First of all, I thought about the methodology of validation. In simple terms, the principle is to use an equivalent of human blood left as a residue on surgical instruments, devise a process that will remove it in the shortest possible time and, when the cycle is complete, all is left to prove that there is nothing left on the instruments. Simple…but is it really?
Every single part of the process is subject to interpretation or limitations, therefore we must be extremely cautious not to optimise cycles to clean blood equivalent from a set of instruments, that would never have been used in practice and then prove it with inappropriate method. Believe it or not, it happens quite often!
There is a lot of hype about the ProReveal system from Synoptics. It certainly helps evaluate whether the optimisation was successful by testing the regular load after the cycle, but one must understand its limitations. It only takes a picture of one side of the instrument at the time and does not check the inside of hollow instruments, meaning it must be used in conjunction with other methods to evaluate efficacy of the cleaning process for complex surgical instruments.
Although putting Dettol in Yakult is surely an abstract idea, you may however intuitively get the feel of the complexity of the problem we are dealing with when reprocessing surgical instruments. How many bacteria are in a bottle of Yakult, how much Dettol to add and how do I know that all bacteria are gone? I think there needs to be a balance between the advance in optimising cleaning efficacy of the machine as well as methods of protein detection after the cycle. It is the conjunction of these two methods that I see as the solution that will allow optimising cleaning processes comprehensively and, as a result, lower the risk of instrument carried infections.
I would like to take this opportunity to thank Dara O’Briain for seeding the “Dettol vs. Yakult” idea in my head. To find out more just watch this: https://www.youtube.com/watch?v=3cwYh3Qb4rc
…if you’re impatient, you can skip to 09:37.
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