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Archive Infection Control 2018

Combat Biofilm

Tips to prevent bacteria's slimy fortress from forming on your instruments.

Margaret Wasserman

Margaret Wasserman, BSN, RN, CNOR


Surgical Instrument
SLIMY CULPRIT More than 60% of correctly-processed surgical instruments exhibit residual protein soiling.

Some may view pre-cleaning instruments as unglamorous grunt work, but manually wiping, soaking and hand-scrubbing the tools of surgery is the key to preventing biofilm buildup. You've heard it many times before, but it bears repeating: It's impossible to disinfect or sterilize inadequately cleaned instruments. Just ask Porter Adventist Hospital.

Biofilm appears to be behind the infection breakout that last month forced the Denver hospital to suspend all surgeries for nearly a week. We don't know for certain what caused post-op infections in several patients who had orthopedic or spine surgery performed at the hospital over the last couple of years, but a trail of evidence points to improper instrument cleaning practices and the hidden menace known as biofilm.

  • When surgical site infections are linked back to surgical instruments, biofilm is likely a root cause.
  • The infection outbreak spanned nearly 2 years, from July 21, 2016, to April 5, 2018. Whatever was causing the infections was recurrent and undetectable, telltale characteristics of biofilm.
  • The hospital sent precautionary letters to about 5,300 patients who underwent orthopedic or spinal surgery at the hospital during that time. The letter explains that the sterilization issue revolved around the first step in a multistep process: a pre-cleaning process that occurs before instruments go through "an intense heat sterilization."
  • Health officials determined that the infection control breach was due to human error that occurred during "a gap" in the manual pre-cleaning phase — before the tools underwent heat sterilization. Staff at Porter Adventist wiped down, soaked and scrubbed certain spine and orthopedic instruments, but apparently not well enough. The instruments likely still contained bioburden when they were sent along for automated cleaning and heat sterilization.
  • Since warning patients of the pre-cleaning breach, the hospital discovered residue on instruments after sterilization. The hospital first suspected this was due to a water quality issue, but tests showed the water quality was well within the typical range found in drinking water. It turns out that a mineral buildup in a cleaning machine caused the residue.
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