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Compulsory standardised education for decontamination sciences

Compulsory standardised education for decontamination sciences. Angela Cobbold Senior lecturer Anglia Ruskin University angela.cobbold@anglia.ac.uk. Research objectives. Exploring attitudes & experiences of decontamination staff during the transition to professionalization

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Compulsory standardised education for decontamination sciences

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  1. Compulsory standardised education for decontamination sciences Angela Cobbold Senior lecturer Anglia Ruskin University angela.cobbold@anglia.ac.uk

  2. Research objectives • Exploring attitudes & experiences of decontamination staff during the transition to professionalization • Identify any perceived barriers, Positive or negative aspects of current job roles • Raising awareness of decontamination technicians’ roles • Acknowledging contribution to control/prevention of HCAI • Provide insight into how this may empower staff, improve staff retention, job satisfaction & career progression opportunities.

  3. How it used to be…….

  4. How it is today….

  5. Healthcare Associated Infections(HCAI) • Approx…4.2 million surgical operations annually in England • = 1 operation for every 12 people(RCS 2012) • Estimated 300,000 HCAI cases reported yearly • Causing around 9,000 deaths • At any one time, 10% patients have a HCAI…

  6. Annual cost to NHS approx... £ 1.9 Billion

  7. Why bother with professionalization? • Raising National & International awareness of decontamination technicians’ roles • Raising awareness of staff contribution to control & prevention of HCAI • Improve career progression, staff retention & job satisfaction • Pay bands- (Modernising Scientific Careers framework) • Voluntary register • Professional recognition (HCPC / NMC).

  8. UK Decontamination services • Approximately 168 NHS hospitals managed by acute trusts in England • Over 150 Central sterilization/Decontamination Units • Over 750 Endoscope Decontamination Units • Over 9,000 Dental practices with Local Units • On average - 35 employees each………. • Approx. 9,450 staff in need of training • Scotland, NI & Wales… • Private sector – approx. 5,000 staff • Endoscopy Units (that cannot transport scopes) approx. 12,000 staff.

  9. Decontamination departments: • With >10,000decontamination staff • On the whole, employed in extremely technical roles - often on the lowest NHS pay bands • Major risk of cross contamination for both patient & staff - ultimately leading to infection • Lack of compliance with established guidelines nationally & internationally • Failure to comply- led to numerous outbreaks…

  10. Why do we need compliance? • Health service criticised for ‘systematic failures’ in the sterilisation of hospital equipment 22/06/04 • ‘Hygiene concerns’ at surgical instruments factory lead to inquiry 28 Mar 2009 • Surgical patients to be screened for CJD risk 20.08.06 • Tubes 'not sterilised after use‘’ 24.11.04 • Inquiry over scope issues 19.08.04

  11. Isolated cases…? • NHS 'chaos' over surgical tools 24.04.08 • Operations cut for lack of sterile equipment 29.01.07 • Dirty instruments ‘stopping surgery‘’ 31.01.03 • Thousands of patients told of HIV risk after visiting 'dentist with dirty instruments‘’ 01.06.09 • Dirty scalpels bring 5,000 ops to a halt 02.03.08

  12. Outbreaks….. • Middlesbrough General Hospital 2002 patients exposed to surgical instruments - previously used on a patient diagnosed with vCJD • Northern Ireland 2004 - inadequately disinfected flexible endoscope (internal channels) used on patients • Wales 2007 patients exposed to surgical instruments - previously used on a patient diagnosed with vCJD • USA 2012– inadequately reprocessed instruments used on patient…..

  13. My Research study… ‘Exploring the perceptions and attitudes of decontamination staff as professionalization is implemented’

  14. A phenomenological approach- qualitative methodology • Evaluative survey questionnaire • IDSc membership database • Semi-structured interview –lived experiences • An initial pilot study.

  15. Ethical considerations… • Research study information packs • Consent form-signed & dated • Voluntary-Option to withdraw • Confidential & anonymous • Individual unique identification codes • Participants access to findings • Study results disseminated • Storage of information & data • Information & data destroyed - witnessed.

  16. Methodological Criteria-Internal validity &Trustworthiness • Validity of results ensures research tests what it sets out to test • Defined as ‘how close what is being measured in practice is to what we intend to measures in our theory’ (Dyson & Brown 2006) • ‘Hawthorne effect’- participants giving answers they want researcher to hear, or if being observed, behave differently.

  17. Methodological Criteria-Reliability • Reliability: ‘a measure is reliable if it yields the same result over & over again’ (Dyson & Brown 2006) • Can similar research be undertaken by another & same outcomes achieved • Achieving saturation • ‘Triangulation’ - interprofessional practitioners from multiple sites - differing perspectives.

  18. Transferability or Generalizability (external validity) • Wider population - can we generalise or transfer findings beyond the immediate study sample • Preconceived theories – utilisation of the study as an informed starting point to progress from.

  19. Skilled profession…..

  20. Skilled profession…..

  21. Standardisation……

  22. To conclude… This study aims to: • Explore experiences & opinions of staff directly affected by professionalization • Ask participants to describe as fully / deeply as possible covering all aspects of their thoughts & feelings • There is minimal evidence-based research surrounding decontamination sciences perceptions & attitudes of their current job roles • This exploitative study aims to pre-empt how the implementation of professionalization will affect those directly involved.

  23. Why should we care…

  24. On a final note… “Here is Edward Bear, coming downstairs, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it” (A.A. Milne 1926)

  25. Any questions….

  26. References & additional reading • Annells, M (1996). Hermeneutic phenomenology: philosophical perspectives and current use in nursing research. Journal of Advanced Nursing. 23, p705-713. • Bazeley, P (2007). Qualitative data analysis with NVivo. London: SAGE publications. • BS EN ISO 13485 (British Standards Institute, 2003). Medical devices. Quality management systems. Requirements for regulatory purposes, London. HMSO • De Montfort University (2010). Human Research Ethics. [On line] available from: http://www.dmu.ac.uk/faculties/technology/student_support/hre/reseach_degree.jsp • Dempsey, P.A and Dempsey, A.D (2000). Using nursing research: process, critical evaluation and utilization. 5th Edition. Philadelphia, New York: Lippincott Williams and Wilkins. • Denscombe, M (2010). The Good Research Guide. 4th Edition. Berkshire: Open University Press. • Dyson, S.M and Brown, B (2006). Social Theory and Applied Health Research. Berkshire: Open University Press.

  27. References & additional reading • Gerrish, K and Lacey, A (2010). The Research Process in Nursing. 6th Edition. Chichester, England: Wiley-Blackwell. Graziano, A.M and Raulin, M.L (2010). Research methods: A process of inquiry. 7th Edition. London: Pearson Education International. • National Patient Safety Agency (NPSA) (2009). Integrated research Application System (IRAS). [On line] available from: http://www.nres.npsa.nhs.uk/applications/integrated-research-application-system/. • Norwood, S.L (2010). Research essentials: Foundations for evidence-based practice. New York: Pearson Education International. • Plack M.M (2005). Human Nature and Research Paradigms: Theory Meets Physical Therapy Practice. The Qualitative Report. 10 (2) p223-245. • Polit, D.F. and Beck, C.T (2004). Nursing research: Principles and methods, 7th Edition. Philadelphia: Lippincott, Williams and Wilkins Publishers. • Rutala W, A and Weber, D, J 2007 How to Asses Risk of Disease Transmission to Patients when there is a Failure to Follow Recommended Disinfection and Sterilization Guidelines, Infection Control & Hospital Epidemiology 28 (2) 146 – 155

  28. References & additional reading • Royal College of Surgeons (2012) Surgery and the NHS in numbers [online]. Available at: http://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/surgery-and-the-nhs-in-numbers • Skills for Health 2009 The Foundation Degree Framework for the Health Sector: Providing Clear guidance for developers of Foundation degrees, Available at: http://www.skillsforhealth.org.uk/~/media/Resource-Library/PDF/Foundation_Degree_Framework.ashx • Spach D, H and Silverstein (1993) transmission of infection by gastrointestinal endoscopy and bronchoscopy. Annals international medicine 118, 117-128. • Weston D (2008) Infection Prevention and Control: Theory and Practice for healthcare professionals. England. Wiley-Blackwell Publishing. • Uttley A,H and Simpson (1994) Audit of bronchoscope disinfection: a survey of procedures in England and Wales and incidents of mycobacterial contamination. Journal of hospital Infection 26 301-308. • Van der Zalm, J.E and Bergum, V (2000). Hermeneutic-phenomenology: proving living knowledge for nursing practice. Journal of Advanced Nursing. 31 (1): p211-218.

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