March 2018 The self-study lesson on this central service topic was developed by STERIS. The lessons are administered by KSR Publishing, Inc.

Earn CEUs After careful study of the lesson, complete the examination at the end of this section. Mail the completed test 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 at

Certifi cation The CBSPD (Certification 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 publica- tion. Successful completion of the lesson and post test must be

documented by facility management and those records maintained by the individual until re- certifi cation is required. DO NOT SEND LESSON OR TEST TO CBSPD. For additional information regarding certifi cation contact CBSPD - 148 Main Street, Suite C-1, Lebanon, NJ 08833 • www.

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 February 6, 2021. The approval number for this lesson is STERIS-HPN 180602. For more information, direct any questions to

Healthcare Purchasing News (941) 927-9345, ext. 202.


1. Discuss the value of residual soil testing.

2. Differentiate between protein testing and ATP testing.

3. Develop a quality program that includes protein testing as a component of verifi cation of the cleaning process.

Sponsored by:

The case for residual soil detection testing

by Delores. O’Connell, BA, LPN, AGTS, CRCST, CIS, CHL

ears ago, if you had asked me what ‘CSI’ stood for, I might have said, “That stands for the College of Southern Idaho.” Today, thanks to some very popular television shows, I would say, “CSI stands for crime scene investigator.” Crime scene investigators (CSIs) have an interesting job. They walk through a crime scene and collect evidence without know- ing if there is any evidence present or not. CSIs play an important role in ensuring that the perpetrator of the crime is arrested and convicted. “Crime scene investigators must be able to apply scientifi c methods, techniques, and knowledge in the applica- tion of the law and recognize the intricacies involved with the examination of physical evidence at the crime scene”1

Y . Once the

century the fi rst evidence of modern pathology was revealed, and in 1909 the fi rst school of forensic science was estab- lished. You may by now be asking yourself, “What does forensic science have to do with sterile processing?” These depart- ments are not typically crime scenes. But there is a connection: there are tools and techniques available to sterile processing professionals (SPPs) that are like the tools and techniques used by CSIs.

evidence is collected, it is identifi ed and evaluated by forensic scientists. Medical practitioners began using foren- sic science in the 16th 18th

Like CSIs who must collect all evidence

that can lead to prosecuting the right criminals, SPPs must collect and document evidence that the surgical instrumentation they process is thoroughly cleaned and sterilized before use on the next patient. If they don’t, they put patients at risk for a surgical site infection (SSI).

There are SSI risk factors that are out of SPD personnel’s control, such as patients who are immunocompromised or have heart disease, or who are diabetic or obese. There are also surgical procedures that have a higher rate of SSI (i.e., open-heart, gynecologic or lower GI surgeries). How- ever, there are risk-reducing efforts that are easier to control, such as antibiotic steward-

58 March 2018 • HEALTHCARE PURCHASING NEWS • century. In the late

ship policies, hand-hygiene programs and instrument processing procedures. There are standards, guidelines and new tech- nologies that help SPPs assure that they deliver clean, sterile and complete instru- ments sets to the OR on time, every time.

If it’s not clean it can’t be sterilized

Dirty medical devices, regardless of where they are processed (e.g., central services, outpatient surgery or endoscopy depart- ments) are fi rst delivered to the decontami- nation area/room where they are cleaned and decontaminated before they go to the assembly area for inspection, instrument set assembly and packaging, and then on to be sterilized or high-level disinfected. Since all SPD professionals know the statement, “if it’s not clean it can’t be sterilized,” they must continually answer the question, “Are these instruments really clean?” before they let devices leave the decontamina- tion area. Even if no soil is visible to the naked eye, the instrument may still be contaminated. So, the corollary to the fi rst question is; “How do we verify that the instruments are clean and ready for the next step in the manufacturer’s reprocess- ing IFU? The answer: we measure and evaluate residual contaminants on medical devices after completing the established cleaning protocol.

The responsibility for developing and validating methods for effective reusable medical device processing falls to the device manufacturer. Further, they are expected to test and validate any labeling claims of “fi tness for reuse that are pro- vided in the written instructions for the handling, cleaning, disinfection, packag- ing, and sterilization of medical devices in a health care facility.” 2

The manufacturers

of cleaning agents also must demonstrate compliance with their label claims. “They [too] must validate that their cleaners pro- vide the expected level of soil removal and determine its materials compatibility.”2 Based on published recommended prac- tices or guidelines, published data on the

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