CS CONNECTION
is having signifi cant corrosion issues with their instruments, one of the primary cul- prits is inadequate water quality. It will have a signifi cant impact on the life of the instruments.” Ciullo urges CS/SPD professionals to
have their cleaning chemistry supplier perform an initial test on the department’s water so they can dose their chemistry accordingly. For departments that have a reverse osmosis or deionization system, he recommends the company that installed the system test the CS/SPD’s potable and purifi ed water initially and after preven- tive maintenance to make sure the purifi ed water is “up to snuff.” “Since the quality of both potable and
purifi ed water is subject to change, I typi- cally recommend facilities check their wa- ter quality at least weekly using a simple water test system — either a dip strip or a water test meter — that tests for pH and total dissolved solids at a minimum,” said Ciullo. “If any variance is found that might impact either detergent dosing or rinsing you should notify either your washer or purifi cation technician so the proper ad- justments can be made.” Dave Geddis, President of ultrasonic equipment manufacturer, Geddis Inc., comments on the need for water/cleaner compatibility, stating: “We are always asked whether our en-
zyme cleaner, SurgiSoak, is pH neutral, which it is,” said Ged- dis. “The more important question is ‘what is the quality of the water you are using?’ With our SurgiSoak, as with most con- centrates, CS/ SPD staff must mix one ounce of the solution to one gallon of water. A gallon is 128 ounces. Therefore, the pH of the wa- ter is the most
Geddis SurgiSoak pH neutral enzymatic cleaner important question by far.”
IFUs and staff education A CS/SPD can have state-of-the-art equip- ment, perfect water quality and superb support from the OR but none of that mat- ters if the staff members aren’t properly trained and following IFUs. “The instrument IFU should always be your guide for teaching and training staff
on instrument decontamination,” said Ferriero. “If the IFUs aren’t clear, utilize your vendors as a resource. They should be your resource and will provide support for their products.” Ciullo notes how laminated wall in- structions and spiral bound books can be extremely helpful for staff when they are tasked with decontaminating diffi cult to clean complex specialty instruments. He points out how instrument manufacturers are often happy to supply these types of resources. Balch explains how many instrument
tracking systems already allow users to upload photos, videos, and other docu- ments to specific instrument trays. He suggests adding the ability to immediately display step-by-step cleaning instructions on a wide screen TV in the decontamina- tion area to provide instant, readable and facility-centered cleaning instructions to CS/SPD teams. Lastly, Davis points out the need for CS/SPD to have standard processes for decontamination that are based on IFUs, industry standards and evidence-based lit-
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erature. Standardized workfl ows, coupled with quality monitoring, can reduce risks associated with cleaning. “Defects can occur by either manual or mechanical reprocessing so you need to create systems that seek to reduce risk and monitor overall quality for improved patient safety,” said Davis. “Further- more, ongoing review through process audits and metrics will support the use or identify the need for cleaning meth od adjustments.” HPN
References:
1. The Association for the Advancement of Medical Instrumen- tation (AAMI) Comprehensive guide to steam sterilization and sterility assurance in health care facilities ST79:2010 & A1:2010 & A2:2011 & A3:2012 & A4:2013.
2. Standards of Practice for the Decontamination of Surgical Instruments, Association of Surgical Technologists (AST) http://
www.ast.org/uploadedFiles/Main_Site/Content/About_Us/ Standard_Decontamination_%20Surgical_Instruments_.pdf.
3. Recommended Practices for the Care and Cleaning of Surgical Instruments and Powered Equipment, Association of periOpera- tive Registered Nurses (AORN), AORN Journal, January 1997,
http://www.aornjournal.org/article/S0001-2092(06)63033-0/ fulltext.
4. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, Centers for Disease Control and Prevention (CDC),
http://www.cdc.gov/hicpac/pdf/guidelines/Disinfec- tion_Nov_2008.pdf.
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