CJD Protein, NICE IPG196 & Instrument Coatings

The recent NHS Scotland Decontamination Seminar (11th May 2016) underlined the heightened focus around dealing with all aspects of CJD in decontamination of surgical instruments and how the risk can be reduced for NHS patients.

Alan Stewart, of Greater Glasgow Cowlairs Decontamination Site, presented his solution for the interpretation of the IPG196 guidance in relation to surgical instruments. The problem is, how can we ensure instrumentation used in high risk procedures for post 1997 born children/young adults, remains clearly identifiable and separate from pre 1997 instrumentation.

Alan and his team trialed a number of different solutions, including some coloured coatings. However, they found that the coatings were not robust enough and showed signs of coming off and a high repetition of  decontamination cycles. As a result of this issue, it was decided that laser marking would be used to distinguish the first stream of instruments.

Sulisti Holmes presented on current testing methods available for protein detection. There are a variety of swapping and semi quantitative protein detection methods available for decontamination staff to evaluate and implement. Dr Katy Sinka presented advice around Cjd incidents and their approaches for dealing with these.

The penultimate session of the day was by Stephanie Dancer, of NHS Lanarkshire (Microbiologist). Stephanie raised the issue of post sterilsation contamination and how her work around several incidents in Lanarkshire and led this to be traced back to poor standard decontamination practices, including dirty equipment and storage of sterile packs, which was found to be directly attributed to several post sterilization infections and one fatality.

This resonated with us, as Surgical Holdings have been looking at dealing with the issue of post sterilisation contamination and infection since 2009, when we met Dr Alistair Kean (then of Mantis Deposition) of NikaWorks (http://www.nikaworks.com). Dr Kean was applying nano coatings to medical devices, which were proactively antimicrobial, so we began work to look at applying these through various mediums to surgical instruments.

The aforementioned Cjd issues around decontamination have lead to the subject of coatings on instruments to be very pertinent. Surgical Holdings utilize NikaWorks exclusively as their coatings consultant and have developed robust coatings solutions firstly for the purpose of distinguishing and identifying surgical instruments. This can be directly utilised to solve issues such as Alan Stewart’s at Cowlairs. Our coatings are ultra hard and permanent and come in a variety of colours, allowing the customer to code their sets potentially, or they might simply decide to coat their Post 1997 instrument pool gold, as some customers have already started doing. This coating can also incorporate matrix marking, to provide a solution that meets the NICE 196 recommendations.

Colour coding is just one advantage of utililising coatings. NikaWorks and Surgical Holdings are working on groundbreaking solutions that will change surgical instruments forever. Issues as described by Dr Dancer above, could be dealt with proactively by instrument coating in the future.

As a proactive action, Surgical Holdings have also taken the step of designing a bespoke instrument finish on their current reusable instrument range, which is design protected at the Intellectual Property Office. Our new Duo Surface Finish provides the benefits of highly bright polished finish on the working end for the best cleaning and decontamination efficacy and a chic satin finished working end, to reduce glare as much as possible. The bright polish ensures the instrument can be effectively cleaned during reprocessing, which can improve protein adhesion resistance on a smooth surface and reduce the risk of corrosion.

Please email me danielcoole@surgicalholdings.co.uk if you would like any further information around the subjects discussed in this blog.