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Instrumental News


Endoscopes still contaminated after cleaning, study shows Potentially harmful bacteria can survive on endo- scopes used to examine the interior of the digestive tract, despite a multi-step cleaning and disinfect- ing process, according to a study published in the August issue of the American Journal of Infection Control, the offi cial publication of the Association for Professionals in Infection Control and Epide- miology (APIC).


Though endoscopes were cleaned in accordance


with multi-society guidelines, viable microbes and residual contamination remained on surfaces after each stage of cleaning, according to study fi ndings. Researchers from Ofstead & Associates in Saint


Paul, MN and Mayo Clinic in Rochester, MN tested samples collected from 60 encounters with 15 colonoscopes and gastroscopes used for gastroin- testinal procedures after each reprocessing step to assess contamination levels. Investigators observed all reprocessing activities, using a checklist to ensure that cleaning protocols were performed in accordance with published guidelines. Reprocessing consisted of: bedside cleaning,


manual cleaning in dedicated reprocessing rooms, and automated endoscope reprocessing with a high-level disinfectant. Disinfected endoscopes were stored vertically after drying with isopropyl alcohol and forced air. When contamination levels exceeded pre-determined benchmarks for each cleaning step, technicians went beyond guidelines and repeated cleaning procedures, retesting after each attempt to reduce contamination. Researchers performed microbial cultures and


various rapid tests to detect viable organisms and organic residue that remained after each step of cleaning. Viable organisms were detected on 92 percent of devices after bedside cleaning; 46 per- cent after manual cleaning; 64 percent after high- level disinfection, and 9 percent after overnight storage. Rapid indicator tests detected contamina- tion above benchmarks on 100 percent of devices after bedside cleaning; 92 percent after manual cleaning; 73 percent after high-level disinfection, and 82 percent after overnight storage. “This study demonstrates that colonoscopes and


gastroscopes can harbor residual organic material, including viable microbes, even when adherence with recommended reprocessing guidelines is verifi ed,” said the study authors. “More research is needed to identify processes that can ensure all fl exible endoscopes are free of residual contamina- tion and viable microbes prior to patient use, includ- ing the potential use of routine monitoring with rapid indicators and microbiologic cultures. Results from this study suggest that current standards and practices may not be suffi cient for detecting and removing residual contamination.”


CS CONNECTION


Innovative SPD renovation Designing for safety, effi ciency and convenience by Kara L. Nadeau


or most central service/sterile pro- cessing department (CS/SPD) pro- fessionals, the idea of a department renovation or rebuild with state of the art equipment and improved workfl ows is a more than welcome prospect. But what is it really like to transform a CS/SPD in terms of design/planning, construction, equipment installation, staff transition and other factors? In this month’s CS Connection article, we report on best practices and lessons learned from individuals who have successfully completed this process.


F


Stepping up the SPD at New England Baptist Hospital When Mark Duro, Director of Sterile Processing Operations for New England Baptist Hospital in Boston, joined the organization in 2007, administration tasked him with transform- ing the current CS/SPD into “the best sterile pro- cessing department in the country.” Duro had previ- ously served as Manager of


Mark Duro


Central Processing and Supply Distribution for the Lahey Clinic, where he had overseen a recent CS/SPD renovation.


“Sterile processing has always been an afterthought and a place that wasn’t always planned out well because we don’t generate revenue,” said Duro. “But if for some reason we shut down, that’s when people recognize our importance.” At the time, New England Baptist Hospital’s CS/SPD was on the same fl oor as its operating rooms (ORs), which was convenient for both departments but the space was poorly designed and outdated. As a result, the decontamination, washing, pack and prep and sterilization processes were highly manual and inefficient. The equipment and storage were inadequate to support the OR’s growing volume of ortho- pedic cases. Furthermore, the ceilings were low, the lighting dim and spaces cramped, which made it a less than desirable work environment. In 2008, New England Baptist Hospital began its CS/SPD renovation. With input


36 September 2015 • HEALTHCARE PURCHASING NEWS • www.hpnonline.com


from Duro and his team, architects de- signed a completely new CS/SPD located one fl oor below the previous department. Using LEAN and MUDA methodology, they evaluated the drawbacks of the current space in terms of workfl ow, and determined where they could increase effi ciency and reduce waste. The hospital also hired light- ing specialists to improve visibility for the technicians. Duro and his team evaluated equipment from manufacturers and selected washers, sterilizers and other essential tools that would automate manual processes, deliver the most effective and safest results in the most effi cient manner, and make it easier and more comfortable for technicians to perform their work.


Technician input was critical to the new CS/SPD design, according to Duro. He recalls an example of when a tech pointed out an obvious problem with the new design that others had missed.


“I had the new plans posted in the old department and told the technicians that if they saw a problem they should let me know,” said Duro. “One of the techs came to me and asked where they were expected to go to the bathroom, because there were no restrooms planned for the new space. We were originally going to store the code carts in the new department but decided to move them elsewhere to free up that space for restrooms. This changed helped in two areas, one locating code carts closer to patient care areas.”


Decontamination


The team put a lot of thought around trans- porting dirty carts from the OR down to the new CS/SPD and the clean back up to the OR. They decided on a three-elevator system: one “dirty” for transporting carts from the OR to the CS/SPD, one “clean” for transporting sterilized trays from the CS/SPD to the OR and a two-door freight elevator, which could be used as “dirty” or “clean” if one of the designated elevators was down. They configured the “dirty” elevator to always return downstairs to the CS/SPD with its door open so that techni- cians could clearly see if there was a cart ready for processing.


See CS CONNECTION on page 38


CS CONNECTION


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