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Efficient outpatient surgery depends in large part on efficient reprocessing-cleaning
and sterilizing the instruments and getting them back in the OR rapidly
so the next case can start on time. That's why experts recommend doing
everything you can to streamline-but never rush-the reprocessing process.
Here are a few ideas on how:
1. Standardize instrumentation
All manufacturers develop cleaning recommendations unique to their own
products. Manufacturer A's orthopedic drill should not necessarily be
cleaned in the same manner as the drill of Manufacturer B. When staffs
have to work with heterogeneous products in this way, the hassles of changing
protocols can slow them down. Work with your physicians to consolidate
the instruments you use, recommends New York medical sterilization consultant
Charles O. Hancock. This will make it much easier for your staff to become
familiar with each instrument and learn the nuances of sterilizing each
device.
2. Keep it moist
Start the reprocessing process while the procedure is still underway,
recommends Trisha Barrett, BSN, Director of Infection Control and Sterile
Processing for the Alta Bates Medical Center in California. Ask your scrub
nurse to be sure to rinse instruments such as forceps and scalpels in
sterile water and wipe them down periodically throughout the case. This
helps prevent body fluids and other debris from drying on the instruments
and making them hard to clean.
As soon as the surgeon is finished with an instrument, place it immediately
into a container of enzymatic detergent or distilled water, says Ms. Barrett.
This will keep soil from drying.
Maintain a policy on how to replace your solutions in the event of a long
procedure, Mr. Hancock advises. Organisms can actually begin to grow in
solutions when procedures last in excess of three hours.
When the procedure is finished, leave the instruments in their liquid
environment and transport them to the decontamination area. Always use
an OSHA-approved covered container that allows you to remove the instruments
without having to reach in with your hands; this minimizes the risk of
accidental sharps injuries.
Do not use saline solution as your liquid medium for transportation,
says Kansas-based healthcare sterilization consultant Neal Danielson.
Long exposure can cause oxidization and pitting of metal instruments,
he warns.
3. Plan ahead
Many facilities wait until the instruments arrive in the reprocessing
area to sort and rack them. When possible, have your scrub personnel do
this while the instruments are still in the decontamination area, says
Mike Murphy, Manager of Central Sterilization Services at the University
of Iowa Hospitals and Clinics. Typically, instruments sit in the decontamination
area for a little while before being reprocessed. If OR personnel rack
instruments when they arrive in the decontamination area, they will be
ready to be put into a washer or sterilizer as soon as the reprocessing
personnel receive them. If the instruments are left unorganized, reprocessing
personnel have to take the time to sort and rack them-time that can be
better spent on the actual reprocessing.
4. Always warm up
Having a sterilization cycle fail is a huge time-waster. To avoid
having to run an automated reprocessing cycle over again, Charles Hughes,
General Manager of SPSmedical Supply Corp. recommends the following:
- If your flash sterilization device isn't in constant use (i.e. if it
has time to cool off between cycles) run a warm-up cycle before loading
the device. It takes a while for the temperature within the chamber and
the jacket of the sterilizer to become hot enough before the exposure
phase can even commence. A flash sterilizer that has warmed up only requires
an 11-12 minute exposure phase, while a cold machine requires a 20-30
minute exposure phase.
- Never overload a steam sterilizer, for the same reasons you should not
overload a dishwasher or a clothes washing machine: You need to leave
enough space inside of the sterilizer to facilitate the sterilant's contact
with the instruments. Cramped conditions can actually prevent complete
sterilant contact.
- Use chemical, biochemical, or enzyme integrators with every load to
test the reprocessing cycle's time, temperature, and steam contact.
5. Avoid unnecessary extra steps
In the past, infection control staff believed that instruments used
on highly infectious patients needed to undergo "terminal sterilization"
or "pre-cooking" before the regular sterilization process as an extra
infection control precaution. But most experts now agree that this practice
has no scientific basis and should be abandoned completely. Your sterilization
method should be effective for all cases; terminal sterilization only
increases your turnaround time. "Precautions for all patients should be
standard," says Ms. Barrett. "As long as it's effective, non-toxic, fast,
and cost-effective, it should work in all scenarios."
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