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Sterile Service Department – What’s it all about?

Have you ever wondered what happens to all those dirty instruments used in Theatres or Clinics? I often hear people saying “What is ‘Sterile Services’, what do they do”? Well take a few minutes and allow me to introduce you to the fascinating world of decontamination.

What is Sterile Services?

A Typical Sterile Service department (SSD or HSDU Hospital Sterilising Disinfection Unit) will have typically between 20 - 80 sterile service personnel ranging from Technicians, Senior Technicians and Management Support Staff. The sterile service technician role is varied, but centres on the safe decontamination and processing of medical devices. These devices (Surgical Instruments and Flexible Endoscopes) include comprehensive re-usable surgical instrument trays, single packaged devices and consumable (disposable) packs.

A strict pattern of work is followed to prevent the risk of infection being transferred to other staff or indeed patients. Medical devices returned after use are washed and thermally decontaminated. This is done using fully automated washer / disinfector that allows for safe handling of devices. Afterwards, careful inspection of each device is carried out, often under high magnification, and a function test to ensure the device is working properly.

The instruments are then re-assembled and checked against an Instrument Check-List before being packaged in a clean room environment, either individually or as procedure sets, using special wrapping materials. Finally, packaged medical devices are placed into chambers (Autoclaves), which when sealed, are supplied with steam under pressure to destroy any remaining pathogens. After cooling the now sterilised devices are distributed to the next user.

High Quality service

Strict adherence to written operating procedures is essential and high standards of hygiene are maintained in the working environment. The Sterile Services department has to be accredited and compliant with ISO9001 / 2008, ISO 13485 and Medical Directive 93/42/EEC. This requires extremely high standards of work, including a requirement that all staff are adequately trained. The SSD and its processes are fully audited both internally and by external auditors. The quality standards are high as the life of a patient may depend on the correct equipment being available at the right time and in good working order.

 

3D printing is a newly popularised and innovative technique for producing a physical object from a three-dimensional digital model. Its an additive manufacturing process, rather than a subtractive. Subtractive processes carve away excess material from blanks. Additive processes build objects using layering techniques. This is typically achieved by laying down a large number of thin layers successively, of a particular substance, to recreate the original model to scale.

Imagine downloading a set of plans from the Internet for just about any solid object that you wish, adding the correct base materials to your 3-D printing machine and printing the object of your desire in your home or office. This is what 3D printing is capable of delivering in the near future. As well as drastically reducing production costs, 3D printing has also been recently been hailed as “the harbinger of sustainability”, with heavy research into using the most recyclable plastic filaments in the creation process.

Whilst 3D printing has been around, in one form or another, for well over a decade, it has only recently become something of a buzzword in the surgical industry. This innovative technology is being used in many different ways for everything from reconstructive surgery to brain surgery. 3D printers are currently producing casts for broken bones which are capable of healing the fracture up to 40% faster than a standard plaster and gauze cast. This is achieved via a built-in device that delivers low intensity ultrasound pulses, which was only recently discovered to hasten bone regeneration.

There have also been several reported cases, in the last 12 months, of successful surgical operations using 3D printing technology. These include the reshaping of a patients face after a motorcycle accident left him severely disfigured, and the replication of a baby’s brain that suffered with a form of aggressive epileptic seizures; enabling surgeons to study the area of his brain which was affected, by first producing a 3D printed replica. This process has been referred to as ‘surgical preparation via simulation’ as it enables surgeons to be prepared for every possibility before surgery has even begun.

Just last month in China, a 12 year old suffering with cancer had the very first operation of its kind. Surgeons at Beijing's Peking University Hospital removed a tumour in the second vertebra of the boy's neck and they then replaced the bone with a 3D-printed implant between the first and third vertebrae. After spending more than two months laying on his back, it’s believed that this groundbreaking surgery will enable the boy to walk again.

Image Source: Manufacture of surgical instruments at Surgical Holdings.

In February 2014, the Journal of Surgical Research published a study conducted by scientific researchers looking into the viability of 3D printing surgical instruments. The study showed that 3D printers are capable of producing sterile and durable surgical instruments at a cost of about 10 percent of the price of current stainless steel surgical instruments.

So now that 3D printed organs skulls and vertebrae can literally be a part of us, and research has shown how manufacturing costs can be drastically lowered, 3D printing is an emerging solution for a number of real world problems. The next step for the surgical industry should be to ensure that these processes and techniques are used more widely across the globe as the costs fall and as the design and manufacturing tools improve.

My first blog entry. What do I blog about? Well the one thing I feel passionate about, nursing.

Nursing is my vocation and has been for 25 years. I trained in the olden days, you know when Florence was swinging her lamp down in the Crimea.

My School Of Nursing was on site at the hospital as was my living quarters, we couldn’t escape.

It was tough. A thrown in at the deep end sink or swim kind of training. You survived or you didn’t, simple. My set started with 12, finished with 10, not bad and unusual at 5 women and 5 men.

We had Matron, just before she had to re-apply for her job as Manager, had a breakdown and retired poor thing. She was one scary woman but boy she ran it well. The re-org near on killed her.

So what has bought about this reminiscence? Well last week I had the pleasure of inducting a lovely newly qualified nurse into my workplace, a 25 bed nursing dementia unit. High, complex needs. I thought it was perhaps a good idea to do the medicine round together. I was not surprised to reach the end and realise that she had very little if any pharmaceutical knowledge. After 3 years training and a degree she could not tell me anything about ranitidine, domperidone and gaviscon, the very basics. This is something I have encountered again and again with both new nurses and students. So how did we get to the point where a nurse/student can tell me all about govt policy but not the medicines he/she is actually giving on a daily basis?

Back to ancient history. We were the penultimate set prior to the great saviour of nursing - Project 2000. We were told all about the disaster that was awaiting us in the new Millenium. An ever increasing elderly populous with complex medical needs and a complete lack of young nurses to care for them. It was obvious nurse training needed to change. So a bright spark thought that moving nurse training into university was a great way to go, much like the US. Except it soon became apparent that this was not going to work. Too much time in lectures and not enough time on practical skills resulted in nurses who were poorly prepared for qualified life. So a re-think was ordered. Now student nurses spend much more time ‘on the floor’ as it were, which is just as it should be. So much so that we had student nurses on placement in a previous nursing home of mine. They were there to learn washing, bathing, continence needs, nutrition and hydration, simple wound care, pressure area care, communication, record keeping, prioritising, medicines and team working. If a nurse does not have these skills early on she has little chance of developing assessment skills which are crucial in caring for people. Most of the students enjoyed it, some fell by the wayside but then they didn’t want to ‘nurse’ I have always maintained that nursing is a practical job, pure and simple.

There still appears to be little preparation for these students when they qualify. Their pre-ceptorship as it’s now called consists of all the things I learned in my 3rd year in preparation for running a ward. This is of course not the nurses’ fault at all.

Did the overhaul in training increase UK trained nursing numbers? No. In fact in the early 2000’s the Philippine govt place a moratorium on the numbers of nurses the UK could recruit such was the impact on their own hospitals. We are still recruiting 1000’s of overseas nurses each year. The NHS and private care homes would cease to function without.

On a side note. En’s. Yes Enrolled nurses. Wonderful, skilled, competent nurses. Scrapped as part of the overhaul. This was a major error in my opinion. The back bone of many wards these were the staff nurses back up, fabulous assets. Gone….but not forgotten by me.

Of course university training means a racking up of the entry requirements. A levels and GCSE’s in maths, English and a science essential. Forget about common sense, an eagerness to learn, a congenial personality, well presented, good communication skills and an unfailing willingness to want to help, nope, A levels is what cuts the mustard.

In some areas the diploma is no longer available and eventually nursing will be an all degree vocation. This makes my soul cry. There are so many young people out there who would be amazing nurses. Yes I know nursing has come a long way with technology and science however the principles of nursing have not changed one iota.

I’m happy that nurse training changed. My training was dangerous and risky and we had little prep for what we would encounter. I do not look at it with rose coloured spectacles. Some of my experiences still give me nightmares. Did the powers that be go too far? Yes….it does now appear they have noted their error. However they have a long way to go to produce competent newly qualified nurses who don’t need another years training to bring them up to scratch.

So what did I do with my lovely but pharmaceutically challenged nurse? I sent her home with a list of the most basic medicines to learn before we move onto the more complex ones and lord help me…drug calculations! 

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