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INSTRUMENTAL NEWS CS CONNECTION


Tips for proper pre-cleaning by Dick Flynn, Principal, LogiQuip


Since the reprocessing of surgical instruments starts and ends in the OR, there are three steps that should be followed prior to sending them to the CS/SPD, according to Flynn.


1. Point of use in the OR (during surgical case) a. During the surgical case, instruments should be kept free from gross soil and wiped with sponges moistened with sterile water. Gross debris and/or tissue should be removed at the point of use in the OR prior to being sent to CS/SPD decontamination.


b. Lumened and/or cannulated instruments may be- come obstructed with soil and should be irrigated and/or flushed at point of use.


c. OR staff should disarm/disassemble all reusable sharps and position in the basket or tray so they are clearly visible to CS/SPD decontamination staff.


d. Remove all disposable sharps from trays and dis- card in appropriate red sharps container.


e. Also remove any waste (e.g., paper, indicators, suture) from instrument tray before placing on the used case cart.


2. Preparing instruments for transportation to decontamination


a. Ensure all instruments are returned to their original basket and/or instrument tray.


b. System trays should have gross bioburden removed and the used instruments placed back in their original location in the modular tray. Spray with an instrument enzyme foam.


c. Restring unused ringed instruments when possible and place back in basket. Separate the used from unused instruments with a towel and spray with an instrument enzyme foam.


d. Application of the instrument enzyme foam starts the breakdown of protein soil and keeps the soil moist on the instruments until they arrive in the CS/SPD decontamination area. When spraying, turn the nozzle to the foam setting.


e. Extra single instruments should be placed in one of the containers unstrung.


f. To avoid damage to instruments, place soiled deli- cate instruments on the top and heavy instruments on the bottom of the basket or container. Place the lids back on the container to protect the instruments.


3. Preparing case carts for transportation to decontamination area


a. Place trays back in the case cart for transportation to the CS/SPD soiled elevator and the decontami- nation area. i. Ensure instruments are placed back into their original basket/container (e.g., scopes & light cords).


ii. Don’t place heavy instruments on top of delicate ones.


iii. If an instrument does not have a container or basket; place it in another basket or tray.


iv. Ensure enzyme solution covers all levels of trays.


b. All disposable supplies and trash are removed from the OR suite and discarded by OR staff. Disposable items do not go on the case cart.


Quality in — quality out


Best decontamination practices require diligence at every step in the process by Kara Nadeau


W


e’ve all heard the expression — if it’s not clean it’s not sterile — but the decontamination process


is no simple task. It begins in the operating room (OR) where OR staff are responsible for proper pre-cleaning of instruments before they are sent to the central sterile/ sterile processing department (CS/SPD). Once in the CS/SPD, there are a variety of factors that influence whether or not an instrument can truly be cleaned — in- cluding the detergent and water used for decontamination and the adequacy (or inadequacy) of the equipment and work space itself.


“I would argue with any CEO or hospital adminis- trator that decontamina- tion is the single most important place in the hospital,” said Carmen Ferriero III, Infection Con- trol Account Manager for Getinge Group. “It is infec-


Furthermore, contamination can lead to permanent instrument damage such as corrosion, rusting or pitting, shortening the instrument’s lifespan.


To address these issues, industry stan- dards related to surgical instrument cleaning and maintenance clearly state that the decontamination process must begin in the OR. • Association for the Advancement of Medical Instrumentation (AAMI): In- struments should be kept free of gross soil during procedures, kept moist until they can be cleaned and be cleaned as soon as possible after use.1


Carmen Ferriero III


tion control 101 and it is where the battle against deadly pathogens truly begins. It is the single most important step in the sterilization process and if technicians do not perform their jobs to standards, it can directly impact patient safety.” In this article, we explore the com- plexities of decontamination from the perspective of CS/SPD professionals and equipment/supply manufacturers, and offer tips for improving this critical step on the path to sterile processing.


It all starts in the OR Instruments are much more difficult to clean when bodily fluids, tissue and other materials are left to dry on them after use. An unclean instrument cannot be properly sterilized. When a healthcare facility fails to properly decontaminate an instrument before sterilization, it runs the risk that the contaminated item will be used in a procedure, potentially leading to a surgi- cal site infection or another complication.


20 June 2016 • HEALTHCARE PURCHASING NEWS • hpnonline.com


• Association of Surgical Technologists (AST): Instrument cleaning should begin during the surgical procedure to prevent drying of blood, soil and debris on the surface and within lumens. Instrument cleaning should continue at the point of use post-procedure, including sort- ing and disassembly of instruments, containment and transportation to the decontamination room.2


• Association of periOperative Registered Nurses (AORN): Instruments should be kept free of gross soil during the surgical procedure and initial decontamination of instruments should begin immediate- ly after the completion of any invasive procedure.3


A major complaint among CS/SPD


professionals is that OR staff fail to follow these guidelines resulting in instruments returning to the CS/SPD caked with dried blood, tissue and other matter. In his con- sulting practice, Charles J. Ciullo, CSPDT, CSPDS, has worked at or visited facilities where dirty in- struments have sat from 8:00 a.m. till after noon before arriving at the CS/SPD for decontamination. “When met with the situation of grossly soiled instruments being sent to decon-


Charles J. Ciullo


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