The clinical application of hazard analysis critical control points (HACCP)

Abstract

BACKGROUND/OBJECTIVES: In the United Kingdom, healthcare-associated infections (HAIs) continue to attract media and consumer attention, to impact upon healthcare delivery, and to cause morbidity and mortality. "Winning ways" (a UK hospital action plan) has identified seven action areas, including one that recommends use of hazard analysis critical control points (HACCP), although little guidance on its application is provided. This study applies approaches and strategies based upon HACCP and relevant prerequisite programs (PRPs) (an approach used in the food industry) to the decontamination of endoscopes. METHODS: The reprocessing of endoscopes in two hospitals was audited, including observations of practices combined with examination of the documentation. The procedures used were compared to the British Society of Gastroenterology guidelines and the seven HACCP principles and 12 logic sequences outlined by the Codex Alimentarius. RESULTS: Endoscope reprocessing was conducted in accordance with the British Society of Gastroenterology guidelines in both hospitals. A process flow diagram was produced as part of the HACCP approach. Comparison of in-use practices with HACCP principles indicated that neither unit implemented all HACCP steps and that there was variability between units. One unit partially implemented two logic sequence steps, the other partially implemented seven. Monitoring (as defined by the Codex Alimentarius) indicated that cleaning, an essential step prior to decontamination, was often not adequately performed. CONCLUSION: Guidelines exist on the principles for reprocessing endoscopes, although the way these are to be implemented and managed is not so clearly articulated. The HACCP and PRP approach can be applied to reprocessing endoscopes and could help to provide a more structured approach to managing the process. Suggestions are also provided on how HACCP could be applied to other clinical procedures.