Nitrous Oxide in the NHS – Risks, Plans, and Targets

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For years, the NHS made extensive use of nitrous oxide as an anaesthetic gas. Yet there are concerns that prolonged exposure to nitrous oxide could pose certain health risks. Practitioners are also becoming increasingly aware of the possible environmental impact of using anaesthetic gases.

How is Nitrous Oxide Used in Healthcare

Nitrous oxide is an odourless and colourless gas. In sub-anaesthetic concentrations it acts as a powerful analgesic. It is most commonly used in a 50:50 mix with oxygen. This mixture is otherwise known as “gas and air”, or Entonox.

Nitrous Oxide Health Risks

Short-term exposure to Entonox can cause dizziness, fatigue, and nausea. Long-term exposure can affect the body’s capacity to absorb vitamin B12. This can damage the body’s nervous system and red blood cells, which can lead to a number of neurological conditions.

Prolonged exposure to nitrous oxide may also increase the risk of developing certain liver and kidney diseases.

The exposure risks for patients are low, as patients inhale the gas through a demand valve. However, when they breathe out, they can release some of the nitrous oxide back into the room. Over time, this can create an exposure risk for medical personnel. The risk will be greater if there are ever any gas leaks, or if staff routinely administer the gas in a poorly ventilated area.

This is why it’s essential to monitor the levels of nitrous oxide in hospitals. Our workplace exposure monitoring servicecan help you address your staff’s exposure to nitrous oxide and other potentially harmful substances.

Nitrous Oxide Environmental Risks – And The Solution

In a 2022 report, the NHS discussed the environmental impact of using certain anaesthetic gases. They revealed that emissions from one bottle can produce the same amount of carbon as burning 440kg of coal.

The NHS’s long-term plan is to reduce the carbon footprint associated with anaesthetic gases by 40%. Part of this strategy involves switching to lower carbon alternatives, such as sevoflurane.

The NHS is also exploring techniques for capturing, destroying, or reusing anaesthetic gases. They estimate that capturing and destroying nitrous oxide could cut over 33% of their total anaesthetic emissions.

There’s also a focus on cutting down on nitrous oxide wastage. Up to 30% of nitrous oxide may remain in cannisters after use. This residual gas can carry an environmental risk if it leaks, and recycling or reusing it can prove difficult.

We Can Help You Address The Risks of Nitrous Oxide in Your Hospital

Nitrous oxide leaks in your hospital contribute to your overall carbon footprint, and they may also present long-term workplace exposure risks for your personnel.

Keeping on top of equipment maintenance can help prevent leaks. It’s also important to ensure that any area of your hospital where nitrous oxide or other anaesthetic gases are administered is as well-ventilated as possible.

Yet if you want to address the exposure risks in your hospital, first you will need to understand the risks. This is where we can help. Our workplace exposure monitoring service can help you address your staff’s exposure to nitrous oxide and other potentially harmful substances.

We can provide a comprehensive report including discussions and recommendations based upon our findings. In this way, we can help you meet your COSHH obligations wherever your staff are exposed to hazardous substances in your hospital.

For information on our workplace exposure monitoring services, give us a call on 0845 226 0185 email us at info@cairntechnology.com

Greenwashing in Healthcare – How to Take Effective Action

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In recent years, growing numbers of healthcare providers have been accused of “greenwashing”.

In this post we’ll explore what greenwashing in healthcare is, and what it looks like. We’ll also explore some ways you can ensure your environmental performance delivers in practice, and not just on paper.

What is Greenwashing?

“Greenwashing” essentially means that there’s a disconnect between your environmental policies and your environmental practices. It means that you might describe your services and your operations as environmentally responsible and sustainable, when in reality your practices are not nearly as green as they seem.

Why Does Greenwashing Happen?

Greenwashing isn’t always intentional. Sometimes it can happen by accident, when managers overlook certain processes, or when staff members or service users do not properly follow certain procedures.

But increasingly, people want to know that the services they use are taking steps to address the environmental impact of their operations. So if you claim to be green, then you must ensure you deliver on your promises. Otherwise, you could be misleading the public. And in healthcare settings, overlooking the environmental impact of certain processes can also carry some health risks.

What Does Greenwashing Look Like in Healthcare?

Your healthcare setting might set an environmental policy, and you might make certain declarations, and set certain aims, in your internal documents and communications. You might also communicate your environmental goals to your staff and patients, via onsite posters, leaflets, brochures, and even press releases.

If your environmental impact does not meet the standards you set in these materials, then you might be accused of greenwashing.

Examples of Greenwashing in Healthcare

How Can Healthcare Take Effective Environmental Action?

The need for effective infection prevention and control can make going green particularly challenging for healthcare settings. For example, how can a hospital commit to reducing waste when the Standard Infection Control Precautions advise using single-use items as often as possible? How can a care home embrace recycling when PPE best practice often advises disposing of items immediately after use?

The answer – and it is by no means an easy one – is to review all of your operations, from start to finish, and look for any areas where you might make any improvements to your environmental performance. And you need to do this without compromising on your operational efficiency, or your infection prevention and control processes.

Once you have reviewed your processes and established some possible areas of improvement, you need to communicate these to all staff at all levels. Your staff will be accustomed to doing things in a certain way. They might need some additional training if they need to get used to a greener way to complete a certain process.

Case Study – The Green Theatre Checklist

For some examples of how healthcare teams can improve their environmental performance without compromising on care standards or safety, take a look at the Green Theatre Checklist. This is a set of guidelines for how operating theatre teams can address their carbon footprints and work towards sustainability in surgery.

It recommends actions for every stage of surgery, from anaesthetic care to postoperative. Guidelines include:

  • Sourcing materials as locally as possible, to cut down on carbon emissions during transit.
  • Using “greener” substances wherever possible, such as sevoflurane instead of isoflurane.
  • Switching to reusable equipment wherever possible. Your PPE may always have to be single-use. But other equipment, such as underbody heaters, slide sheets, and trays, can be reusable.
  • Minimise waste. For example, follow a policy of “don’t open it unless you need it” when it comes to drugs and single-use equipment.
  • Reduce your water and energy consumption. This could include switching to automatic or peddle controlled taps. And when it comes to hand hygiene, adopt a “rub not scrub” approach: A water scrub to start the day, and alcohol rub for all subsequent procedures.

You can access and download the full Green Theatre Checklist.

Case Study – “Toxic Air at the Door of the NHS.”

The Toxic Air at the Door of the NHS report revealed that over 2,000 UK health centres are located in areas where the atmospheric concentration of particulate matter exceeds the World Health Organization’s recommended limits. This accounts for around 25% of all hospitals in the UK.

Particulate matter – including PM2.5 and PM10 – is a hazardous air pollutant that can contribute to, or worsen, a number of health conditions when inhaled. Road traffic is a major source of particulate matter. According to one study, over 20,000 respiratory and cardiovascular hospital admissions each year can be linked to air pollution.

Hospitals and healthcare settings might address this problem through setting strict onsite speed limits, and through banning smoking on the premises. Though as we suggested earlier, unless you also take measures to address the air quality inside your healthcare setting, then you might reasonably be accused of greenwashing.

There are two strategies you can adopt to improve the onsite air quality throughout your setting:

We Can Help You Deliver On Your Environmental Policies

At Cairn Technology, we can advise on switching to products and services that will help you cut down on unnecessary waste without compromising on your infection control or your operational efficiency.

We have a wide selection of reusable high-quality surgical instruments. Make the switch from single-use instruments and help to cut down on the waste associated with their mass production and disposal.

Take a look at our super absorbent floor mats, which cut down on the waste associated with higher volume production and waste of mats with much lower absorbency, such as inco pads.

We can also provide specialist air quality monitoring services, and we stock a complete range of hospital-grade air purifiers.

Get in touch with our friendly team of expert consultants to discuss your requirements today.

A Net Zero NHS: Plans for a Sustainable Tomorrow

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The NHS, like many large organisations, is taking a proactive approach to reducing its carbon footprint by achieving Net Zero.

Net zero refers to the balance between the amount of greenhouse gases emitted and the amount removed from the atmosphere.

Achieving net zero emissions is a critical step in mitigating the impact of climate change. The NHS, as one of the largest employers in the world, has a substantial carbon footprint primarily due to energy consumption, transportation, and waste generation.

The Health and Care Act 2022 requires commissioners and providers of NHS services to specifically address the UK Net Zero emissions target.

In its report, Delivering a ‘Net Zero’ National Health Service, the NHS has set out two clear targets:

  • Achieve a net zero NHS by 2040 for emissions directly controlled by the NHS.
  • Achieve a net zero NHS by 2045 for emissions that the NHS can influence.

How will the NHS achieve Net Zero?

To achieve this, it will look at reducing emissions from the 3 scopes covered by The Greenhouse Gas Protocol, which are:

  • Scope 1 – direct emissions from sources that are directly owned and controlled by the NHS, e.g. anaesthetics, NHS fleet and leased vehicles, etc.
  • Scope 2 – indirect emissions from the generation of purchased energy, mostly electricity.
  • Scope 3 – all other indirect emissions that occur in producing and transporting goods and services, including construction, medical devices, staff commuting, etc.

In addition, as part of the NHS Carbon Footprint Plus, they will aim to reduce emissions from patient and visitor travel to and from NHS services, and medicines used at home.

Key Components of the NHS Net Zero Plans

  1. Optimising Estates: The NHS estate and its supporting facilities services comprises 15% of the organisation’s total carbon emissions profile(1). As a result, it will look at at a number of interventions to reduce emissions. These will include upgrading existing buildings and optimising building usage, as well as generating renewable energy on-site and building 40 new NHS Net Zero Carbon hospitals.
  2. Travel and Transport: Approximately 3.5% (9.5 billion miles) of all road travel in England relates to patients, visitors, staff and suppliers to the NHS, contributing around 14% of the organisation’s total emissions. To address this, it will look to transitioning its fleet to zero-emission vehicles. Other measures include reducing unnecessary journeys through preventative medicine and digital care, and enabling healthier, less polluting types of travel such as cycling and walking.
  3. Supply Chain: While the NHS does not control emissions directly from its many suppliers, it can use its considerable purchasing power to influence change. From reducing the use of single-use items in hospitals, to sourcing more local food suppliers, and transforming anaesthetic practice, the NHS will use an array of methods to optimise its carbon footprint. It will also push all suppliers to decarbonise their own processes and activities.

The Net Zero Emissions Journey

The NHS’s net zero plans underscore its dedication to addressing the global climate crisis and ensuring a sustainable future for generations to come. By focusing on energy efficiency, sustainable transportation, responsible procurement, waste reduction, and carbon offsetting, the NHS will be able to make significant reductions in emissions.

However, the nature of its commitment means that its Net Zero journey will take it far beyond its medium-term targets, with innovation in products and services continuing to enable improvements on an open-ended basis.

How we can help

We are already helping NHS hospitals to reduce their carbon footprint in a number of ways:

  1. By supplying reusable surgical instruments with a much lower cardon footprint than disposables – click here for more information
  2. By supplying super-absorbent mats that reduce the amount of waste generated through producing the mats and disposing of them compared to inco pads and less absorbent mats – click here for more information
  3. By offering workplace exposure monitoring services that help to identify anaesthetic leaks and thus mitigate losses that escape to atmosphere – click here for more information

If you would like to talk to the Cairn Technology team about how we can help your hospital with its Net Zero plans, please call us on 0333 015 4345 or click here to contact us via web form and we will be happy to help.

 

(1) All statistics in this article are drawn from https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf

 

What is a Clean Air Zone: Which Hospitals Are In Clean Air Zones?

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Local authorities are introducing clean air zones in towns cities across the UK.

What is a Clean Are Zone?

Clean Air Zones are designated areas where authorities will take targeted action to improve the local air quality. The measures mainly involve targeting vehicle emissions with charges for any vehicles that exceed certain emission standards. There may also be reduced speed limits in clean air zones, which have been shown to have an impact on air quality.

Why Are Authorities Introducing Clean Air Zones?

The Government’s Clean Air Zone framework states that clean air zones are being introduced with a specific focus on reducing NO2 concentrations.

What is NO2?

NO2 is nitrous dioxide, a harmful chemical compound that’s mainly formed in the combustion of fossil fuels. You can read our full guide to the health risks associated with NO2.

But NO2 is not the only hazardous or toxic air pollutant found in vehicle exhaust fumes. Clean air zones can also help reduce levels of particulate matter, including PM10 and PM2.5.

The Different Types of Clean Air Zones

There are four types of clean air zones – Class A, Class B, Class C, and Class D. Each class denotes the type of vehicle to which restrictions apply:

  • Class A – Buses, coaches, taxis, private hire vehicles.
  • Class B – All of the vehicles included in Class A, along with heavy goods vehicles.
  • Class C – All of the vehicles included in Class A and Class B, along with vans and minibuses.
  • Class D – All of the vehicles included in Class A, Class B, and Class C, as well as cars. In Class D clean air zones, the local authority may also include motorcycles.

Which UK Cities Have Clean Air Zones?

Currently, seven UK cities have clean air zones:

  • Bath – Class C, 1.2 square miles.
  • Birmingham – Class D, 2.96 square miles.
  • Bradford – Class C, 9.35 square miles.
  • Bristol – Class D, 1.18 square miles.
  • Portsmouth – Class B, 1.16 square miles.
  • Sheffield – Class C, 0.9 square miles.
  • Tyneside (Newcastle and Gateshead) – Class C, 0.94 square miles.

Greater Manchester is also planning to introduce a clean air zone, though it’s not yet apparent what class this zone will be, or how big an area it will cover.

In addition to this, London has a separate system of low and ultra-low emissions zones (ULEZ). There is also a separate system of low emission zones (LEZ) in certain Scottish cities.

The Importance of Clean Air Zones

Clean air zones may have a positive impact on public health. For some years now there have been serious concerns about the effects of air pollution on vulnerable populations – particularly in healthcare settings.

One report found that 25% of UK hospitals are located in areas with dangerously high levels of air pollution. A further study found that 60% of hospitals and NHS facilities in London are in areas that exceed air pollution limits.

Which UK Hospitals Are in Clean Air Zones?

To find out which UK hospitals are in Clean Air Zones, check this RAC Foundation clean air schemes map. In some areas there may be certain exemptions for hospital patients driving in clean air zones.

In Bristol, for example, residents do not have to pay to drive in the zones if they qualify for NHS travel costs support. This includes people on benefits such as universal credit, income support, and jobseekers allowance.

Is Your Hospital in an Area With High Pollution Levels?

If your hospital or healthcare setting is not located in a clean air zone, then you may have concerns about the pollution levels in your area, and the effects they may be having on staff, patient, and visitor health.

Cairn Technology can help you address the air quality in your hospital. We can provide specialist air quality monitoring schemes in any areas of your hospital where vulnerable patients congregate, as well as any areas where there may be exposure risks for your staff.

We also stock hospital-grade air filtration systems which can help you significantly improve the air quality in your hospital – and quickly.

Our Blueair HealthProtectTM air purifiers are fitted with advanced HEPASilent technology. This is capable of catching 99.97% of particles down to 0.1 microns, which includes PM2.5 fine air particles. But at the same time, they’ll capture many other hazardous and toxic air pollutants. They can also capture and kill 99% of viruses and bacteria.

Take a look at our specialist air purification systems for hospitals.

DAS 2024 – Decontamination and Sterilisation Conference

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Is DAS 2024 already in your calendar? If you are a decontamination manager or lead, or part of the sterile services team then this is an event not to be missed.

Taking place on 6th February at the National Conference Centre in Birmingham, this transformative conference aims to shape the future of decontamination and sterilisation.

DAS 2024 Speakers and Workshops

Hosting a range of speakers including Trevor Garcia, Chairman of the Institute of Decontamination Sciences, and Sharon Fox, Head of Decontamination at University Hospital Birmingham NHS, talks will cover a range of topics from developing an effective staff competency framework to best practise for patient safety.

There will also be 15 workshops throughout the day, exploring topics including:

  • the role of the decontamination lead,
  • innovations in ultrasound decontamination,
  • advanced endoscope decontamination, and
  • the role of surface disinfection.

Other benefits for Decontamination Professionals

As a delegate, you can access a host of other benefits:

  • earn 7+ hours of CPD Accredited Points for your Annual Assessments,
  • interact with leaders in decontamination and sterilisation,
  • connect with professionals and stakeholders in the field, and
  • shape practices in decontamination and sterilisation.

Interested in best practice and products?

Come and see us on stand B12 to find out why decontamination and CSSU managers across the UK specify our products and services.

  • Stille Surgical Instruments

Come and handle our range of Stille surgical instruments, which are warrantied for 30 years.

You’ll be able to see how these instruments have been carefully designed to optimise longevity through ease of cleaning and maintenance. That’s why they offer exceptional precision, strength and durability despite decades of use.

Covering a wide range of specialisms from general and orthopaedic surgery to cardiothoracic, plastic surgery and more, they can be the stalwarts of your instrument sets for years to come.

To find out more about our Stille surgical instruments click here.

  • COSHH Monitoring for Endoscopy

Our workplace exposure monitoring helps endoscopy departments to achieve and maintain their annual JAG accreditation.

This provides important evidence that an NHS or independent UK endoscopy service is competent to deliver against the criteria set out in the JAG standards and fulfil IHEEM annual AE(D) audit part 9.6.

Our monitoring of endoscope decontamination rooms is carried out to assess staff exposure to peracetic and acetic acid.

It enables our customers to demonstrate that their control measures are keeping any exposure within required limits, as stated in regulation 10 of the Control of Substances Hazardous to Health 2002 Regulations (COSHH).

To find out about our monitoring service for endoscope decontamination rooms click here.

Want to attend the Decontamination and Sterilisation Conference 2024?

To find out more about the DAS 2024 speakers, agenda and how to register just click here now.

We look forward to seeing you at the conference!

 

Health and Wellbeing and Indoor Environmental Quality in Buildings – A Guide to BS 40102-1:2023

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BS 40102-1:2023 – Health and Wellbeing and Indoor Environmental Quality in Buildings is a new code of practice which launched in April 2023.

In this post we’ll explain what BS 40102-1:2023 entails and discuss how you can meet the new regulations in your workplace.

What is BS 40102?

This new code of practice outlines a monitoring and reporting strategy for assessing wellbeing and indoor environmental quality (IEQ) of non-domestic buildings. It establishes a rating system for benchmarking the quality of the:

  • Air
  • Light
  • Thermal comfort
  • Acoustics and soundscape

With these benchmark scores, facility managers can identify any problematic areas and make any necessary improvements.

BS 40102 applies to all forms of non-domestic buildings, existing or new.

Why Has ‘Health and Wellbeing and Indoor Environmental Quality in Buildings’ Been Introduced?

The BSI Group acknowledges that previous regulations, coupled with certain commercial pressures, encouraged designers, builders, and facility managers to prioritise energy efficiency. All too often, a focus on energy efficiency means that the health and wellbeing of a building’s occupants gets overlooked. For instance, a building might be constructed with efficient insulation, but with little thought given to the quality of ventilation and light levels.

These new standards will help facility managers and others improve the IEQs of the buildings they oversee. Improving IEQ can help reduce operating costs through increasing energy efficiency. But for hospitals and other healthcare settings, addressing IEQ can help improve staff and patient health and wellbeing while contributing to infection prevention and control.

BS 40102 Air Quality Standards

When it comes to air quality, BS 40102 outlines rating systems for:

Example Indoor Environmental Quality Benchmarks

Below are the BS 40102 rating systems for two forms of particulate matter – PM2.5 and PM10.

PM2.5

Level Description 24 Hour Average (μg/m3)
0 Very High ≥32
1 High 16 – <32
2 Acceptable 10 – <16
3 Low 5 – <10
4 Very Low <5

 

PM10

Level Description 24 Hour Average (μg/m3)
0 Very High ≥68
1 High 46 – <68
2 Acceptable 30– <46
3 Low 10 – <30
4 Very Low <10

 

How Cairn Technology Can Help You Meet BS 40102 Regulations

We can measure the air quality throughout your healthcare setting and monitor your staff’s exposure levels to any potentially harmful substances. As well as the hazardous pollutants covered by BS 40102, we can also test for levels of sevoflurane, isoflurane, Entonox, and more. This will help you understand your risk levels so you can devise an air quality solution that works for you. Head here to learn more about our bespoke air quality monitoring services.

We also stock a range of specialist air purification systems. Our Blueair HealthProtectTM  air purifiers are fitted with advanced HEPASilent technology. This is capable of catching 99.97% of particles down to 0.1 microns, including PM2.5 fine air particles, as well as VOCs, dust, mould, and up to 99% of viruses and bacteria. Browse our full range of hospital grade air purifiers.

Acetic Acid Medical Uses, Hazards and Exposure Limits

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Acetic acid is a clear and colourless organic liquid with a strong vinegary odour. Household vinegar is about 5% acetic acid and 95% water.

In this post we’ll examine some of the risks associated with acetic acid and discuss some of the ways you can manage these risks in your workplace.

Medical Uses for Acetic Acid

Acetic acid has many applications. In the medical sector, it can be used in the manufacture of vitamins, antibiotics, hormones, and other chemical products.

Acetic Acid Hazards

The form of acetic acid that’s widely used as a raw material and a solvent in industrial, manufacturing, medical and pharmaceutical processes and is known as glacial acetic acid. It’s a colourless and corrosive liquid at 99.5% concentration.

It’s very unlikely that any consumers, patients, or other members of the public will ever come into contact with glacial acetic acid. However, as it’s so widely used in a variety of manufacturing processes, glacial acetic acid does pose occupational exposure risks.

Acetic Acid Exposure Risks

Occupational exposure to high concentrate acetic acid through inhalation, skin contact, and eye contact can result in:

  • Eye, nose, and throat irritation.
  • Possible damage to lungs, eyes, and skin.
  • Pharyngeal edema.
  • Chronic bronchitis.

Acetic Acid Exposure Limits

Health and safety bodies set standard exposure limits for glacial acetic acid. For example, the Health and Safety Executive (HSE) sets a long-term workplace exposure limit (WEL) of 10 ppm or 25 mg.m³ over an eight-hour time weighted average (TWA) reference period. Meanwhile, the short-term exposure limit is 20 ppm or 50 mg.m³ over a 15-minute reference period.

How to Manage the Occupational Exposure Risks of Acetic Acid

Here are some measures that will help you manage the exposure risks of acetic acid in your workplace:

  • Wear appropriate PPE when using or transporting acetic acid (gloves, goggles, face mask). Read our full guide to the key factors you should consider when selecting PPE.
  • Follow the manufacturer’s instructions in regard to how you store and transport acetic acid, paying particular attention to the temperature at which you store your supply.
  • Only use acetic acid in clean and well-ventilated areas. Again, the manufacturer may recommend air quality precautions to take, including the number of air changes per hour you should implement.
  • In the event of a spillage, acetic acid is fully miscible in water. So you may have to use a specialist chemical spill kit to safely clean up the spillage.
  • Any staff who’ll be handling and using acetic acid should receive full training on the possible hazards, on managing the risks, and on the steps to take in the result of a spillage.

 

Understand the Acetic Acid Occupational Exposure Risks in Your Workplace

Our workplace exposure monitoring services will help you identify the acetic acid exposure risks wherever your staff might work with acetic acid in your workplace. Following our expert consultation, you’ll get a detailed report and actionable advice on the measures you can take to meet your COSHH obligations and safeguard your staff’s health and wellbeing.

Learn more about our specialist workplace exposure monitoring services.

 

Decontamination of Endoscopes and Reusable Medical Devices

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In this post, we’ll take a closer look at the specific decontamination processes that should be used for endoscopes and other reusable medical devices.

Levels of Decontamination

There are three levels of decontamination for medical devices: cleaning, sterilisation, and disinfection.

Every individual piece of medical equipment carries a different level of contamination risk – low, medium, or high. The level depends on how and where a device is used, and it also determines the appropriate decontamination procedure.

Read our full guide to the three levels of decontamination for infection control.

General Principles of Decontamination of Endoscopes

  • Endoscopes come into contact with a patient’s intact mucous membranes, and they can sometimes breach gut mucosa. Endoscopes are also they’re likely to be contaminated with virulent or transmissible organisms. This means that endoscopes carry a medium to high infection risk.
  • Because of the high infection risk, endoscopes will need to be cleaned and disinfected before use. Depending on their intended use, some endoscopes may need to go through an additional sterilisation process.
  • Following decontamination, endoscopic equipment should be labelled and dated to confirm it’s clean and ready for use.
  • Decontamination of endoscopes should only be carried out by staff who have been adequately trained in the correct procedures.
  • To prevent cross-contamination, in the designated room for endoscopic decontamination, there should be a one-way flow between dirty returns and clean dispatch areas.
  • There must be clear physical separation of clean and dirty procedures and areas, with specific handling, storing, and processing procedures for each area. Ideally, there’ll be two separate rooms – a dirty room, and a clean room.

Detergents and Disinfectants for Decontaminating Endoscopes

  • To decontaminate endoscopes, use purpose-designed washers with single-use disinfectants. Start with a manual cleaning stage to ensure the endoscopes are visibly clean but note that manual disinfection processes are not suitable for endoscopes.
  • Many best practice guidelines discourage the use of aldehyde- and alcohol-based disinfectants. Such disinfectants have fixative properties, which could bind certain proteins in the endoscope channels.
  • Instead, only use detergents and disinfectants that are compatible with both the washer and the endoscope.
  • Follow the detergent and disinfectant manufacturers’ instructions exactly, paying particular attention to the temperature and concentration recommendations.

Water Used for Decontamination

  • Any water used in an endoscope washer disinfector should be free of particulate and chemical contamination, as well as any micro-organisms.
  • If your local water supply delivers hard water, you may need to add in-line water softeners.
  • Test the final rinse water at least once a week for microbiological levels.

Drying and Storing Endoscopes

  • Decontaminated endoscopes should be stored separately from dirty endoscopes, ideally in a separate room.
  • To reduce the risk of contamination, use dedicated endoscope drying and storage cabinets that are capable of delivering high-efficiency particulate filtered air (HEPA) at the correct temperature and flow rate.
  • Never use alcohol solutions to assist in drying endoscopes, due to the fixative properties.

PPE for Staff Carrying out Endoscopy Procedures

  • Any staff carrying out endoscopy procedures, along with all staff involved in endoscope decontamination, should wear the appropriate personal protective equipment (PPE).
  • PPE procedures should advise on what PPE to use and where. They should also advise on the storage, application, and removal of equipment to reduce cross infection.
  • You can read our full guide to PPE considerations.

Effective Decontamination For Infection Control in Endoscopy

The chemicals used in decontamination procedures can be harmful to human health. So all staff involved in endoscopy must comply with the Control of Substances Hazardous to Health (COSHH) Regulations wherever these chemicals are used.

Our workplace exposure monitoring services will help you identify the exposure risks for your endoscopy staff. Following the consultation, you’ll get a detailed report and actionable advice on the measures you can take to safeguard your staff’s health and wellbeing.

Learn more about our specialist workplace exposure monitoring services.

How Does Infection Spread in a Hospital?

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In this post we’ll discuss how infections spread in hospitals and explore some ways you can prevent and control infections in your hospital.

Ways Infections Spread in Hospitals

Most hospital-acquired infections (HAIs) spread in one of two ways:

  • As a result of treatment.
  • From person-to-person, or via another communicable disease vector (pathogens on a surface, or in the air, for example).

You can read our guide to the most common hospital-acquired infections.

How Infections Spread as a Result of Treatment

Some hospital-acquired infections can spread as a direct result of certain medical treatments.

Examples include:

  • Surgical Site Infections (SSIs) – Invasive procedures involve making incisions in a patient’s skin. Though such procedures are performed in highly controlled sterile environments, it’s possible for incision wounds to get contaminated by microorganisms from the patient’s own body, or from outside sources.
  • Clostridium difficile infections (CDIs) – diff bacteria can exist harmlessly in the bowel. But a course of antibiotics can sometimes cause a bacterial imbalance in the gut, triggering a CDI.

How Communicable Diseases Spread in Hospitals

A patient or a member of staff might bring an existing infection into a healthcare setting such as a hospital. Or a patient may develop an infection during their hospital stay while receiving treatment for an unrelated condition.

These are communicable diseases, and they can spread in a number of ways:

  • From Person-to-Person – Coughs, sneezes, and even touches can spread viruses and bacteria from person to person. CDI, for example, is a common hospital-acquired infection because a major symptom is diarrhoea, which can act as a vector for the spread of bacteria. And of course, during the 2020 pandemic it became clear just how quickly Covid-19 can spread from person-to-person in a hospital.
  • Indirect Contact – Viruses, bacteria, and other pathogens can survive for hours, or even days, on surfaces and inanimate objects. A patient may cough or sneeze into their hand. If they then use a doorhandle or a light switch, any staff member or patient who subsequently touches that item may pick up their germs. And if they then touch their mouth, nose, or eyes, they may introduce the germs into their bloodstream.
  • Contamination – Finally, eating or drinking contaminated food or water can spread communicable diseases. E. coli, for example, is a common hospital-acquired infection, and it can be contracted from eating undercooked meat.

How To Prevent The Spread of Diseases in a Hospital

The National Institute for Health and Care Excellence (NICE) issued recommendations that could help prevent SSIs in hospitals. These include a series of steps for the preoperative phase (including showering and nasal decolonisation), recommendations for staff and patient theatre wear, and a series of checks to make both before and after the procedure. Read the full NICE guidelines for preventing SSIs here.

When it comes to controlling communicable diseases, hospitals must follow the standard infection control precautions (SICPs):

These include:

  • Patient placement – Perform a comprehensive infection risk assessment for each patient, and isolate patients with a high risk of cross-infection.
  • Hand hygiene – Follow a specific hand-washing technique to thoroughly clean your hands at key touchpoints – such as before and after interacting with a patient and their surroundings. Also advise patients to follow good hand hygiene guidelines and provide plenty of handwashing stations throughout your hospital.
  • Personal protective equipment (PPE) – There should be clear procedures for what PPE to use and when. You should also have procedures for storing, applying, removing, and disposing of PPE.
  • Cleaning – Commit to safe management of both care equipment and the care environment. Thorough cleaning should take place regularly and on an ongoing basis. You should also have specialist procedures for cleaning, disinfection, and sterilization in the event of outbreaks, and for high-risk equipment and environments.

Read our full guide to standard infection control precautions in hospitals and healthcare settings.

Control the Spread of Hospital-Acquired Infections

At Cairn Technology, we’ve been helping both NHS and private hospitals prevent and control infections for over 20 years.

We can help you with:

To discuss how we can help you prevent and control infection in your hospital, get in touch to talk to one of our friendly experts today.

 

Entonox Monitoring in Maternity Departments

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Entonox – also referred to as N20, or “gas and air” – is a painkiller that’s used in multiple healthcare settings, including maternity departments. Though it provides effective short-term pain relief, there are some risks to using Entonox.

Short Term Entonox Exposure Risks

Short-term exposure to Entonox can cause dizziness, sleepiness, nausea, and hallucinations.

Long Term Entonox Exposure Risks

Long-term exposure to Entonox can affect the body’s ability to absorb vitamin B12, which can cause damage to nerves and red blood cells. This can lead to neurological conditions, infertility, and even miscarriage.

How Big Are The Risks of Entonox Exposure?

If patients use Entonox only as advised, then the short-term effects should pass quickly, and there should be no long-term health risks. However, there are concerns about hospital staff’s occupational exposure to Entonox – particularly among midwives in maternity care.

Entonox Exposure Risks for Midwives

The risks are particularly high for midwives not just because of the widespread use of Entonox in maternity care, but also because of the nature of their work. It’s common for midwives to work 12-hour shifts, several days in a row. To protect patient privacy, they’ll work with the door closed, which will lead to poor air circulation. Plus, compared to other areas of the hospital, labour wards are less likely to be fitted with sophisticated air purification systems.

How to Manage the Risk of Entonox Exposure in Maternity Departments

Maternity wards should routinely test their staff for their exposure to potentially hazardous substances like Entonox.

In March 2023, the NHS released new guidance on minimising long-term exposure to nitrous oxide in healthcare settings.

The guidance suggests that hospitals should only stop using Entonox as “a measure of last resort and only following appropriate risk assessment, clinical consultation, and mitigation.” Their recommendations include:

  • Environmental ventilation.
  • Staff training on positioning relative to exhaust N20, COSHH risk assessment and controls, and training in administration of Entonox.
  • Awareness and review of monitoring results.

 

The efficacy of these mitigations must be demonstrated by monitoring exposure to N20.

How We Can Help You Reduce Occupational Entonox Exposure in Your Maternity Department

At Cairn Technology, we routinely support both NHS and private hospitals.

Here’s how we can help you control your staff’s occupational exposure to Entonox in your maternity department:

  • Exposure Monitoring – Cairn Technology adopt a personal sampling technique to monitor your staff’s exposure levels to N20. Once used, personal passive sampling tubes are analysed followed by a comprehensive report, including recommendations and actions you can take to reduce exposure risks in your hospital.

Get in touch to discuss how we can help you manage the risks of Entonox in your maternity department.