Tony Forsyth, decontamination manager at BMI Decontamination’s facility in Stockton
Tony Forsyth, decontamination manager at BMI Decontamination’s facility in Stockton

A quality provider of surgical instrument decontamination and reprocessing services, BMI Healthcare’s Decontamination Centres recently completed an important and impressive scheme to centralise some of the reprocessing of endoscopes carried out in the individual hospitals.

Two of the organisation’s fully compliant facilities, at Aylesford in Kent and Stockport near Manchester, now include purpose-designed, state-of-the-art endoscope decontamination services. They enable many of BMI Healthcare’s hospitals to concentrate on patient care, safe in the knowledge that their delicate scopes are now being reprocessed to the highest standards.

Tony Forsyth, decontamination manager at BMI Decontamination’s Stockport facility, tells Hospital Matters: “From this site we service 12 hospitals for instrument decontamination. While the majority are BMI hospitals we look after several other customers. Additional hospitals are expected to come online now that we can undertake compliant endoscope reprocessing.

“About 18 months ago we looked at how certain hospitals were reprocessing their endoscopes on-site including reviewing the facilities and the age of the various machines they were using. The decision was taken to build an endoscopy reprocessing centre here in Stockport and a second facility at Aylesford.”

Penni Brennan, endoscopy supervisor, loads an endoscope into one of the Getinge ED-Flows
Penni Brennan, endoscopy supervisor, loads an endoscope into one of the Getinge ED-Flows

Tony Forsyth explains: “When we first took control of instrument decontamination off-site 12 years ago there was a degree of reluctance. However, in the fullness of time the hospitals have come to appreciate the benefits and reliability of the service. They are now all keen for us to take endoscope decontamination off their hands too, allowing them to concentrate on high quality patient care. They now see the new process as a ‘breath of fresh air’.

BMI hospitals have no worries over water quality

“We have the latest, high quality machines and facilities. So, the BMI hospitals have no worries over testing and water quality. Consolidation of the process through a centre of excellence takes those headaches and problems away.

“We looked at the pros and cons of the machines available on the market,” says Tony. “At the various BMI hospitals, we had used a number of different manufacturers’ endoscope washer disinfectors. This enabled us to speak to the users about their experiences.

The Getinge trolley wash
The Getinge trolley wash

“We looked at the hospitals endoscopy usage profile for the different scopes over 12-months. That helped procurement to decide how many scopes they’d need to purchase to cover periods of high usage. While the hospitals’ scopes are their property, BMI Healthcare has also invested in in many of the most modern endoscopes from Olympus. The hospitals can book these scopes for their lists and this will lead to an increase in bookings at these hospitals and a greater utilisation of the expensive scopes.”

Tony explains: “The plan was to establish two identical facilities. In terms of the layout, we had a clean slate here at Stockport. The area we’ve used was part of the warehouse and a meeting room. At Aylesford they used existing space, so the footprint there was more of an issue. While work began on both units at the same time, Aylesford had more limited space and completed its installation first. Here at Stockport, we were the longest on the build. We had to dig foundations and build a mezzanine floor for the plant room and a new meeting room. The work here was completed in April.

“The equipment specification is identical for both sites. We looked at cycle times, detergent usage, cost of consumables and service contracts. We operate seven-days-a-week, so we need a seven-day call-out facility. We invited various manufacturers to quote against the specification we had devised.

Feedback from existing BMI Healthcare users

“It was a close call but we chose Getinge. While cost is always important we’d had feedback on reliability from our existing BMI Healthcare users, some of whom had experience of Getinge’s latest machines.

“Our BMI users had spoken highly of Getinge for reliability, tightness of limits and that they test the system well. I’d rather have a failure than ‘ifs and buts’ and the scope go to a hospital and something goes wrong. Getinge also offered the service contract we were looking for.

“We carefully specified the centres with three, two-chamber Getinge ED-Flow machines,” says Tony. “It’s more than we currently need but we’ve allowed for future growth. It also gives us the capacity to deal with any eventualities, such as servicing or machine failure.

“The short cycle time is obviously beneficial and the machines are easy to use. There’s a recipe card for each type of scope on the system. The cards are programmed into the machines and show the technician the appropriate connectors for each scope.

“Water for the machines is supplied by a TripleRed duplex RO system, located in the new plant room above the reprocessing area. For the manual wash, we have two height-adjustable, twin-bowl sinks supplied by Neocare.

HM79D“To ensure the delicate scopes are safely transported to and from site, we designed a purpose-built transport trolley. This was also manufactured by Neocare. There are three transport trollies per hospital and each trolley will hold seven scopes. With the number of trollies and to ensure a high standard of infection control during transportation, we also installed a Getinge trolley wash.

“The Getinge Trolley wash ensures that each transport trolley and metal scope container are thoroughly cleaned every time they are returned to the unit.

“As all the scopes are delivered back to the hospitals, the project team chose Cantel Medical’s SureStore vacuum-packing system. We’ve installed two at each site. We already had experience of the SureStore at some our BMI hospitals. Using the system obviated the need for drying and storage cabinets.”

Tony explains: “The new HTM 01-06 is leading everyone to release the product through an independent monitoring system (IMS). Neqis IMS modules are built into the SureStore machines and fitted to the Getinge EWDs too. It’s easy to use and gives us all the information we need. We can interface with the washers without any problem.

Loading of the chemicals is a simple and safe process. No container needs to be opened as the membrane in the cap is pierced through inside the machine
Loading of the chemicals is a simple and safe process. No container needs to be opened as the membrane in the cap is pierced through inside the machine

“BMI Healthcare is already using Health Edge’s fully automated software system for tracking and traceability in the sterile services department, so we simply added the endoscope module.”

Tony says: “Equipment installation all went relatively smoothly, as you might expect with a completely new installation, compared with the hassles you can experience when replacing old with new.

“BMI Decontamination’s AE(D), Eric Miller, who worked with us throughout the scheme, signed-off the completed projects.

Aylesford went live early March. With the additional building work required at Stockport, we completed the new facilities here in April and are now gradually migrating the hospitals work across and increasing activity.”

Tony explains: “We worked with the hospitals to ensure that all the existing endoscopes held by them were thoroughly serviced to meet the exacting standards demanded by the Getinge ED-Flows. We want to ensure that we will be reprocessing scopes that are more likely to ‘Pass’ in the washer, rather than have the higher number of ‘Fails’ you may experience when first operating new machines.

“It was pretty hectic here in the weeks prior to the ‘go-live’. We cross-trained staff and took on new staff for logistics and administration, for booking-in the scopes, and new technicians for endoscope reprocessing. We were also pleased to promote one of our existing decontamination team leaders to endoscopy supervisor.

Singing from the same hymn sheet

“We’re all new to endoscopes here, so we were all learning afresh and being trained together. No-one brought in old procedures. So, all the staff are ‘singing from the same hymn sheet’. All the training was delivered by experts in their field and we’ve written the procedures.

“The staff interest was excellent throughout. We had many of them wanting to be involved with the new processes, which is refreshing these days.

“Getinge delivered the washer-disinfector training. This will be followed up with further sessions for the operators and support staff to enable them to become more comfortable with the machines. Getinge helped every step of the way – from the manual cleaning at the sinks, water process, consumables and advice and help on making up all the connectors for the scopes. They handled all that for us.

“Karen McHale delivered the Getinge training and, while Karen was away, Helen Ashwell made up the connectors and saw us through the ‘go-live’ stage.

“We also had training on the endoscopes from Fuji, Pentax, and Olympus, and from Cantel Medical on the operation of the SureStore for the vacuum packing.

“I completed the Management of Endoscopes course with Getinge and the Weekly Endoscope Testing course with AVM,” says Tony. “The Quarterly and Annual training will be undertaken at Eastwood Park.

The Getinge chemical store
The Getinge chemical store

Tony is rightly proud of the well-designed and equipped endoscope reprocessing facility. It beings with a gowning area with interlocking doors. This leads into the spacious receiving area, where the incoming trollies with their loads of used scopes arrive from the various BMI Healthcare hospitals.

“Following existing items which they’d manufactured for Aylesford, Neocare were chosen for the two, manual wash, height adjustable, twin-basin sinks,” says Tony. “The design, standard of finish and workmanship are excellent, very high quality.”

Tony explains: “The sinks have a Getinge supplied ScopeTech for leak testing of the scopes, detergent dosing, and temperature recording. They help reduce the risk of repetitive strain injury for the technicians, as flushing of the scope channels is effortless. ScopeTech also ensures consistency of operation.

“Getinge Natural Detergent is automatically dosed into the sinks for the manual wash of the scopes.”

Once the transport trollies are emptied they are loaded into the Getinge pass-through trolley wash. The machine takes two trollies at a time in a 45-minute cycle.

Following the manual wash the scope and its tray are loaded into the endoscope washer-disinfector. The department has three of the popular Getinge ED-Flows, each with two asynchronous chambers, allowing up to six scopes to be processed at any one time, in an efficient, 24-minute cycle.

“The ergonomics of the machines are good,” explains Tony. “Staff have found loading the scopes very easy and straightforward. RFID control logs the user and every step of the process. This also helps the machine identify the type of scope and model.

Windows in the machines add to the light and airy atmosphere, aiding a better working environment
Windows in the machines add to the light and airy atmosphere, aiding a better working environment

“All the connectors are colour-coded, which is supported by the display that identifies each channel. There’s a full LCD display on each machine, which shows each stage of the process, with such things as cycle time, temperature and any faults which might occur. We have a full list of fault codes. So, should a fault arise, we can advise the engineer in advance before they arrive on site.

“The technician can view the chamber through the glass top and see the process. That was not the case with some of the other machines, which had metal doors. Also, with the windows incorporated into the ED-Flows, users can see through into the clean area, which adds to the spacious feel.”

Designed with staff safety in mind

Designed with staff safety in mind, Getinge ED-Flows use the highest level of peracetic acid-based Aperlan disinfectant to ensure a safe endoscope. Aperlan is delivered in two separate containers, Aperlan A and Aperlan B, to support safe transportation and storage, with no risk of staff exposure during chemical loading.

Tony explains: “When we looked at safety of use of the chemicals, ease of changing the bottles was a key factor. One of the benefits of Getinge’s Aperlan, is that no container needs to be opened as the membrane in the cap is pierced through when it is inside the machine. So, the chemicals are mixed within a fully controlled environment. Loading of the chemicals is a simple and entirely safe process. There’s no possibility of mixing up the containers as they are different shapes, as are their receptacles in the machines.

“We have a Getinge chemical storage cabinet for the Aperlan. It uses filtered air and there are spillage trays on each level. We also have a spillage kits available to deal with any spillage from the chemicals.”

Tony says: “Providing the cycle passes, the machine’s door will open on the clean room side. This gives the technician the assurance that the scope has successfully completed reprocessing.

“Traceability-wise, the ED-Flows give a full print out, which can be compared to the independent monitoring system. The IMS has senores in the machine which independently monitor the different levels, which it compares against the machine levels. It will Pass or Fail on the IMS and allows the user to interrogate the data. This enables us to pick up on any potential points of failure before they become a major fault.

Using the SureStore system obviated the need for drying and storage cabinets
Using the SureStore system obviated the need for drying and storage cabinets

“In the positive air pressure clean room, we wipe down the exterior of the scope with sterile pads, to ensure it is dry externally, before placing it into the shaped tray of the SureStore system,” says Tony. “The SureStore pumps a solution of hydrogen peroxide through the channels to prevent bacterial growth and safely seals the scope into the vacuum-packed tray. The scope can remain in the sterile environment of the vacuum-packed bag, which has a tamper-proof seal, until it is required in the hospital procedure room. The process is validated to ensure the scopes are kept in an air tight vacuum for an approved period before the hospitals use them.

“BMI Healthcare has taken the step to only use the SureStore vacuum pack system and to then transport the scopes to the various hospitals. Adopting the SureStore system obviated the need for drying and storage cabinets.”

There are two Goldsworth pass-through hatches. “We already had Goldsworth pass-through hatches in the sterile services department,” explains Tony. “There’s a large one for a trolley and one for individual trays. These lead through to the despatch area.

“The SureStore trays fit snugly into the holders in the transport trollies to protect the delicate instruments during transit. ‘Fit for purpose’ is the major criteria here and they fit the bill perfectly.”

Good working environment for technicians

Eric Miller, BMI’s AE(D), who worked closely with Tony and Steve Buchanan, chief engineer at BMI throughout the project and was responsible for signing-off the scheme, says: “I’m impressed with the unit and how it’s turned out. It’s very bright, very airy, which makes it a good working environment for the technicians. This is important when people are inside working all day.

“The department shows how endoscope reprocessing has moved forward over recent years. They’ve allowed for future growth and achieved the HBN13 standard in terms of layout, together with ISO 15883 for endoscope reprocessing and HTM 01-06 the guidance for the management and decontamination of flexible for endoscopes.”

In the spacious and well laid out reprocessing suite, Penni Brennan, endoscopy supervisor, explains: “The training was excellent. Getinge were on hand during the ‘go live’ for any queries we had with the machines and the chemicals. They were very helpful indeed.

“The machines are easy to use and efficient, really quick, giving a thorough washing process. Everyone’s really happy with the equipment, its top of the range. Staff from the hospitals have visited and they’ve all been really impressed with everything here, compared with their own on-site facilities. This is much more high-tech.”

Tony says: “The Stockport unit was designed on a blank canvas, without compromise. This allowed us to ensure that space was not an issue and that the flow of the process was as required.

“These projects we’ve undertaken for endoscope reprocessing are a new and exciting venture for BMI Decontamination and the hospitals we serve. The clinical leads from each hospital have been very impressed with the facility.

“The help and training given by Getinge throughout the project has proved invaluable as many of the staff had little experience in the field of endoscopy.

HM79J“The Getinge ED-Flows provide an easy to use experience for the technicians and ensure that each scope is cleaned and tested to the highest standard. This will enable the hospitals to deliver the highest standards of patient care.”

Tony adds: “We started receiving scopes from the first hospitals in mid-April. Over the past few weeks we’ve successfully migrated a further three hospitals. Three more hospitals will migrate over the coming weeks.

“We’re seeing a good demand for scopes daily from each hospital and the equipment is dealing with the capacity.”

For further information, call Tony Forsyth on 0161 476 7981 and Getinge UK on 01773 814730 or visit www.getinge.com