Decontamination technology assessments - who assesses the assessments?

Decontamination technology assessments who assesses the assessments?

I N B R I E F

Suggests that two 2013 reports by the Scottish Health Technology Assessment Panel were awed in estimating costs relating to decontamination processes.

Proposes that poorly performed technology assessments confuse practitioners and undermine healthcare improvements and patient safety.

OPINION

A. J. Smith1

The driver to improve surgical instrument decontamination has been the introduction of vCJD into the UK population over the last two decades, although concerns over transmission of other infectious agents remain valid. Though signicant improvements have been made in primary care, this is usually in spite of limited access to technical advice on decontami nation equipment. A technology assessment for key elements of equipment and processes used in this environment should be welcomed. However, two reports by the Scottish Health Technology Assessment Panel are awed in estimating costs as sociated with wrapping instruments, omission of appropriate references and inaccurate data in the costing models. These assessments contribute little to health economics debates, confuse practitioners and frustrate technical experts.

The BDJ has a long standing interest in publishing opinion and scientic manuscripts on the topics of infection prevention and instrument decontamination. Central to this has been calls for improvements in the evidence base for changes to policies and procedures and quite rightly so. A technological area where there has been signicant change over the last decade has been medical device decontamination. In its broadest sense the decontamination of medical devices refers to the reprocessing of surgical instruments used in the wide variety of surgical specialties so that the tools of the surgeons choice are available for subsequent patients. The end result of this process whether in hospitals or dental practice is sterile instruments at point of use.

Within hospitals most of this activity takes place behind closed doors in the sterile service department, out of sight of the surgical team until delays in turnaround

time force the cancellation of surgical lists. Much work has been undertaken in the UK to improve the quality of medical device reprocessing while keeping pace with increasing demands for extra volumes of work. Drivers to recent improvements were the identication of poor performance (including quantities of residual protein on instruments ready for re-use14) and the risk assessments...