My view is that we should all be aware of the potential risks and be given suitable training and the facilities to deal with this. There are plenty of guidelines around, and whether they are 'official' policy or not, they should be used, if only for your own safety.

What about scenarios where equipment may be cleaned externally, for example after a spillage, but the fluid works its way inside the equipment without the operator being aware. Of course, only when the technician asked to look at the equipment opens it up does the problem then become apparent - at which point there's exposure. This can only be dealt with at service or repair - precautions probably always need to be taken if there's a risk of this scenario but I doubt they are in the majority of departments.

Some MHRA guidance has actually suggested that internal filters, fans, etc, on ventilators/respiratory therapy equipment be cleaned on a regular basis, by those technically qualified to access them, to minimise the potential for patients and staff being exposed to MRSA-like infection or other airborne contaminants in dust. This is a service issue and one that, unless there's facilities to handle potentially comntaminated dust and particles, can affect everyone in a workshop.

I'm inclined to agree with techman but the facilities need to be provided to enable tecchnicians that are trained and knowledgeable to do this safely without putting anybody else at risk of exposure to potentially harmful substances.

I can only comment on this subject from the outside as I don't work for the NHS. When I get to a unit (usually an NICU, PICU or theatre) to service something, if the item looks like it could do with a clean, then that is what I will give it before I start work. If it is on a patient, I will clean it as soon as it comes off the patient (whilst still on the unit and using what the staff use to clean it and only if the relevant person is unavailable), then do the service, then return the item to the sluice for cleaning again. I have only ever once had to return an item to the user for cleaning as it was contaminated with blood. The relevant person was extremely embarassed. (And rightly so)

My feeling on this is it is better to be cautious and safe then just risk it, as engineers could quite easily spread bugs from one unit to another before they are discovered.

Mark

We have been through all this before. Initially when the decontam certificate was not completed we would remove the unit but inform staff that they should complete the appropriate form otherwise the next time equipment would be left with a reminder that unless a certificate was completed the unit would be not be uplifted. Again the ward would be informed that a valid certificate would be required. Should this happen again the technician arriving to collect the equipment would inpect and if a certificate was not present there would be no verbal warning but the technician would leave the equipment where he found it. Should there be any follow up ie complaint the details would have been logged on our system and a copy would be provided to the area manager. Copy would also be sent to infection control. Slowly the message is getting through.

If the equipment is cleaned by the ward staff you are not transporting dirty/infected equipment through the hospital exposing staff and visitors to the risk of infection. If it does happen report them to risk and infection control (or the local newspaper ). Given the current feeling on infection this should stimulate action.

"Should technicians clean equipment before repair" - There should be no need.
Should technicians take precautions to protect themselves against potential infection from internal contamination or badly cleaned equipment - Of course.
Robert

A written procedure to tell nurses how to clean equipment? Whatever next! Should have been something they learned at their mothers’ knee.

The Decontamination Declaration is universal throughout the NHS, surely? Of course the policy must be followed, and insisted upon. It doesn’t hurt to send a few back occasionally, just to remind 'em, as it were.

But meanwhile, doesn’t every technician take necessary precautions, especially when opening up equipment? By this I mean putting on the gloves when necessary, donning a mask occasionally, and washing hands regularly?

Should technicians clean equipment? Yes, when necessary. But I would add cleaning after repair too. I like to have equipment sent back as clean as possible (and I’m talking about Mr. Sheen here). It helps to reassure the user that something was actually done with the equipment! All part of the service, Ma’am.

Hi John et al.

Persistence, no I gave up!

Risk Management accused me of creating a risk to patients and ward staff, (ignore my staff - we are single use and disposable).

Risk Management, Infection Control and the Auditors clearly stated that EBME were in fact removing medical devices from wards and departments without a Certificate of Contamination Status. That this is a risk to all concerned and following any service or repair of a medical device, EBME were transferring the risk back into the patient environment.

This was also reported to the external Patients Forum who insisted on seeing me about it, a cortege of some six lovely persons.

Risk Management and Infection Control said that I and not EBME were a 'chink in the armour' and that I create and support infection risks associated with medical devices.

Support, yes! I focused and implemented a scorched earth policy. No certificate number when reported, no technician.

Works well now, but is a pain to my staff and no doubt nursing too.

Progress, be proactive, not reactive.

Jimbo