It was my first CSC conference and I must admit I did not expect it to be of such value. What I found particularly interesting was the multitude of perspectives on Decontamination Sciences. That is a great indicator and a reminder of the problematics’ complexity and how often different disciplines of science intersect with each other. I think there could not be a better start than Walter Popp talking shit! – literally and scientifically.
I have picked up on three issues that are worth elaborating on.
1. Decontamination of complex surgical instruments.
I was very much looking forward to the talk on developments on reprocessing of EndoWrist instruments for Da Vinci not only because of my experience with them but also because I did not have a chance to work on them for over two years. Wayne Spencer presented on behalf or Marcus Wehrl. The challenge that lays ahead -multiple linkages, electrical wiring and the mechanism that moves the EndoWrist head around – all that encloses in a hollow channel. Due to the complexity and mode of operation, and positive pressure of the end tip the seal does not always provide sufficient barrier for the contamination what results in body fluids entering the lumen cavity. This in turn creates a real challenge for reprocessing.
Apart from robotic instruments there is a whole range of rigid endoscopes and accessories that are being reprocessed on a daily basis by sterile services departments. Presentations by Dr Nayuni and Prof. Perrett gave good foundation for optimisation of Washer Disinfectors but at this stage ValiPro tags deal with challenges of external cleaning. I wrongly assumed that effective cleaning of simple instruments is throughoutly achieved but evidence shows clearly that we are still quite far away from effective protein removal – even in very simple cases. I also realised what a challenge it must have been for Medisafe to pioneer solutions and educating about the need for internal cleaning – kudos to them for not giving up.
On that note I must stress out that I got really worried about the revelation that manual cleaning of EndoWrist instruments is considered acceptable and even recommended as other companies besides Medisafe were not able to provide valid solutions for automated cleaning (hope I got this wrong). Taking into consideration that Medisafe had the technology for at least several years I would strongly question general progress in the sector. I am not sure whether allowing manual (unreliable and untraceable) methods is the way forward to diversify the market – I see this as a step backwards.
2. Science and Research versus Marketing and Sales.
I was positively surprised to see the opening slide titled “Annual Scientific Conference”. The lineup of speakers was also promising a healthy dose of recent research, findings and challenging problems. Unfortunately when I skimmed through the list of attendees I found out that there was only a handful of other academics and scientists on the commercial front there were mostly marketing and sales related representatives.
I believe that stronger proactive involvement of R&D is necessary to innovate and push the technology forward. These presentations do not provide simple answers but rather spin off discussions, ideas and give the possibility to exchange and validate concepts and ideas. I am thinking about the progress of entire sector.
We also need more scientific research. Decontamination is a fascinating science but still not many people actively research solutions. I also believe that more multidisciplinary research is needed that will engage natural sciences with engineering.
3. Instrument manufacturers – the core missing ingredient.
Two great presentations from Mark Higgins and Karen Tweed highlighted major problem of i suppose lack of communication between instrument manufacturers and sterile services. Results of Karen’s study show the incompatibility of solutions with decontamination processes and in some cases in my opinion a complete lack of understanding of the processes by manufacturers. Yes, it is the surgeon who instruments are designed for but they need to be safe at every single surgery.
Surgical Holdings were at the conference – and yet again Kudos to them as well as hopefully we will see surgical instruments that are designed with reprocessing in mind. Perhaps a formal invitation to CSC sent to other manufacturers – especially those mentioned in Karen Tweed’s research – would address the problem.
Conclusion
I am very much looking forward to future conferences and more debate. I would like to see more focus on the complex instruments and challenges they pose, more science and academic involvement as well as cross industry cooperation as this way we can come together and really make a change.
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