Flagship centralised decontamination hub for Ramsay Health Care

“Having a regional sterile services hub incorporated into a hospital is a departure for us,” says Duncan Roper, National Decontamination Lead Ramsay Health Care. “While we have onsite TSSUs (theatre sterile services units) in seven hospitals, our other regional sterile services hubs units are offsite and staff there don’t get to see patients and hospital staff. Here we’re part of the hospital, so our people feel part of something more tangible. It’s a model we may use elsewhere. Our long-term plan is to have a network of facilities like this.”

Casper Mudenha, left, Quality Manger; Elizabeth Mason, Decontamination Manger Midlands Hub;
Karen Passerini, National Decontamination Quality Improvement Lead;
Duncan Roper, National Decontamination Lead.

Duncan explains: “A great deal of work went into establishing where our Midlands hub would be located. We looked at a range of economic factors and it was a difficult business case to complete.

“As the TSSU at Glendon Wood is built to service at least nine hospitals, a lot of work was completed early on to assess capacity. We based our decisions on detailed process analysis data and from the track and trace system. While our other regional hubs at Braintree and Preston have four washer-disinfectors and four autoclaves, Glendon Wood has six of each to allow some capacity for containerisation should we ever require it.

“Ramsay Health Care’s Estates and Procurement teams look after the requirements of the hospitals and the sterile services facilities. It’s meticulously organised and professionally done,” says Duncan. “We also have group arrangements with our preferred equipment suppliers: Sychem, for Steelco instrument washers and autoclaves, and Envirogen for RO (reverse osmosis) equipment. They provided additional advice on capacity planning.”

Preferred suppliers

The department has six Steelco DS 1000s instrument washers and six Steelco VCS 10 autoclaves. The Envirogen EndoTherm Modular reverse osmosis unit is a twin-pass, heated system specifically designed to generate the clean steam water quality for silicates as specified in HTM 01-01.

“A lot of time went into the planning of the hot RO system,” explained Duncan. “It’s false economy to down-spec on RO.”

Keeping departments operational

While the new facility neared completion, the Ramsay hospitals whose instrument decontamination was scheduled to transfer to Glendon Wood had to continue operating. When staffing numbers at those facilities became an issue, due to the imminent closure, it fell to Elizabeth (Lizzie) Mason and Karen Passerini, National Decontamination Quality Improvement Lead, to keep all departments operational.

“We had to maintain staffing levels by using our trained technicians to backfill whilst waiting for us to go-live,” explains Lizzie.

Meanwhile, there had been some construction delays at Glendon Wood. “We only had a four-week window after handover before the new hospital and our department were scheduled to open,” says Lizzie. “We were presented with an empty shell with all the machines installed. What was a very hectic time turned into a great team building exercise. As all equipment and supplies were delivered the staff from all hospital departments worked together setting it up room by room. It was great for them to mix and get to know each other before we went live.”

After going live on 1st August 2023, the Midlands hub now reprocesses instruments for nine Ramsay Health Care hospitals:

Karen Passerini, National Decontamination Quality Improvement Lead, Ramsay Healthcare, explains:

“We phased-in the various hospitals to enable us to handle the steadily increasing workload. On average, we currently reprocess 9,000 trays per month, and we have reached 10,500. There’s a very wide range of kit coming through, including a lot of loan kit due to the increased orthopaedic activity. We anticipate that the unit will be open 24/7 in the near future.”

Now that the sterile services hub is fully operational there can be up to 25 trollies on site at any one time. These are cleaned and dried in the department’s Steelco trolley washer before being loaded with the reprocessed instruments ready for their return journey to the various hospitals.

With the centralised facility already busier than expected, Lizzie adds: “We’re now working towards our ISO Accreditation. The gap analysis is scheduled for July, followed by the two-day audit in October.”

Elizabeth Mason, Decontamination Manager of Ramsay Health Care’s Midlands Hub.

Compact RO systems

Looking at the reverse osmosis water system technology in more detail; Envirogen is Ramsay Health Care’s preferred supplier and has a maintenance contract for all the company’s locations. This includes a small number of sites where Envirogen is responsible for other manufacturers’ systems.

The Hospital sterilisation and decontamination unit (HSDU) at Glendon Wood has Envirogen’s EndoTherm Modular compact duplex RO system providing 100% resilience. Designed for large, centralised endoscopy and sterile services departments, the system has been installed in a number of UK hospitals where it has proved to be a reliable, cost-effective duplex reverse osmosis water purification solution. Compact, pre-assembled and skid-mounted, EndoTherm Modular units are fast and easy to install, commission and validate. Envirogen also installed the stainless-steel ring-main and all the points of use in the HSDU.

Meeting the water quality standards of HTM 01-06, HTM 01-01, ISO 15883 AS/NZ 4187 and AAMI ST108, the modular range is upgradeable and can be set to operate at ambient or elevated temperatures (user adjustable) with automatic thermal sanitation taking place out of hours.

As there is no onsite steam, the system at Glendon Wood is electrically heated with 72kW coils in the tank to generate clean steam quality for silicate water specified in HTM 01-01. All EndoTherm models can be electric and/or steam heated to meet the requirements of each installation.

A combination of reverse osmosis, ultra-violet disinfection, sub-micron filtration and constant recirculation all work together to maintain maximum water quality at a range of dispense rates matched to single or multiple decontamination equipment needs.

The full colour touchscreen display allows for personal identification number (PIN) secure access levels, simple maintenance procedures and displays real-time graphical data. Remote diagnostic monitoring programmes, which enable Envirogen’s service centre and engineers to access the system remotely, are a feature that hospitals find particularly useful. In fact, Glendon Wood Hospital’s engineer, Paul Keeble, says: “Using the remote access, they can do it from a settee at home.”

The reprocessing of endoscopes is undertaken in a separate department at Glendon Wood. Receiving its JAG accreditation on the day of inspection, this department is equipped with two STERIS RapidAERs (automated endoscope reprocessors), while an Envirogen EndoTherm Mini supplies the purified RO water.

Widely-installed across UK healthcare, the EndoTherm Mini is a compact solution with a small footprint delivering reliable, cost-effective reverse osmosis water purification solutions for endoscopy and sterile services applications.

Like the larger EndoTherm Modular, the EndoTherm Mini complies with HTM 01-06, HTM 01-01, EN ISO 15883, and AAMI ST108. Similarly, the units can be programmed for thermal sanitisation to take place out of hours, while a combination of reverse osmosis, ultra-violet disinfection, sub-micron filtration and constant recirculation all work together to maintain good water quality at a range of dispense rates.

Again, the HMI (human machine interface) touchscreen display is a particularly well-liked feature, enabling simple maintenance procedures, it displays-real-time graphical data and allows remote diagnostic monitoring by Envirogen’s service centre and engineers.

All models are pre-fabricated inside a small footprint cabinet, making the EndoTherm Mini fast and easy to install, commission and validate. Envirogen also installed the smaller stainless-steel ring main for the two AERs.