Decontamination of reusable instruments in primary care.

Staff who undertake effective decontamination in non-centralized settings such as general practices must be provided with training and easy-to-follow guidance. In this article we present a distillation of the current guidance in an industrial quality control format of fishbone charts. A fishbone chart (or cause-and-effect chart) depicts all the causes of an outcome in a logical way to facilitate the identification of a specific problem. We developed our fishbone chart to include instructions that, if followed, would achieve safe and effective cleaning and sterilization. A survey of those given the charts showed high user acceptability: 76% found the fishbone better than existing guidelines - although the response rate was low at 46%. The charts will enable those involved in decontamination of instruments, including managers and infection control staff, to audit the facilities, equipment and practices. The use of industrial quality tools may assist other specialties that require complicated and comprehensive guidelines to be presented in a more user-friendly design.