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HEALTHCARE SELF-STUDY SERIES N


PURCHASING EWS


June 2020 The self-study lesson on this central service topic was developed by 3M Health Care. The lessons are administered by KSR Publishing, Inc.


Earn CEUs The series can assist readers in maintaining their CS certifi cation. After careful study of the lesson, complete the examination at the end of this sec- tion. Mail the complete examination and scoring fee to Healthcare Purchasing News for grading. We will notify you if you have a passing score of 70 percent or higher, and you will receive a certifi cate of completion within 30 days. Previous lessons are available on the Internet at www.hpnonline.com.


Certifi cation


The CBSPD (Certifi cation Board for Sterile Processing and Distribution) has pre-approved this in-service for one (1) contact hour for a period of fi ve (5) years from the date of


original publication. Successful completion of the lesson and post test must be documented by facil- ity management and those records maintained by the individual until re-certifi cation is required. DO NOT SEND LESSON OR TEST TO CBSPD. For ad- ditional information regarding certifi cation contact CBSPD - 148 Main Street, Suite C-1, Lebanon, NJ 08833 • www.sterileprocessing.org. IAHCSMM (International Association of Health-


care Central Service Materiel Management) has pre-approved this in-service for 1.0 Continu-


ing Education Credits for a period of three years, until May 4, 2023. The approval number for this lesson is 3M-HPN 201405. For more information, direct any questions to Healthcare Purchasing News: (941) 259-0842


LEARNING OBJECTIVES


1. Explain the differences of the sterility assurance levels for HLD as opposed to sterilization.


2. Discuss recommendations for the disinfection and sterilization of fl exible endoscopes.


3. Explain the difference in storage time between high-level disinfected and sterilized scopes.


4. Discuss steps to take when transitioning from HLD to sterilization of fl exible endoscopes.


Sponsored by: T


Scopes require higher level of disinfection


by Susan Klacik, BS, AS, FSC, ACE, CHL, CIS, CRCST


he objective of healthcare is to provide the highest level of quality outcomes for patient care. Seeking this higher level often occurs with the introduction of research and new technol- ogy. Often this new technology includes medical devices that are complex and diffi cult to clean and sterilie or disinfect. Flexible endoscopes are among this cat- egory. Through the use of scopes, patients can be diagnosed and treated with mini- mally invasive techniques and experience a reduced recovery time. any fl exible endoscopes have a com- plex design and are processed using HLD. Based on recent investigations of patient outbreaks related to fl exible endoscopes, it is time to look into moving from high-level disinfection (LD) to steriliation. his article will examine the benefi ts of moving from LD to steriliation for fl exible endo- scopes that are used directly or secondarily to enter normally sterile tissue. Regardless of the disinfection or steriliation modal- ity used, it is important that scopes are thoroughly cleaned before being subjected to a disinfection or steriliation process. Without adequate cleaning, steriliation or disinfection cannot occur. Performing a cleaning verifi cation test after cleaning and before disinfection or steriliation verifi es the effectiveness of the cleaning process, ensuring the scope is prepared for the next critical step.


Sterility assurance levels for HLD vs. sterilization


The decision of whether to use HLD or steriliation to reprocess a particular device is based on the Spaulding classi- fi cation scheme. here are distinct differ- ences between LD and steriliation. he biggest and most important distinction is sterility assurance level or SAL. Spaulding divided medical instruments and equipment into three categories (critical, semicritical, and noncritical) on the basis of the risk of infection from contamination on the item (Spaulding, 1972). The Centers for Disease Control and Prevention (CDC) uses this scheme to describe the level of disinfection or


30 June 2020 • HEALTHCARE PURCHASING NEWS • hpnonline.com


steriliation needed after decontamina- tion and before patient use:


a) Critical devices are instruments or objects that are introduced directly into the human body, either into or in contact with the bloodstream or other normally sterile areas of the body, and products with sterile fl uid pathways. Critical items present a high risk of infection transmission if contaminated and must be sterile at the time of use. (Note: Unless contraindicated, steam ster- ilization is the preferred processing method. Low-temperature processes (e.g., ethylene oxide (EO) sterilization and other processes with exposure temperatures lower than steam sterilization) can be used to sterilize some heat-labile devices when time between uses allows such processes to be used.) b) Semicritical devices are instruments or objects that contact intact mucous membranes or nonintact skin of the patient during use, but do not usually penetrate the blood barrier or other normally sterile areas of the body. Semi- critical devices should be sterilied, if possible. owever, if steriliation is not feasible, the device, at a minimum, must be subjected to a HLD process that would be expected to destroy all microorganisms except for small numbers of bacterial spores. In most cases, meticulous physical cleaning followed by HLD provides reasonable assurance that enough pathogens have been eliminated and the device is safe for patient use.


c) Noncritical devices are instruments or objects that usually contact only the intact skin of the patient. Depending on the particular item and degree of con- tamination, cleaning with a detergent and warm water could be appropriate. Disinfection is a process that kills pathogenic and other microorganisms by physical or chemical means. Disinfection destroys most recognied pathogenic microorganisms but not necessarily all microbial forms, such as bacterial spores. teriliation results in an instrument free from all viable microorganisms including bacterial spores.


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