What is decontamination?
Decontamination is all around us. Healthcare organisations like the NHS depend on decontamination to provide safe environments to patients, especially those coming into hospital for surgery or needing emergency treatment. It also plays a part in a range of other industries such as construction, industrial safety and scientific research. But what is decontamination? Simply put, it’s the word we give to the process of removing contaminants from objects and environments. Contaminants include harmful microorganisms, toxic substances and others. Contaminants pose a risk to humans, so decontamination is about keeping people safe. This can be by sterilising surgical instruments in hospitals, controlling hazards in industrial settings or in our commercial cleaning industry.
Where did it start?
Almost as soon as we discovered the presence of infectious microorganisms in the 19th century we started thinking of ways to protect ourselves against them. British physicians were at the forefront of developing antiseptic surgical techniques, particularly in the two World Wars where chemical warfare and outbreaks of disease forced an urgent focus on organised methods of preventing infection.
Are there different levels of decontamination?
In healthcare environments, decontamination is categorised into three levels, as outlined by the Spaulding Classification:
- Non-critical decontamination: Low-level disinfection involving cleaning surfaces and equipment that only come into contact with intact skin
- Semi-critical decontamination: Involves disinfection methods targeting certain types of microorganisms. This level is suitable for equipment that contacts mucous membranes, such as endoscopes and dental tools.
- Critical decontamination: Sterilisation used for instruments that penetrate body tissue or enter sterile body cavities, like surgical scalpels and orthopaedic implants.
What is involved in the decontamination process?
Decontamination typically follows three key stages:
Cleaning:
This is the removal of visible dirt and organic material. It typically involves water and detergents and is a crucial first step. Dirt can protect microorganisms from the chemicals we use, so removing it is essential. Too often, outside of the healthcare sector, we see the misconception that cleaning on its own is enough. Spoiler alert: it isn’t!
Disinfection:
This stage is about reducing the microbial load (or number of microorganisms) to safe levels. We do this by applying chemicals called disinfectants, or by applying heat. Cleaning followed by disinfection is the 1-2 punch that anyone with a decontamination role in any setting needs to understand and apply.
Sterilisation:
This stage destroys all forms of microbial life. This isn’t about a safe level – it’s the total cleansing of a surface. It’s mainly used in hospitals, especially surgical theatres, and that’s where a lot of specialist equipment and chemicals come into play.
Who is in charge of decontamination?
The UK is among the best countries in the world when it comes to the amount of guidance and safety measures that are built into the decontamination system. We have a network of different authorities that work together to maintain a high standard:
- NHS England – Oversees decontamination policies in healthcare settings in England. The devolved governments in the UK have their own policies and procedures but these are broadly in line with NHS England
- Health and Safety Executive (HSE) – Provides guidance on safe decontamination practices
- Care Quality Commission (CQC) – Ensures compliance with standards in healthcare facilities
- Medicines and Healthcare Products Regulatory Agency (MHRA) – Lays out the rules and guidance that healthcare organisations have to follow, including as regards to decontamination.
Who needs decontamination training?
I would argue that everyone working in healthcare should understand the fundamentals of decontamination. This is because it is so closely linked to infection prevention and control, and there are lots of little things that anyone working in healthcare can do to reduce the risk of infection to patients and visitors. Even if all you do in a normal day is wipe down surfaces after using them, there are things decontamination can teach you that relate to that task.
Aside from that of course, decontamination is a profession. Sterile service technicians and infection control nurses are the two obvious groups that require a strong understanding of decontamination. However, decontamination relies on a lot of machinery such as washer disinfectors, autoclaves etc. and all of those machines require trained engineers to test and validate them. Then you have the management of those departments who need specialised training to help them keep the processes running the way they should.
Outside of healthcare, there are specialist teams that need decontamination qualifications, such as hazardous material responders that are called out, for example, when asbestos is discovered during construction or demolition work.
Where is decontamination heading?
The UK continues to be at the forefront of advances in decontamination and recent developments in technology have seen improvements in the industry. For example:
- RFID tracking of instruments has improved traceability in sterile service departments
- Antimicrobial coatings are able to create surfaces that are hostile to microorganisms and therefore much easier to decontaminate.
- AI is still in the early stages of what it can achieve but already AI-assisted auditing tools are improving how decontamination departments are able to manage performance.
Taken together, these innovations boost efficiency, reduce manual labour, and improve infection control outcomes.
What are the challenges on the horizon?
In a way, decontamination always faces similar challenges. There are a wide variety of factors that can have an impact on decontamination compliance in a healthcare setting, and we will always find ourselves trying to implement preventive measures that can lessen or negate the impact of a situation upon decontamination outcomes. We’re always going to face cost and resource constraints, particularly in the NHS. The biggest challenge coming down the road is the emergency of antimicrobial-resistant microorganisms – in other words, contaminants that resist the tools we’re used to using. As the germs evolve to survive our current methods, so too will we need to evolve to stay ahead of them.
At All Things Decontamination, we’re on a mission to tackle these challenges head-on, by opening up training to everyone that is cost-effective and makes best use of resource, that embraces emerging technology to fast-track knowledge and skills to the people who need it, and by championing the best in innovation within the industry. It’s an exciting time to be part of this vital community, and we’re looking forward to supporting anyone whose job involves any sort of decontamination.
