Q I work at a large academic teaching hospital and we have recently opened a new Oncology Specialty Center. The Center will be providing chemotherapy to outpatients and performing many diagnostic, research and therapeutic procedures. The center has all types of new medical devices and procedure sets and our Sterile Processing will be responsible for the reprocessing and sterilization of all these items. I am concerned relative to occupational safety and was wondering if there were any special handling or precautionary protocols that should be followed when handling supplies and medical devices used with chemotherapy.

A It sounds like you are going to be reprocessing many new medical devices and accessory products which you have not handled before. For such items you will want to be sure to obtain the care and handling instructions along with related technical data from each manufacturer. Regarding occupational hazards relative to chemotherapy, there are no special handling requirements for the reprocessing of instruments or other medical devices exposed to chemotherapy medications. You should adhere to all OSHA requirements regarding the use of proper PPE for the handling of sharps and devices which are potentially contaminated with blood borne pathogens. You should also follow the routine decontamination protocols and recommendations set forth by AAMI, AORN and IAHCSMM. You should be certain that you are using appropriate protective gloves in your decontamination department. Many hospitals simply use the short style latex procedure gloves or the household "Playtex" dishwashing gloves; neither of these gloves really provides adequate protection as they are not durable and may easily tear or puncture in use and are not long enough to offer full protection. There are special decontamination gloves available on the market which are longer in style, and made of thicker 15 ML textured powder-free latex. These gloves are also certified for use in chemotherapy. (See figure 1.) If you are involved with handling nuclear radiotherapy devices in your decontamination area you will need to consult with your safety engineer and radiology department, as these devices may require special handling and facility design considerations.

Q I am a CRCST but have been working in a private GI clinic reprocessing endoscopes for the past five years. I recently accepted a similar position in a hospital based Endoscopy clinic. I was surprised and concerned to find that flexible endoscopes are disinfected immediately before use. When I confronted the nurse manager about this she informed me that their procedures were compliant with recommended practices and there was no need to change the manner in which scopes are processed. Could you please tell me what the correct practice is?

A SGNA and AORN recommendations for the cleaning and reprocessing of flexible endoscopes and endoscope accessories advise that if an endoscope has been cleaned, disinfected, and stored correctly within the previous five-day period, reprocessing immediately before use is not necessary. Previously the recommended practices did state that flexible scopes should be reprocessed immediately before use. Cleaned, disinfected scopes should be protected and stored in a clean, dry, well-ventilated, secure, controlled environment to minimize the possibility of recontamination. All valves and the water-resistant cap should be removed during storage to facilitate drying. The water-resistant cap (distal tip protectors) are basically sponges and could absorb and retain moisture. The moisture may harbor micro organisms which could reproduce during storage and be a source of recontamination. Flexible endoscope drying/storage cabinets are also available which will provide protection of disinfected scopes preventing damage and contamination. The storage cabinets have filtrated air pressure and flow controls.

Q We have a new manager who instituted new dress code and personal hygiene policies. I can accept and understand the rationale and her thinking on some of the new rules, although there are some that just don’t seem reasonable. She does not allow us to wear any nail polish, and we must not have nails that extend beyond our fingertip. False nails, wraps or any other faux nail treatments are prohibited. I like to look nice and enjoy having pretty fingernails. I am very clean and my personal hygiene includes cleaning my nails. I have worked in CS for many years and never had a boss tell me I had to cut my nails or could not have acrylic fingernails. I can’t afford to remove my nails every week. Can you help me convince my new boss she is being unreasonable?