Leanne Gater, a documentary film maker from Wild Films contacted SMTL earlier this year about a documentary project on Horseshoe Crabs.  SMTL undertake endotoxin testing for NHS facilities across Wales using  LAL, a substance derived from the blood of these Horseshoe Crabs.

Leanne wanted to to demonstrate how Horseshoe Crabs aid in keeping millions of people safe though endotoxin testing, but also how they’re also suffering from a decline in population and what could be done to help save the species.

Endotoxins are complexes associated with the outer membrane of Gram-negative bacteria which are constantly shed into the environment and released when the bacteria die or multiply. Bacterial endotoxins are the most common and by far the most potent pyrogen (pyrogen literally means heat generating, and the term refers to any substance, microbial or otherwise, which would induce a temperature rise when introduced into a patient). Commonly used methods of sterilisation generally do not destroy endotoxins, therefore a product may be sterile and free of viable microorganisms but not necessarliy be endotoxin-free.

Leanne spent time at SMTL in October 2019 and filmed SMTL staff undertaking the tests which we perform for Health Boards across Wales, checking that their surgical instruments have been reprocessed appropriately and that there is no unsafe level of residual endotoxin on their instrument. 

We will update this page when we know the date of release of Leanne's film.


The Evidence Based Procurement Board have published their latest advice which is on Farco-fill protect, a sterile solution containing 0.3% triclosan that is used for the inflation of indwelling urinary catheters in an effort to reduce bacterial colonisation of the catheter

Following consideration of the published evidence, the EBPB consider that there is currently insufficient evidence to support its use in the Welsh NHS.  Read the full review on the EBPB web site.

Dr James Evans, a healthcare researcher at SMTL, has had a  paper published in the Pacing and Clinical Electrophysiology (PACE) journal  (Evans, J. M., Withers, K. L., Lencioni, M. , Carolan‐Rees, G. , Wood, K. A., Patrick, H. and Griffith, M. (2019), Quality of Life Benefits from Arrhythmia Ablation: A longitudinal study using the C‐CAP questionnaire and EQ5D. Pacing Clin Electrophysiol. Accepted Author Manuscript. doi:10.1111/pace.13675).

James carried out the work whilst working at Cedar. The study presents results for generic and arrhythmia related quality of life using patient reported outcomes gathered at baseline, post-ablation and at 1 year follow-up.

Results showed significant improvements in symptom severity, impact on life scores, EQ-5D-5L indices and VAS scores at baseline versus three months (post-ablation) and at baseline versus 1 year follow-up. Impact on life score showed additional improvement at 1 year follow-up versus three months, while improvements in symptom severity, EQ-5D-5L indices and VAS scores continued to be maintained between 3 months and 1 year follow-up.

Cardiac ablation therefore provides patients with arrhythmias relief from symptoms, and results in an improvement in quality of life.




Dr Gavin Hughes recently presented at the 2019 International Lymphoedema Framework (ILF) conference hosted in Chicago. 

Gavin was invited to present on the work SMTL have undertaken in conjunction with Welsh NHS lymphoedema clinicians to independently assess compression garments supplied by manufacturers for NWSSP Procurement Services  contracts.  The presentation focused on laboratory testing that measures the pressures exerted by garments. 

The test results identified numerous quality issues with garments supplied in the market, and raises the question as to whether clinicians can have confidence in the pressures claimed by manufacturers of  lymphoedema compression garments when applied to patients.

The differences in pressure classification between the UK and other countries was highlighted, and the resulting confusion this causes for users and clinicians was discussed.

SMTL undertook a multicentre simulation of the (at the time)  proposed ISO 80369-6 connector for the neuraxial route in 2014 (the standard was published in 2016, and the connectors are now known as NRFit connectors).

The standard was produced to help mitigate the risk of wrong route injections, such as the case of Wayne Jowett in 2001 where intravenous chemotherapy was accidentally injected spinally, resulting in Wayne Jowett's death.

Thirty-eight doctors and 17 nurses performed simulated clinical procedures on manikins, using devices fitted with either Luer connectors or draft ISO 80369-6 ‘non-Luer’ connectors. The procedures included spinal anaesthesia; intrathecal chemotherapy; lumbar puncture, cerebrospinal fluid collection and pressure measurement; epidural catheter placement with bolus injection and critical care use. Participants attempted cross connection between neuraxial connectors and a range of other medical device connectors to check that the design achieved the deiredlevel of non-connactability.

The results of the usability testing have been published in Anaesthesia:

Cook TM, Wilkes A, Bickford Smith P, Dorn L, Stacey M, Kinsella SM, Sharpe P, 
Phillips P. Multicentre clinical simulation evaluation of the ISO 80369-6
neuraxial non-Luer connector. Anaesthesia. 2019 May;74(5):619-629.

Most cross-connection attempts failed, even using above clinical forces and, when successful, were judged of low clinical risk potential; the exception was a malaligned connection between the non-Luer slip and female Luer connectors. This led to revision of the dimensional tolerances of the non-Luer connector to reduce this risk, before publication of the final specification in 2016.

The authors concluded that the ISO 80369-6 neuraxial non-Luer connector was suitable for clinical use.




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