18th World Sterilization Congress
Joint meeting of WFHSS and DGSV - Bonn, Germany. October 4-7 2017.
Beethoven Square - Bonn.
The conference sessions opened. Thursday 5 October
I skipped the morning run along the Rhine. Didn’t bring my trainers! The day started with breakfast Symposia from Miele and Dr Weigert.
The conference kicked off with an opening address by Wim Renders.
“Dare to Change” Wim outlined the evolution of CSSD and standards. He called for changes based on scientific rationale rather than relying on tradition, and called for global standardisation of practises. All CSSD should embrace progress and operate similarly.
Sterility Assurance was the theme for the first session. Hartmut Dunkelberg told us of his research
into shelf life. Airflow was tested into sterile packs. Findings were quite alarming. Only Tyvek
pouches remained sterile for longer than a few weeks. Polypropylene wrap lasted only 9 days.
Following air treatment in the store room by cold air plasma to reduce the microbial count, the
shelf life could be considerably increased. Polyproylene wrap remained sterile for up to 21 weeks.
Ingo Berthelsen presented the Air Mobile sterilisation unit of the German armed forces. He invited participants to visit the unit erected outside the conference centre.
Sandra Winter compared methods for pre-cleaning RMD. Various commercial agents were tested but found to be no better than placing the used RMD in a ziplock bag with moistened gauze swabs. The results also showed that all pre-cleaning methods resulted in cleaner RMD post automatic washing than when there was no pre-cleaning.
Winfried Michels presented the latest developments in cleaning robot instruments. The results were that the use of ultrasonic cleaning could replace the manual cleaning of DaVinci wrist instruments. Winfried recommended using H2O2 solution instead of steam cleaning to remove eschar.
Thomas Vanzieleghem discussed the removal of biofilm from endoscopes. These are best removed with enzymatic detergents at 40°C soaking for 60 minutes with 3 brushings – at the start, middle and end of the washing.
Wayne Spencer evaluated manual versus fully automated cleaning. Findings were that fully automated washing with a pre-clean by hand was the most effective. He called for development of a PCD that simulated box joints so that the wash efficacy could be more accurately tested. Wayne also discovered that larger crevices in instruments were the hardest to clean as there was more room inside for soil to adhere.
Teressa Normington moderator
Jochen Steinmann presented findings on the virucidal efficacy of Peracetic acid. Must have been the big German lunch. I found it very hard to concentrate and didn’t take any notes – sorry.
Matthias Tschoerner gave an interesting talk on staining of RMD. Stains are not harmful and do not detach. Brown staining of RMD could be from Silicone dioxide from steam condensate. Blue stains are Titanium dioxide from detergents.
Ulas Tezel gave us a very alarming insight into the proliferation of hyper resistant bacteria.
Sewage in Turkey was tested. They found microorganisms that were multi resistant to all antibiotics and used detergents as food.
Gerald McDonnell updated the audience with a very informative talk on the updated ISO and CEN standards on cleaning efficacy. The concern expressed is that accepting the current standard for cleaned RMD will miss the presence of protein. Prions are transmissible at levels 100-1000 times lower than can be detected by protein tests.
Roel Castillo discussed penetration times on various hollow instruments and how various steriliser cycle times may need to increase to ensure that there is adequate holding time at 134°C inside the lumen of instruments with an outer insulative covering.
Matias Pilasi also discussed air removal and steam penetration.
Sterilisers in nine hospitals in Chile were tested with PCD’s of different diameter and length.
There were varying results. Some sterilisers passed on empty loads but failed with full loads. Some failed completely but passed BI’s on the same load. The recommendation is that PCD’s were more consistently reliable than BI.
Robert Eibl from MMM discussed the validation of automated cleaning processes. Robert recommended that for validation, only 2 repetitions is sufficient, using the load carrier with the lowest water pressure. If wash cycles use the same chemistry, water supply, and carriers, and are of the same make and model then only one of them needs to be tested.
Anke Carter discussed manual cleaning and chemical disinfection to close off the day.
Friday 6 October
The day started with breakfast sessions. Borer presented their steriliser cleaning machine. It
removes those stubborn stains on the inside of the chamber that regular cleaning cannot.
The first session began with Tsagaan Gantumur and reprocessing RMD in Mongolia. Liver cancer is the biggest cause of death in Mongolia due to the 20% incidence of Hepatitis C and B. Access to healthcare is a major problem as the country is sparsely populated.
Walter Popp outlined the hospital hygiene project in Mongolia. Walter has visited many times and has engaged the German Ministry of Health to assist with funding and support for the project. A hand hygiene program is underway encouraging the use of paper towels and handwashing detergents. They also run vaccination programs for Hepatitis. One of the obstacles to providing quality care in Mongolia is access to medication. Many of the drugs used in the country are fakes from China and Russia, and are of no therapeutic benefit.
Martin Exner raised the awareness of the importance of surface cleaning. In Germany there are 1 million nosocomial infections each year and 225,000 post operative wound infections. MRSA has been increasing each year since 2011 when a statement decreed that environmental cleaning was not necessary. Currently they are developing tests to determine the efficacy of disinfectants. So far it has taken 18 years to develop a standard.
Christian Jakel discussed the prevalence of SUD reprocessing. Depending on which country, it can be illegal, legal, or unregulated. In Germany it is permitted to reprocess single use devices provided that stringent safeguards are followed. Next door in France it is banned.
Mirco Vitr presented the timely supply of sterile goods. In Aachen Hospital their IT system enables them to deliver just in time services by analysis of theatre lists. All RMD are washed immediately after use, but are only packed into sets and sterilised when required for theatre lists. This enables them to reduce their inventory and storage requirements, and nothing goes out of date. Staff wear ‘smart glasses’ which overlays
information into their field of view, e.g. they can view packing instructions while packing
instrument sets. Thomas Mickley reviewed processing costs. His analysis of costs was very thorough and findings demonstrated that the cost of a metal container was €1.43 to reprocess compared to €2.42 for a wrapped set.
Lunch Symposia – Matachana presented their latest equipment, including a washer that only uses approx. 20l of water per cycle. Much less than competitors.
Sulisti Holmes reviewed the findings from a critical incident in the UK, where a patient died from Hepatitis following a TOE procedure. Health Services in Scotland were surveyed, 60% of them did not follow the TOE manufacturer’s IFU for reprocessing and in most instances there was no SOP and the cleaning done by clinical staff. SOPS have since been developed.
Markus Wehrl discussed the development of PCDs to monitor the effectiveness of endoscope cleaning. 2m long, 2mm diameter transparent tubes were impregnated with sheep’s blood. 91.7% of visibly clean tubes still showed presence of protein after automated cleaning
Heike Martiny investigated the control of cleaning efficacy. Recommended that disinfectants not be used for cleaning as they fix biofilm to surfaces. Use of disinfectants in AER’s is ineffective if endoscopes are not cleaned first.
Holger Biering. Established a common test protocol to assess the biocompatibility of cleaning
chemical compatibility with surgical instruments
Thomas Kiessling Reviewed the legal aspects of RMD reprocessing in Germany and the progress made in German hospitals over the past 10 years to comply with KRINKO/BfArM recommendations.
Christophe Lambert discussed the validity of the water test for evaluating the seal efficacy of
containers. 29% of containers used in France leak. 76% of French containers passed visual
inspection. 87% of containers tested showed ingress of microbacillus. The water test is deemed
valid for determining the efficacy of the seal, failed containers should be removed from use.
Lena Cordie presented a broad perspective of ISO13485 quality systems for reducing risk in sterile processing.
Friday sessions concluded in time for the Gala dinner and cruise along the Rhine.