Author: Megan Pietura

Sterile Processing’s Role in Preventing Healthcare Associated Infections

Posted on by Megan Pietura

Imagine requiring a surgical procedure on your hip. It’s a standard surgery performed hundreds of thousands of times every year in the US. You don’t spend much time considering that something could go wrong. Now imagine a couple weeks have passed since your surgery. You feel great and have a follow-up appointment with your surgeon. The surgeon confirms you’re healing well, and you are very thankful to the surgeon for a successful procedure and your ongoing recovery.

Unfortunately, some people are not so lucky. Some patients do experience unforeseen and unnecessary consequences from routine procedures, leaving them with a surgical site infection (SSI) or other healthcare-associated infection (HAI). While you were right to thank your surgeon for doing an excellent job, you also should have thanked the Sterile Processing Department (SPD) for properly cleaning, disinfecting, inspecting, and sterilizing the instruments before they were used during your procedure. The risk of an SSI would have increased if the sterile processing department had not properly cleaned the instruments used.

Two types of healthcare-related infections

What are healthcare-associated infections and surgical site infections?

  • An SSI is an infection that occurs after surgery in the part of the body where the surgery took place. While they are both infections resulting from medical treatment, SSIs refer specifically to an infection acquired in surgery.2
  • HAI’s are infections acquired while receiving any treatment, not only in surgery.

According to the CDC, “each day, approximately one in 31 U.S. patients contracts at least one infection in association with his or her hospital care”.1 That number might seem high, but it would certainly be higher if the central sterile department wasn’t doing its job properly.

How sterile processing prevents infection

What role does SPD play in preventing these infections? When instruments are used between patients, residual human bio-burden on surgical instruments (blood, feces, mucous, bone, etc.) can potentially contaminate another patient. Sterile processing follows strict, technical instructions for use (IFU) to ensure every crevice, corner, hinge, bend, and channel of medical instruments are thoroughly cleaned. Instruments must also be fully functional. Surgeons can potentially make unnecessary mistakes during the procedure if scissors get stuck, if blades don’t cut, and graspers can’t grasp.

 

Sterile processing departments need highly technical and efficient devices to perform their job correctly. For example, even a department’s reprocessing sink should be considered. If a sink can’t fit the large, heavy instruments used during a hip surgery, how can they be properly cleaned? These sinks are not just sinks you would find in your house or a restaurant, nor are the brushes, sponges, detergents, washers, and other pieces of specialized equipment. Because SSIs, HAI’s, and patient safety are such serious concerns, they need to be treated as such with the proper equipment.

The sterile processing department in your hospital is crucial to patient safety and is needed to run a safe, efficient, and effective surgical department. So next time, if ever, you need to go in for a surgery, make sure to not only thank the doctors, surgeons, and nurses, but also the people working behind the scenes to keep you safe: the sterile processing department.

 

Looking for more information on improving cleaning outcomes to prevent surgical site infections and HAI’s? Watch our free, 1 CE program, A Royal Flush: Your Winning Hand for Pre-Cleaning Protocol, to learn how the reprocessing sink is at the heart of every successful patient procedure.

 

References

  1. “Current HAI Progress Report.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 26 Oct. 2021, https://www.cdc.gov/hai/data/portal/progress-report.html
  2. “Surgical Site Infection (SSI).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 24 Nov. 2010, https://www.cdc.gov/hai/ssi/ssi.html

Visual Inspection of Surgical Instrumentation: “We Cannot Clean What we Cannot See”

Posted on by Megan Pietura

Instrument reprocessing departments are at the heart of their facilities. Without their crucial work inspecting, cleaning and sterilizing instrumentation, operating rooms and physicians would not be able to provide life-saving procedures to their patients. One of sterile processing’s core functions, visual inspection, is critical in assuring that the instruments delivered are safe for patient use.

“We cannot clean what we cannot see” is unmistakably clear. Instrument reprocessing professionals must be able to visualize theirGuidance for Internal Inspection instrumentation fully to deliver high quality cleaning outcomes. External inspection is good for 50% of the device, but what about the other half of your instruments? The internal channels and components of devices are as important and yet more dangerous to leave unchecked.

 

Regulatory guidelines and industry recommendations are urging for more internal visual inspection of lumens for this reason. For example, ANSI/AAMI ST79 and ST91 both list guidance on internal inspection:

 

“The internal channels of a flexible endoscope that are accessible can be inspected by a borescope or other appropriate inspection method. Those conducting the inspection should be trained to identify damage and retained contaminants. Refer to the endoscope manufacturer’s written IFU, maintenance bulletins, and other labeling for direction on what is considered a defective or damaged medical device that cannot be used and must be sent to the service provider for further inspection and potential service activities.”

ANSI/AAMI ST79:2021 7.8.3

“Visual inspection is greatly enhanced with the use of magnification and illumination. Visual inspection can include the use of borescopes to inspect the inner channels/lumens present in many flexible endoscopes.”

ANSI/AAMI ST91 13.5.1

 

Facilities will also find updated guidance when inspecting complex devices, such as flexible endoscopes or shavers:

“Complex devices such as flexible endoscopes may require the use of lighted magnification or additional methods to assist with the inspection process..”

https://www.cdc.gov/hicpac/pdf/core-practices.pdf

 

“The internal channels of reusable arthroscopic shavers should be inspected using an endoscopic camera or borescope.”

2017 AORN Guidelines. www.aorn.org

 

Departments reprocessing any of these complex devices or who are adhering to ANSI/AAMI guidelines should consider enhancing their internal visual inspection procedures with borescope technologies. Borescopes remove the guesswork of internal inspection; they provider the users to the ability to inspect internal channels, capture images, and assist in confirming if a device is patient ready.

When implementing borescope technologies, departments may need to ask themselves the following:

  • What am I looking for?
  • What does clean look like inside a channel?
  • What instruments should I inspect, if not all of them?
  • What do I do when I find something inside my channels?

With these questions in mind, department managers can create implementation plans. These plans extend beyond the answers to these initial questions. For example, your technicians may find the following in your instrument channels:

  • Debris
  • Damage, such as kinks, grooves, and scratches
  • Discoloration and staining
  • Residual moisture, notably in flexible scope channels

While it can be intimidating to uncover hidden issues, we also “cannot clean what we cannot see”. Internal visual inspection directly impacts patient safety outcomes when these issues are uncovered. Enhancing cleaning outcomes is at the heart of any instrument reprocessing department.

 

Visual inspection is more than external inspection. While important, it can be further enhanced by also inspecting the other 50% of your instruments through borescope technologies. These technologies uncover many avenues for process and quality improvement, and ultimately, improve the outcomes your department delivers.

 

Do you have questions on implementing a borescope program into your department, or would like to discuss the potential with an implementation professional? We can help start the conversation. Contact our sales and education team at (877) 718-6868, or by emailing info@pure-processing.com to start the conversation.

When to Use Extended Instrument Soaking During Manual Scope Reprocessing

Posted on by Megan Pietura

It’s impossible to ignore. Instrument reprocessing time has increased. A major factor? Extended instrument soaking.

Reprocessing time will continue to increase due to additional instrument technology and safety measures. In fact, the current estimate is an average of 76 minutes for full reprocessing time by staff. But that’s when everything is performed as planned and no added steps are needed to clean properly.

The reality is recommended cleaning at the point of use does not always occur within a specific time frame in the procedure room. Missing the time frame pushes added work to reprocessing professionals and contributes to their backlog. The technicians and nurses must then take on the step of extended soaking to overcome repercussions associated with such a delay.

Pre-cleaning requirements for flexible and rigid scopes

Pre-cleaning must occur immediately after device use to prevent organic material from drying and hardening on instruments. Contaminants left behind on instruments can contribute to less effective high-level disinfection and sterilization procedures. Immediate cleaning practices within 60 minutes after use can prevent disease outbreaks and reduce infection risk.

Keeping track of time can be tricky. We all know manual records can be subject to human error. The Association for the Advancement of Medical Instrumentation (AAMI) recommends electronic record keeping over manual methods for accuracy to ensure cleaning is performed within the first 60 minutes. Even so, delays can occur.

Sometimes it’s more than human error that causes a cleaning delay. Emergency situations may contribute to endoscopes being left out overnight or even over a weekend. Leaving devices out for such time has been likened to a plate of sticky food left to harden that becomes more difficult to clean later. Then the instrument requires extra steps to remove bioburden and prevent infection risk.

Extended reprocessing soaking time

Most manufacturers recommend an endoscope be cleaned within 60 minutes of use to prevent biofilm formation and bioburden hardening. If less than 60 minutes passes between use and manual cleaning, then sterile processing technicians or GI nurses can follow standard leak testing and manual cleaning best practices to continue to remove contaminants.

Extended reprocessing soaking time is recommended if there is a cleaning delay of more than 60 minutes. It loosens hardened debris and bioburden from the instrument. If not performed, biofilms may form which can lead to infection control risk. While extended soaking times vary, they should not exceed 10 hours.1

It is still important to review IFUs for specific instrument cleaning despite common recommended steps for extended soaking. Not all IFUs will include extended soaking directives, however.

The right equipment can also make instrument extended soaking much easier and successful. Many sterile processing or endoscopy departments lack enough sink basins to accommodate extended soaking areas. Review your department’s existing inventory and make an assessment for added basins, transport carts with basins, or mobile soaking stations as needed based on volume of instruments coming through from the OR or procedure rooms.

Steps to include extended soaking look much the same:

Pre-cleaning

Pre-clean instruments as usual

Leak testing

Perform leak testing before extended soaking to prevent moisture damage

Extended (prolonged) soaking

Read IFUs and industry recommendations for extended soaking in detergent solution

Manual cleaning

Follow manual cleaning IFUs and best practices

 

It takes teamwork

Coordinating with the procedure team will help both departments better understand each other’s needs. If the OR or practicing nurses can complete point-of-care instrument cleaning, it reduces the backlog and enables departments to turn instruments around much faster. Not to mention properly pre-cleaning instruments helps to reduce infection risk in the long run.

It is inevitable for reprocessing professionals to reprocess instruments left out too long post-use. And when the time comes, you’ll want your team to be aware of how and when to use an extended soak while having access to enough basins to get the job done.

 

Pure Processing offers many solutions for sterile processing and endoscopy department extended soaking needs, including mobile carts with multiple basins and transport carts.

 

References

  1. Choi, et al (2015). Endoscope reprocessing: Update on controversial issues. Clinical Endoscopy, 2015 Sep; 48(5): 356–360.

 

Have a unique challenge you would like to get input on? We’d be happy to help!

The Three Pillars of Effective Lumened Instrument Cleaning

Posted on by Megan Pietura

Instrument reprocessing technology has come a long way, with many advancements to make reprocessing more efficient, effective, and ultimately serve patients with the highest quality care. But the basics of instrument cleaning haven’t changed. There are no substitutes for highly effective manual cleaning in the decontamination room.

Three core pillars support highly effective lumened instrument cleaning outcomes:

  1. Proper and effective use of cleaning chemistries
  2. Effective brushing
  3. Copious amounts of fluid under pressure

Note that automated cleaning with ultrasonic systems and washer-disinfectors is partnered with effective manual cleaning at the decontamination sink. Automated cleaning is not a replacement for manual cleaning. Many IFU for ultrasonics, automated systems, or instrumentation call for the pre-flushing and brushing of channels before reprocessing. If manual cleaning is done poorly at the reprocessing sink, the steps following will be compromised.

 

1. Proper and effective use of cleaning chemistries

Instrument reprocessing professionals are being asked to deal with human bioburden, so the tools and chemistries used should reflect the unique biology and make-up of that debris. Proteins, fats, and other complex molecules require unique chemicals for effective cleaning.

Consult your instrument IFU to determine what cleaning chemistries are required. Enzymatic detergents are often called to help break down complex molecules and make removal easier, as they are formulated with human bioburden in mind. And if chemistries are being called to be used, make sure there are tools in place to monitor dilution rates, contact times, and temperature ranges when applicable.

Effective use of chemistries is especially important when pre-treatment in OR procedure rooms is not being properly followed. Lack of pre-treatment may adhere bioburden to lumens and require extra soaking and breakdown for proper removal. Chemistries can aid in that process.

 

2. Effective brushing for instrument lumens

Brushing channels is the physical component of effective cleaning. Putting in the elbow grease to remove stuck-on, stubborn, or dried bioburden is important when flushing or soaking hasn’t properly removed that matter.

Brushes aren’t a one-size-fits-all solution. Consult your instrument IFU, and consider the following:

  • Do I have brushes that are the right size for all my lumens?
  • Am I using the right quality of material for my lumens?
  • Do I have brushes for cleaning all instrument components, such as valves, distal tips, and channels?
  • Am I cleaning and/or replacing brushes appropriately?

All those questions answer if brushing is effectively cleaning internal lumens.

 

3. Copious amounts of fluid under pressure for instrument channels

Loosening and removing bioburden wouldn’t be effective if not partnered with flushing. Flushing channels with fluids that are pressurized is the final component to effective manual cleaning.

How can chemistries be flushed into long, narrow channels? How can fragments of bioburden be removed from channels if they don’t remove on the brush? Flushing is important for removing residual chemistries and bioburden and preparing instruments for automated manual cleaning. flushing ocular

It’s also important to note that pressure should be applied appropriately to the channel size. An ophthalmic lumen cannot be flushed with the same pressure as an orthopedic shaver. Flushing methods, therefore, should be flexible for a wide variety of lumen qualities and sizes.

 

With those three pillars in mind, technicians, nurses, and managers can audit and enhance their existing practices while potentially improving outcomes.

For more information on effective manual cleaning practice, check out our free, 1 CE and CBSPD credited program, A Royal Flush: Your Winning Hand for Pre-Cleaning Protocol.

Looking to upgrade from your syringes and spray guns which can be difficult to monitor and standardize during lumen flushing? The FlexiPump Independent Flushing System can flush up to three lumens at once and meet a variety of IFU with hands-free flushing.

Is there a problem your department needs to solve? Let us know!