North Pennine Acute Hospital NHS Trust

No-nonsense test gives an unequivocal indication of autoclave's PASS or FAIL, together with data on critical phases of the steam sterilization cycle at Oldham's Royal Hospital

Sceptical? Well, as Julie Striland, lead HSDU manager at North Pennine Acute Hospitals NHS Trust, explains: "Everyone thought 'no it can't do all that'." But 3M's Electronic Test System, or ETS, quickly won everyone over.

(Confidence builder: Julie Stirland says the introduction of 3M's ETS has been a quantum leap, giving everyone confidence in the sterilization system)

"It's easy to use and the supervisors who perform the daily test like it," adds Julie.
Many APs across the country have also seen it and accepted it.

"The engineers, who do the testing, were being asked more and more to show the evidence. The software produces graphs of the performance and assists the engineers in the preparation of data for the AP."

Julie continues: "The supervisors have full confidence in the ETS and its proof that the systems are working correctly. It's also improved the quality of our presentations.

(Teamwork: North Pennine Acute Hospitals NHS Trusts lead HSDU manager, Julie Stirland, with quality assurance manager Steve Donnelly)

"It can also lead us to problems before they happen."
After a major investment in new equipment, Royal Hospital, Oldham, now boasts an impressive array of five, newly installed MMM porous load autoclaves with the ETS units being used for the test cycle at the start of each day - one per machine.
It's a far cry from four years ago when the ETS system was first trialled, as Steve Donnelly, quality assurance manager HSDU, explains: "While we were fully compliant before, the old autoclaves had been in for around 20-years and required increasing maintenance to continue operating to standard.

"Prior to the ETS we were using the traditional test pack, with engineers having to investigate any problems. One of the benefits of the ETS is that it not only answers the question 'has it passed - yes or no?', so we know if we can use the sterilizer, but we can also get an early warning of any problems and highlight it to the engineers.

"Once we had a 'failure' on the ETS that wasn't being shown up on the autoclave. The ETS trace indicated it may be a problem with a valve and the engineers were able to immediately investigate and remedy the situation before it became major."
Recalling the ETS trial period, Steve says: "We had a couple of units on trial for two weeks. We wanted to know if everyone could live with it and the information they could get out of it."

3M's Dr Jamie Curley ran training sessions with the supervisors, showing them how to activate the unit and read the result.

Test

"The test went well," adds Steve. "If there were any questions, Jamie came in on request and was always on hand if we had any difficulties.

"I think it's proved to be a good system. The fact that we can get a greater precision than the traditional test means we're more assured, its improved the accuracy and independently verifies that the tests were successful."

The ETS is made up of three components: a standalone sensor unit, a data converter unit, and a custom Windows based PC software package.
Sterile services supervisor, Susan Smith, showed how 3M's ETS is used on a daily basis.

"Once the autoclaves warm-up run is completed, at the start of the day, each machine is tested, which takes 30 minutes for each autoclave," explains Susan.

Pulling a switch on the top of the ETS activates the unit - shown by two yellow flashing lights. The unit is then placed in the autoclave for the test cycle.

On removal from the autoclave, the operator simply pulls the switch once to see the results immediately as an unambiguous PASS (flashing green light) or FAIL (solid red light) decision relating to the steam penetration test result.

The electronic test system sensor unit is a self-contained, intelligent datalogger that measures the critical variables - temperature, pressure, time and the residual air level of the steam sterilization process. It also records the adequacy of the sterilization stage in terms of temperature (134OC) and time (not less than three minutes). The ETS also gives an indication of entrained air sufficient to cause a steam penetration test failure but indicative of potential equipment faults.

Acquired data

In the nearby office Susan coupled the sensor unit to the dataconverter - an interface that collects the acquired data, stores it and then, when required, transmits it to either a standard PC printer or a PC running the custom software. Susan demonstrated the easy to use PC software package that is designed to enable a range of anlyses to be carried out on the gathered data relating to the efficacy and long-term stability of the sterilization process. (see the caption below)

(Enthusiasts: Royal Hospital, Oldham, engineers Peter Wrigley (left) and Michael Donaghue are advocates of 3M's easy to use Electronic Test System which records all relevant autoclave parameters and can highlight problems before they occur)

The software shows a graphical representation of the data as a temperature, pressure, time plot, while above the plot are a number of buttons that initiate pre-programmed data analyses.

Key members of the trust's team, who are also ETS enthusiasts, are engineers Michael Donaghue and Peter Wrigley.

"We had the standard Bowie and Dick test before, but it's an interperative test - one person might say it was a PASS while another might say it was a FAIL," says Mike. "With the ETS you get a definitive YES or NO, plus a lot more information.

"ETS tells us the result, it's not an interpretation, so it takes the responsibility off the operators."

Peter says: "As the previous autoclaves were getting older we found the ETS was more and more valuable to us as the failures became more frequent. It was easy to identify problems and the system gave us a head start. For example, being able to magnify the control you're able to predict a failure on a pressure reducing valve."

Highlighting a further benefit, Peter explains: "Another plus is the storage. We previously had to find space to store the chemical test results which can change over a period of time due to ambient conditions."

The system's versatility also enables the engineers to use the ETS as a datalog for the department's washer-disinfectors, undertaking automatic process control, and an induced leak test.

Peter says: "We were involved right from the start when the ETS was first used on trial, liaising with Julie. Training is very straightforward it's very user-friendly equipment.

On a reassuring note, Peter adds: "They're also very robust units - we're not frightened of dropping them."

The final word goes to the trust's lead HSDU manager, Julie Stirland, who concludes: "It's certainly been a quantum leap. Accurate, easy to use and now part of our practice, ETS gives everyone confidence."

Simple traffic light system is a hit with SSDs across Europe

"The ETS is a Bowie and Dick test with enhanced features - you can use it as a diagnostic tool for autocalve functions," says Dr Jamie Curley, 3M's business development manager sterilization assurance products, describing both the simplicity and the advantages of the Electronic Test System.

"It gives definitive results, there's no room for subjectivity, an operator does not need to interpret anything. The result is a simple traffic light system. It's a very simple piece of kit to operate.
"One of the major benefits is that all the results are stored electronically enabling you to easily retrieve them. You can swap them between departments, sites or e-mail them to 3M should you need any further support."

(Pictured right: Dr Jamie Curley)

How about cost?
"Nearly everyone who's moved to ETS has found the benefits of cost savings due to either reduced downtime or the reduced amount of testing required. Any additional cost has been minimal and is more than offset by the benefits that everyone reports from using ETS."

In fact ETS is now accepted technology, with something approaching 150 trusts already using one sensor per sterilizer, and an additional unit per department for the hospital's engineers.
As Jamie says: "Engineers like the early warning function which means you can often spot a problem before it happens - for instance a door seal failure."

And what of the future?
"After it's introduction in the UK, ETS has now been successfully launched across Europe, and we're now looking at several developments to take ETS forward that we believe will bring even greater benefits," says Jamie. "We basically just want to make the job easier for sterile service departments"
It seems the message is clear - ETS is simple and isn't going to cost you a fortune.

Call 3M Sterilization Assurance Products on 01509 613327 or visit www.3mhealthcare.co.uk