Extrospective approach to decontamination – the need for the external perspective

For some time now I have been thinking about the shape of the decontamination process. Almost everyone is now familiar with the famous multicolour diagram depicting the concept of surgical equipment reprocessing. That’s good news. However, at the same time, I am starting to think that we are too familiar with it. We take it for granted to the level where we stop questioning whether it is still the best solution for the constantly evolving knowledge and technology.

This familiarity with the process allows us to increase efficiency. We do it by dissecting its elements into smaller and smaller pieces and addressing the problems of technology, management and education, one step at the time. It is, however quite easy to get carried away and look for further improvements only inside, while neglecting emerging technologies which would really benefit from this kind of attention.

Another layer of complexity is added by the physical size and amount of dependent elements of the process itself, taking into consideration the size of the organisations it is implemented in. This size creates the inertia that does not allow to easily deviate from the current course of action.

Taking external perspective to the decontamination process is the only way to ensure we are not only doing the thing right but first and foremost, doing the right thing.

So, why do we need the external perspective?

The answer lays in changing circumstances we apply our known formula to. These circumstances define the context all elements of the overall processes are considered in.

Looking at the process introspectively, we risk neglecting the changes that are happening outside. Not only in the wide world of science and technology but also management that is affected by the general direction entire healthcare sector is taking.

Central sterile services departments are somewhat similar to large manufacturing plants set up for perfecting large volume production. Large volumes, quick throughput, minimisation of unit cost though advanced process control. Such system works well given sufficient volume and similarity of manufactured elements. Unfortunately, as soon as there is a need for something even slightly bespoke, a big problem occurs, as even minor changes to the components will require costly changes to the production process.

Thanks to the advancement in surgical technologies, decontamination departments get exposed to the variety of instruments, especially complex, at the scale never experienced before. The differences in instrument shapes, functionality and materials are growing and this trend is likely to continue. That is why, I believe we need to start looking at redefining the overall decontamination process and look at tailored solutions that maximise operational efficacy.

Moreover, I believe we should look at customisation based on individual instruments or groups of instruments, as within this variety it is not possible to properly optimise individual elements of the overall process. The problem is most significant with automated cleaning of complex instruments that involve cannulated elements of different shapes and sizes or moving parts that create permanent shadowing condition on the part of the mechanism (hinges, gears, levers, etc.).To add to the complexity they usually come in different materials. Such different elements do require different cleaning conditions.

We should also look beyond the load, at tailoring the process taking into consideration instrument use during individual surgical procedures especially in case of novel ones that are pioneered by highly specialised healthcare units.

I am an advocate of seeking the “why” that stands behind our way of doing things. We need that outside the box approach to fuel the research and development of new solutions that are fit for purpose and futureproof.

Taking external perspective to the decontamination process is the only way to ensure we are not only doing the thing right but first and foremost, doing the right thing.

About the Author

Pawel de Sternberg Stojalowski

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Pawel de Sternberg Stojalowski MBA, MSc, BSc is a research and development specialist focusing on innovation within decontamination sciences. He’s been involved in R&D since 2007, designing equipment, processes and methodologies for cleaning, disinfection and sterilisation of surgical instruments as well as medical and laboratory equipment.