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.

QWe have been experiencing rising costs relative to instrument repairs and/or instrument replacements due to damage. After an assessment of instrument flow we have determined a great deal of the damage is the result of the manner in which instruments are being packaged, stored, transported and/or returned to CS for reprocessing. We have decided to invest in more sterilization containers and/or cases to hold our instrument sets. Could you provide some advice as to what factors we should consider in the selection of containment devices?

AThere are many factors to consider when selecting instrument sterilization cases or containment devices. For clarification I will use the term "case" to refer to a containment device which must be wrapped or packaged for sterilization and the term "sterilization container" to refer to sealed sterilization containment devices. As with any product you first want to obtain the specifications, FDA 510k documentation and technical data from the manufacturer – which must include (a) instructions for use; (b) proper care and handling; and (c) methods for cleaning, packaging and sterilization. Containment devices are most commonly made of stainless steel, aluminum, plastic or a combination of these materials. You will want to be sure that the construction material is compatible with the intended sterilants and sterilization methods, as well as with your cleaning agents and processes.

Q I recently accepted the position of Clinical Director at a large outpatient ambulatory clinic and infirmary in a rural area. I was previously the director of peri-operative services and sterile processing at a large urban teaching hospital. I was appalled to learn that they were reprocessing bulb irrigating syringes here at the ambulatory center. I recall we stopped this practice 20 plus years ago at the hospital after cutting open a bulb syringe to reveal the degree of soil remaining on the internal walls of the bulb. To demonstrate the difficulty of adequately cleaning these bulbs I did the same thing here and quickly convinced the purchasing manager we needed to switch to disposables. We also perform several sigmoidoscopy procedures and of course use the insufflator bulb and bladder; I became very concerned on how these were being cleaned. I reviewed the manufacturers cleaning procedures which require manual processing which is very complicated and labor intensive. Utilizing a protein and blood residual testing device to sample the inner surfaces of "cleaned" bulb and bladder units we found that the majority tested positive for soil.

A Your question prompted me to conduct an informal straw poll on the topic. Although the survey was not scientifically or qualitatively sound, it did give some reflection on what CS practitioners think. Of approximately 150 responses, 148 respondents stated they were very concerned with how sigmoidoscopy accessories, such as the insufflator bulb and bladder are being cleaned. Most stated they were not aware of the detailed instructions the manufacturer provides. All felt it was impossible to clean these items adequately and said they would prefer to use a disposable product. The manufacturers cleaning instructions are indeed very complicated and time consuming.

• Do not disassemble unit

• Submerge unit in an enzymatic bath using soft bristle brush; scrub the external surfaces under water level for 5 minutes, then rinse in clean water for 5 minutes

• Using a clean 60 cc syringe, flush cleaning solution through hose connection into bulb and bladder and gently agitate inside bulb for 5 minutes

• Empty detergent

• Using a clean syringe, flush 60 cc of sterile water through the hose into the bulb and bladder and slightly agitate water inside of bulb for a minimum of 5 minutes

Figure 1

• Empty the water from the bulb and repeat the water flush process 5 more times

• The unit must then be completely dried as any water trapped inside the bulb could affect proper functioning or could dilute disinfectant agents and/or sterilants – one way to dry is to hang it for 24 hours

Once dried, the device can then go through a disinfection process – which is also quite a complex process.

Interestingly I learned that other countries, including Canada, use disposable insufflator bulb and bladders. Recently, a disposable, latex-free, no filter required, bulb and bladder assembly has become available in the US market (See Figure 1).

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.