Labcaire References

Labcaire References: Decisions, Decisions

Decisions, Decisions

By Sister Sally Atkins, Gastro-Intestinal Unit Manager

Hope Hospital, Salford

One of the many responsibilities of busy clinical managers is making important purchasing decisions for major pieces of equipment for their departments. In addition the adhering to budget constraints, they must ensure that the chosen product performs to high standards, is reliable, safe and easy to use for staff at all levels, and is backed up by a good service from the manufacturer.

The Hope Hospital serves the Salford and Trafford areas of North West Manchester, and over the last few years we have been faced with making such decisions when looking for new endoscope disinfection units.

When the Salford Royal closed, their endoscopy service amalgamated with our unit at Hope Hospital, increasing the workload by one third. We now see over seven thousand patients a year in the two endoscopy suites within the Gastro Intestinal (GI) Unit.

The higher volume of procedures and the additional equipment transferred from the Salford Royal meant that we were continuously running four endoscope processors to maintain a supply of disinfected endoscopes. The endoscopes are disinfected with Glutaraldehyde, commonly used in health care as a biocide and chemical disinfectant for medical and surgical instruments since the mid 1960s. When first introduced it was regarded as a “safe” agent and it was some time before it became evident that it has the potential for adverse health effects. However, this is now well documented, with an extensive list of effects from exposure, the main one being occupational asthma from inhalation of glutaraldehyde vapour. The design of the existing auto disinfection equipment was quite outdated. Although the actual washing procedures were automated, the filling and emptying of the disinfection solution was completely manual, exposing staff directly to glutaraldehyde. The equipment was not plumbed in to our drainage system and its operation did involve quite a lot of hands on time. The main problem with the existing equipment was the lack of fume containment and the high release of vapour from the glutaraldehyde. With all our processors housed in one room, the amount of fumes was becoming a problem and we were at risk of exceeding the Health and Safety Executive (HSE) Occupational Exposure Standard for glutaraldehyde of 0.2 ppm.

With most of the “safe” alternatives to glutaraldehyde having cost or efficiency implications, we were left with the need to source new equipment as a means of ensuring staff safety. Our requirements were for endoscope processors that could cope with the large instrument throughput in the department whilst maintaining a safe atmosphere in conformance with HSE regulations. Consequently, we looked at various suppliers and tested three different systems for a fortnight each, with our final assessment based on their efficiency at controlling fumes, reliability, ease of use and cost.

The extensive trials of the range of equipment led to a clear choice for our purchasing decision. We invested in two units from Labcaire, a single F-DT and a Twin F Autoscope.

These machines met all our criteria and also offered other features that make them very user friendly. Most important to us is the total fume containment provided by the Labcaire equipment. The proof of this is that since installation of the new processors, the atmospheric levels of glutaraldehyde have been well below the recommended limits when checked in the biannual routine assessment by the Regional Health Authority. The Autoscope systems' design is based on the principles of Labcaire's ductless fume cabinets, which use specially developed and proven activated carbon filters for the chemisorption of fumes. Out staffs' protection is further guaranteed by the continuous monitoring of airflow and filter efficiency by the Eversafe system that will automatically signal any maintenance requirements.

In addition to the health hazards of inhalation of glutaraldehyde fumes there are other risks, such as allergic dermatitis, from direct skin contact with the solution. The Autoscope systems' design, also ensures against this. Remote handling enables staff to perform washing/sterilising of ‘scopes, irrigation of flexible ‘scope channels, disposal of waste solutions and self-disinfection of the machine without ever coming into contact with the disinfectant. The equipment also incorporates a sealed tank for storage of the solution when not in use.

With two lists of ten to twelve patients each day, five days a week, the Labcaire Autoscopes are being used continuously and have proved to be very reliable. This is vital, since we depend on them to sustain the efficiency of the GI unit. When the equipment has required routine attention we have found Labcaire's service engineers to be prompt, reliable and unintrusive and down time has always been minimal.

The staff have been pleased with the new Labcaire Autoscopes as they find them easy to use and feel reassured by such features as the ability to see the CIDEX glutaraldehyde solution going through the system. The full automation is a major advantage as it frees up more nursing time for patient care, but the option of manual operation provides maximum flexibility for tasks such as flushing through channels. The ability to change the cycles also suits our needs, enabling us to cope well with disinfecting the variety of different endoscopes we are using on a day to day basis.

Product recommendation from colleagues is always reassuring and following the success of the Labcaire Autoscopes in the GI unit, a Twin RF machine was purchased for operating theatres. Hope Hospital has seven main theatres and four day case theatres. A wide variety of endoscopes are used, many of which are autoclavable. Some however, such as bronchoscopes, gastroscopes and GU endoscopes are too delicate to autoclave and must be soaked in CIDEX.

Previously, we had no automated disinfection equipment and were just treating our endoscopes in open troughs. With the gastroscopes being used up to four times a day and the bronchoscopes about three times, the amount of exposure to glutaraldehyde when disinfecting ‘scopes was becoming a health risk for staff.

The Labcaire Autoscope has completely removed these hazards and staff are no longer at risk from respiratory or physical exposure to glutaraldehyde. The theatre staff have also found the equipment easy to use and have been well supported with training provided by Labcaire.

Elsewhere in the hospital, Labcaire also became the supplier of choice, providing a number of solutions for various problems in different departments and for a range of applications. For example, an RG four trough Autoscope was acquired for the Day Surgery Unit. This instrument is specially designed for use in theatres and provides increased capacity to cope with a heavy workload. Autoscope F-DT units were purchased for both the Intensive Care and Medical Investigation Units and an RF Autoscope, for sterilisation of flexible or rigid endoscopes, is now used in the Urology Department.

In making a major purchasing decision it is important, wherever possible, to actually test equipment in the setting in which it will be used rather than just rely on a manufacturers specifications and claims. In our experience the Labcaire Autoscopes have proved that their inbuilt design features fully meet the users needs and justify their long standing reputation.

Sally Atkins is well regarded in her field of Infection Control. She regularly lectures on ‘Basic Nursing Care' and ‘Standardising Nursing Care and Disinfection' on behalf of the British Endoscopy Education Society.

Eversafe is a registered trademark of Labcaire Systems Limited.

CIDEX is a registered trademark of Johnson & Johnson Medical Ltd., Ascot Berks, SL5 9EY.