Ligature Cutter Decontamination Tony Rogers QN BSc Senior

Ligature Cutter Decontamination Tony Rogers QN BSc Senior IPC Nurse GMMH

• Ligature Cutters • The ligature cutter, such as Resqhook, are specially designed items that offer an effective and safe method of cutting a ligature that is tied around a person’s body part, whether the ligature is tied solely to the person or attaches the person to any aspect of the environment eg a door handle. • Although the website of the supplier states the Res. Qhook conforms to the UK Medical Devices standard HTM 2030. Ligature cutters are not officially classed as a medical device (see appendix 3 MHRA & Ligature cutters)

• 1 st Concern – Ligature cutters can become contaminated with body fluids and are not decontaminated in between patient use • When ligature cutters used there is a potential risk that the ligature cutter can become contaminated with body fluids. Staff are currently instructed to re sharpen a ‘sharp’ and are potentially at risk of cutting themselves. If the blade has not been decontaminated then this would be classed as sharps injury. • My observation of a Res. Qhook awaiting re-use initiated this review. It was visually contaminated and did not have a sharpener (see photo). It was therefore a cross contamination risk

How do you clean? Options CSSD? Send to outside company? (Royal mail posting -Legal? ) Single use?

IPS MH and LD SIG responses Subject: Re: Subject for consideration by the members of the MH and LD SIG Name Julia Lewis-West Physical Health Lead 01763 255700 ext. 11222 Pager 211 Response We use the big fish cutter (single use blades) - these are replaced after each use. We have separate wire cutters in our box for stronger cords/wires if used as ligature. Julia. Lewis. West@priorygroup. com<mailto: julia. Lewis. West@priorygroup. c om> Kneesworth House Hospital Old North Road Bassingbourn-cum-Kneesworth Royston SG 8 5 JP Karen FOLTYN, Karen (ROTHERHAM DONCASTER AND SOUTH HUMBER NHS FOUNDATION TRUST) <karen. foltyn@nhs. net> We also use the Barrington LC 1 and have for a while. After each use the cutter must be returned to Barrington International to be cleaned, re sharpened and serviced as the cutters must not be used more than once without sharpening. We have had numbers engraved on the handle so the resus team can keep track of where they all are. Not heard of any issues with the product or company.

Lisa Stone Lisa (TS Somerset Partnership) [mailto: Lisa. Stone@sompar. nhs. uk] We don’t use this particular cutter but have recently moved across to a version made by Barrington. We have arranged for them to go back to the manufacturer for re-sharpening and cleaning post use. Tracey H. Jones Infection Prevention and Control Nurse, Cheshire & Wirral Partnership (CWP) NHS Foundation Trust, 1829 Building, Countess of Chester Health Park, Liverpool Road, Chester, CH 2 1 HJ. As a trust we are considering purchasing the MAC Rescue Cutter to replace our current ligature cutters has anyone got any experience of this product? I’m asking as we are finding it difficult to obtain guidance from the manufacturer regarding how to clean these adequately especially in the unlikely event of the skin being breached and blood coining in contact with the cutter. 01244 397700 tracey. jones@cwp. nhs. uk<mailto: tracey. jones@cwp. nhs. uk> "Miskell Amanda (RLY) NSCHT" <Amanda. Miskell@combined. nhs. uk my advice to our team in resus, wards etc. is to decontaminate similar to that of any non single patient use medical device. However, where visibly contaminated, or known to have had contact with open wounds, and body fluid I would dispose of and replace.

Options?

Options

• Option 5 • Class as re usable device and decontaminate locally using the process in appendix 7 page 39 https: //www. nhslothian. scot. nhs. uk/Services/AZ/Infection. Control. Manual/CP 001. pdf

Options - discussions

Final option • Option 6 • Develop a practical, safe, ward/locality based procedure.

Video of process • You tube link • https: //www. youtube. com/watch? v=2 Xz 97 D 4 GBmo&feature=youtu. be • Not perfect but …. .

validation • 27. 06. 2018 • … (medipal) …have said Chlorhexidine sachets VJT 614 will decontaminate and are suitable for HIV etc

Sharpening/deburring • Sharpening/deburring is a separate matter! • Consider: • Reduce costs (and legality) of posting out (contaminated) ligature cutters to outside companies by training: • all Staff to decontaminate at source • all staff or a member of estates staff to sharpen/deburr

References and Further information

The definition of a medical device is : “‘medical device’ means any instrument, apparatus, appliance, material or other article, whether used alone or in combination, including the software necessary for its proper application intended by the manufacturer to be used for human beings for the purpose of: — diagnosis, prevention, monitoring, treatment or alleviation of disease, — diagnosis, monitoring, treatment, alleviation of or compensation for an injury or handicap, — investigation, replacement or modification of the anatomy or of a physiological process, — control of conception, and which does not achieve its principal intended action in or on the human body by pharmacological, immunological or metabolic means, but which may be assisted in its function by such means” As you can see from this definition the device mentioned would not appear to fall within the definition of a medical device. I hope that this answers your enquiry. Best wishes Sara Vincent Senior Medical Device Specialist Devices Safety and Surveillance MHRA 151 Buckingham Palace Road, London, SW 1 W 9 SZ, UK Telephone: +44 (0) 20 3080 7169 Email: sara. vincent@mhra. gov. uk

Post Office guidance – Contaminated products. • https: //www. royalmail. com/sites/default/files/royal-mail-prohibited-and-restricted-items-may-01 -2018 --23410530. pdf • Item UK Int. • Biological substances (UK) allowed • (diagnostic specimens including urine, blood, faeces and animal remains). Packaging guidelines: The total sample volume/mass in any parcel must not exceed 50 ml/50 g. All biological substances must be posted • in packaging that complies with Packaging Instruction 650, such as our Safebox product. • Clinical and medical waste – Not allowed • (e. g. contaminated dressings, bandages and needles) • https: //www. royalmailgroup. com/sites/default/files/United%20 Kingdom%20 Post%20 Scheme%2030%20 January_to%20 sit%20 wit h%20 delivery%20 confirmation_FINAL_15. 12. 16. pdf • https: //www. royalmail. com/business/sites/default/files/docs%20 part%204/Royal-Mail-Safebox-Terms. Conditions-November-2014. pdf