August 2009 - CS Solutions

INSIDE THE CURRENT ISSUE

August 2009

CS Solutions

Questions can be sent to jakridge@hpnonline.com
called in to Jeannie Akridge at HPN:(941) 927-9345 ext.202 or mailed to:
HPN CS Questions, 2477 Stickney Point Road, Suite 315B, Sarasota, FL 34231
Names and hospital identification will be withheld upon request.

Transporting soiled & sterile items; use of disinfectant wipes

by Ray Taurasi

QI am the nurse manager for ER, OR, and CSR for a 90-bed rural hospital. There is not another hospital within a 100-mile radius. We are in the process of opening two outpatient care centers in the outlying area that will provide routine and emergency care. Each center will have one small OR and we plan to do some minor surgical procedures twice a week. The centers will each have a very small utility room for manual cleaning and scope processing but there will be no sterilizers. Contaminated instruments, equipment and other items requiring sterilization will be returned to the hospital for reprocessing. Are there any special requirements that need to be considered for transporting soiled and sterile items from one location to the other?

AStandards of practice and proper infection control techniques do call for the complete segregation of soiled and contaminated items from those that are clean and/or sterile. There are many resources available to assist you in learning more about the proper techniques for the reprocessing, cleaning and sterilization of medical supplies and devices. The following organizations have a plethora of information including technical manuals, educational programs, guidelines and recommendations which would provide you the knowledge to develop and implement the best practices in this regard:

• International Association of Healthcare Central Service Materiels Management (IAHCSMM): www.iahcsmm.org

• Association of periOperative Registered Nurses (AORN): www.aorn.org

• Association for the Advancement of Medical Instrumentation (AAMI): www.aami.org

In general items that are soiled and/or contaminated with bodily fluids, blood and/or organic matter are considered infectious and biohazardous. Such items must be contained in a manner that will prevent any potential for cross contamination.

Soiled items that are considered biohazardous such as contaminated instruments must be contained and identifiable as a biohazard. Specially colored, marked or labeled containers should be used exclusively for holding and transporting soiled items. Most institutions use red colored containment devices or vessels for this purpose marked with the universally recognized and standard Biohazard symbol.

When transporting such items the containment devices should be secure, rigid (to prevent punctures) and leak proof. If you are planning to utilize transport carts to contain your soiled and clean items you will want to be certain that the cart has leak proof sealed doors which can be secured in transit. The wheels on the carts should have locks to prevent movement while being transported via a vehicle (truck). The carts will need to be cleaned and decontaminated between uses and therefore the design and construction materials should allow for this. Appropriate carts are readily available including those that are compartmentalized allowing the segregation of soiled and cleaned items in transit.

The truck or van you utilize to transport soiled, contaminated and/or sterile items should have a storage compartment/chamber that is thematically controlled to maintain the proper temperatures and humidity levels to ensure sterility maintenance and minimize the proliferation of bacteria. The vehicles’ storage chamber should be of a design and construction to allow for thorough and proper cleaning and decontamination between each use. Ideally the vehicle should have stabilizer suspensions to minimize the movement of carts and goods in transit. You will also need to comply with federal and state Department of Transportation (DOT) regulations related to the transportation of biohazardous materials across the roadways. There are also very strict OSHA (Occupational Safety and Health Administration) regulations which must be enforced relative to the handling of biohazardous materials, sharps and blood borne pathogens. You will need to consult the federal, state and local OSHA regulations as well as your state and local DPH (department of public health) regulations relative to the care, handling and transportation of biohazardous materials.

QWe use disposable disinfecting wipes to disinfect work surfaces, mobile equipment and sterilization containers. We have found this to be a very effective and time-saving process. It is a simple process where one product can be used in a one-step process. Our sterilization containers are removed from the OR prior to the patient entering the room so they really never get soiled. We merely wipe them down with the disposable wipes when they are returned to CPD. I recently attended a seminar and something was said that implied this wasn’t an acceptable process. Why not?

AThere is a lot of misunderstanding and inappropriate use of disinfectant wipes. The whole "one-step" process is a myth and a dangerous practice. Don’t play the "wipe off game". It’s a very big gamble and the stakes are too high. The wipes are not a magic wand and there is no instant kill. As CPD professionals we know better and understand that disinfection is a two-step process and requires adherence to strict procedure. Items must be cleaned prior to disinfection, and to be effective the disinfectant must remain moist and on the surfaces to be disinfected for a prescribed period of time. Disinfectants used on medical devices that will have patient contact must be completely rinsed off following the disinfecting process. There is no such thing as a "one-step process". Read the instructions carefully: even the wipes sold for household use clearly state that the wipe application is a two-step process, the first for cleaning and the second for disinfection. The instructions also state the disinfectant must remain wet and on the item’s surface for a defined and specific period of time. Regarding the use on sterilization containers, your container manufacturer can provide you cleaning instructions which you should comply with. The chemicals on the wipes may be damaging to the containers’ surfaces, finish or working mechanisms. Chemical residuals should be completely rinsed from containers prior to use and sterilization as the chemicals may not be compatible with the sterilization process and the residuals could be transferred to instruments posing a risk to patient safety.

Ray Taurasi is Eastern Regional Director of Clinical Sales and Services for Healthmark Industries. His healthcare career spans over three decades as an Administrator, Educator, Technologist and Consultant. He is a member of AORN, AHA, SGNA, AAMI and a past president of IAHCSMM and has served on and contributed to many national committees with a myriad of professional organizations, manufacturers, corporations and prestigious healthcare networks. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration and health sciences. In addition to this column he has authored several articles and has been a featured speaker on the international scene.