Endoscope contamination and rinse water TVCs
Pamela Ashman, Paul Hay, Emma Lindsay, Fara Shadroo, Joanna Ford and Pete Phillips
October 6th 2015
The link between contaminated endoscopes and outbreaks of infection (both genuine outbreaks of infection and pseudo-outbreaks where positive samples are taken from patients not exhibiting clinical symptoms of infection) has long been established (Srinivasan et al., 2003 and Wang et al., 1995). Failure of procedures can cause contamination (Moses and Lee 2004) and monitoring bacterial levels in rinse water can be a useful indicator of system or technique failures (Leung et al., 2003). The Choice Framework for local policy and procedure (CFPP 01-06) and the equivalent policy in Wales (WHTM 01-06) states that less than 10 colony forming units (or CFUs) of bacteria detected in 100ml of rinse water is considered acceptable. This figure is frequently referred to as the TVC (total viable count).
However, the relationship between rinse water CFU levels and endoscope contamination is still unclear - does a high level of rinse water CFUs correlate with contamination of the endoscope itself?
Strategy Group Review Date: 26th February 2016
Recommendation of AWMCDSG
Following consideration of the Health Technology Assessment on antimicrobial and antiseptic-impregnated urethral catheters (Pickard et al 2012*) and other evidence**, the strategy group were confident to make the recommendation that silver alloy urinary catheters should NOT be used within NHS Wales. The document was considered thorough with robust conclusions and the strategy group through their evidence based approach advised the use of silver alloy-coated urinary catheters did not support positive patient outcomes.
The requirement for exceptionality was considered and the strategy group agreed that none was required.
* Pickard et al. (2012), Types of urethral catheter for reducing symptomatic urinary tract infections in hospitalised adults requiring short-term catheterisation: multicentre randomised controlled trial and economic evaluation of antimicrobial- and antiseptic impregnated urethral catheters (the CATHETER trial) Health Technology Assessment 2012; Vol. 16: No. 47 ISSN 1366-5278
** The AWMCDSG acknowledge and were guided by the conclusions of the HTA** that there is, at best, no clinical benefit compared with standard catheters, that at worst they may increase the risk of UTI and that they are “unlikely to be cost-effective”.
Fluid flow accuracy of syringe drivers
Gavin Hughes, Joanna Ford, Pete Phillips
Syringe drivers are used for controlled administration of fairly small quantities of drugs. They can be set at a particular flow rate or controlled by the patient/healthcare professional in the case of analgesia. This article focuses on the accuracy of flow from syringe drivers that are set at a particular flow rate. Manufacturers often make claims regarding the flow rate accuracy of their products but they do not always stand up to the scrutiny of laboratory tests.
Factors that could potentially affect the accuracy of flow rate in syringe drivers could include the temperature of the medication (increased temperatures decrease the viscosity of fluids) (Capes et al., 1997) or the height of the syringe driver compared with the patient (Donald et al., 2007).
This paper sets out to investigate flow patterns and accuracy using one model of syringe driver over the course of an administration period.
Speciality needles - an update
Joanna Ford and Pete Phillips
22 June 2015
Historically, spinal needles have been used for a wide range of non-spinal procedures where regular hypodermic needles are not long enough. However, changes to the connectors on spinal needles in the near future mean that this will no longer be possible. This paper aims to explain the background and rationale for the proposed changes as well as presenting the current options for health care professionals who must find alternatives to spinal needles for non-spinal procedures.
Peri-operative bodywarming paper published in Journal of Anaesthesia
A review entitled 'Peri-operative warming devices : performances and clinical application' has been published in collaboration with Mark Harper and John Martin. Click on the citation below to view the abstract.