Original article: December 2014 – CS Solutions.
How this applies to body artists:
- Start the cleaning process for instruments right away in the procedure area at the point of use by wiping them off and wetting them with a foam enzyme cleaner product such as the all-in-ONE™ Surgical Instrument Cleaners and Conditioners.
- Transport the instruments to an enzyme instrument soak (diluted all-in-ONE™) or automated washer such as the Hydrim right away.
*Don’t store contaminated instruments dry!
Passing the buck on contaminated instruments, washer placement
by Ray Taurasi
I am currently in a conflict with operating room (OR) leadership at my hospital in regard to how medical instruments are being returned to Decontamination for reprocessing. They believe it is fine to just randomly stack soiled, bloody instruments in an instrument basket or basin and put it in the case cart for return. They do not feel it is the function or responsibility of “professional nurses” to get any further involved in preparing soiled instruments for return to CS. I, however, believe that instrument reprocessing should begin at the point-of-use. Can you provide me any information or advice on how instruments should be coming down to sterile processing from the OR? Do you think bloody, unstrung, mixed instrument sets are appropriate?
All recommendations from professional and educational entities*, such as AAMI, AORN, CBSPD, IAHCSMM and AST state that instrument reprocessing should begin at the point-of-use, which is important for instrument protection and for effective cleaning. Since you are dealing with the OR, I would refer them to the AORN recommendations, which is their professional entity and the source they most commonly refer to. The AORN document, “Recommended Practices for Cleaning and Care of Surgical Instruments and Powered Equipment,” provides excellent advice for the care, handling and reprocessing of surgical instruments, including the following:
- Care and removal of gross soil during surgery
- Care and handling of instruments at case break down including removal of gross soil and the prevention of blood and other organic from drying
- Commencing the cleaning process as soon as possible following an instrument’s use
- Preparation and protection of instruments for and during transportation, including the use of instrument stringers
- Following manufacturer’s IFUs (instruction for use)
- Management and care of loaner instrumentation
- OSHA considerations, sharp safety, blood borne organisms
- Water conditions for reprocessing
- Environmental conditions
- Facility, work flow and environmental control
- Processing equipment and essential cleaning tools
Every Sterile Processing department should have a copy of the AORN recommendations in their library and utilize and reference them often in the development of their policies and procedures.
We are doing some renovations in our Sterile Processing area and replacing our processing equipment. I have always had two ultrasonic washers — one in the decontamination area and one on the clean side to re-clean any instruments that are found dirty after visual inspection. I was planning to continue having two washers but our equipment consultant said the work volume doesn’t warrant purchasing two new machines. If I can only have one machine, where do you suggest it should it go?
The way I have always answered this question was to ask, “What does an ultrasonic washer do?” The answer, of course, is it cleans devices. The next question I ask is “Where is cleaning done in sterile processing?” And the answer I get is in the decontamination area … therefore the ultrasonic belongs in the decontamination area. It is a piece of cleaning/decontamination equipment and it belongs in the appropriate, controlled environment.
* AAMI (Association of Medical Instrumentation), AORN (Association for periOperative Registered Nurses), CBSPD (Certification Board for Sterile Processing and Distribution), IAHCSMM (International Association of Healthcare Central Service Materiel Management) and AST (Association of Surgical Technologists).