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Recently Newham University Hospital wanted to restart its important flexible cystoscopy service which performs crucial checks for cancer patients. Historically these procedures have been done in the endoscopy unit inside the main hospital, with the flexible cystoscopies being reprocessed within that unit.

However in order to provide the safest environment for these vulnerable patients, Newham wanted to keep them away from the main Hospital building as this is where they have treated large numbers of COVID patients during the Pandemic. The decision was therefore taken to try to set up a temporary cystoscopy service based in the Gateway Surgical Centre which had not been involved in the care of COVID patients.

There were a number of issues to be overcome but of particular importance was how to get the endoscopes decontaminated. It was decided that it was not viable to transport them to the endoscopy unit in the main hospital and anyway this would have led to additional risks for all concerned. The solution to this problem was to involve IHSS Ltd who already provide sterile services for the Robotic surgery equipment used by other members of the Bart’s Trust.

The drawback in using such an off-site decontamination service was that the scopes could only be used once in any one day. This would have severely limited the potential size of the cystoscopy lists as Newham only have a small number of cystoscopes. However IHSS was able to help out with that as well! Working with our sister company (Avensys Ltd), IHSS was able to provide a number of compatible flexible cystoscopes to Newham University Hospital to supplement their own stock and allow them to set up a reasonable service.

One additional benefit of this whole process is that unlike the endoscopy unit at Newham which can only high-level disinfect scopes, IHSS are able to offer a gas sterilisation service for these instruments giving an additional level of patient protection.

Three mornings a week an IHSS delivery truck pulls up at the Gateway Centre and unloads trolleys containing sterile packed, ready-to-use cystoscopes. On each of the same three evenings, the truck returns to collect the used scopes to be taken to the IHSS facility for cleaning and re-sterilisation.

This service is allowing Newham University Hospital to catch up with its cancer follow-up backlog and ensure its patients do not have to wait any longer for this vital service.

The Low Temperature Option

Mention budgets and cost cutting and most healthcare professionals will inwardly groan. It probably seems to many people in the sector – especially those with long memories – that financial pressures have been with us since time immemorial. Unfortunately, and without wishing to add to the general despondency around this subject, the situation is unlikely to improve in the foreseeable future.
Even advances in technology, although bringing benefits for clinicians and patients alike, can present fresh challenges if investment in new equipment, staff training or facilities is required, but cannot be adequately funded.  
These devices, however, require specialised handling as they are generally constructed from lightweight composite or flexible materials and often incorporate sensitive electronic components.
There is, therefore, a growing risk if sterilisation has to be compromised or if the use of advanced medical devices has to be curtailed because they cannot be reliably reprocessed, due to cost constraints or lack of skilled staff. Until recently, this issue has been exacerbated by the limited options available. 

The frequently used alternative to high temperature steam sterilisation is manual cleaning with warm water and detergent, followed by disinfection using chlorine dioxide or chlorhexidine wipes. In some instances, disinfection at low temperatures using chemicals or a washer-disinfector may also be used. 
A new and perhaps more viable option for many hospitals is to partner with a specialised outsourced provider, which has the dedicated facilities and levels of investment capable of delivering a fast and cost effective low temperature sterilisation service. IHSS, for example, uses the latest hydrogen peroxide (H2O2) technology, which has been developed specifically for sterilising advanced medical devices, such as ureteroscopes, choledochoscopes, intubation endoscopes and the Endoeye Flex 3D videoscope. 

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