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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
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Cleaning keyboards; goods returned to CPD; overnight soaking
by Ray Taurasi
Q
We have several computer work stations throughout the
sterile processing department including the decontamination area. We
do try to keep the CPU, monitor and keyboards clean by wiping them
down at the end of each shift. I really am concerned that wiping
down the keyboard’s surface areas may not be an effective process.
The keyboards are not moisture proof and the keys consist of many
crevices and movable parts which present a real challenge to
adequate cleaning and disinfection. I am particularly concerned with
the computers in the decontamination area being handled by
contaminated hands and gloves. Could you suggest a
cleaning/decontamination process that would be effective?
A
History has illustrated that over 2 million patients annually
contract an infection while seeking treatment in US hospitals. Of
those infected close to 100,000 die annually, making healthcare
acquired infections (HAI) a Top 10 Killer of Americans. Complicating
this epidemic is a strain of antibiotic resistant staph infection,
MRSA, which has emerged in hospitals worldwide. Keyboards, as well
as the scroll mouse, have been shown to harbor infectious organisms
which can be a source of cross contamination and transmission of
disease. It is therefore critical that these devices be adequately
cleaned to reduce the likelihood of cross contamination. The complex
design and material composition of these devices present a real
challenge and make thorough cleaning and decontamination an
impossible task.
Washable keyboards and mice have been developed and are now
available. (See figure 1 and figure 2.) Users can regularly wash
these frequently used devices thoroughly and safely by simply
putting them in the washer or washing them in a sink of warm, soapy
water. The sealed, waterproof construction is also resistant to
chemicals and disinfectants, which permits for proper
decontamination and disinfection. The devices are reasonably priced,
key pads are available for under $40.00 and scroll mouse can be
purchased for under $50.00. It is highly recommended that these
washable key pads and mice be utilized in the CPD department as well
as throughout other clinical departments.
Q
On occasion a case cart may be returned from the OR
to the decontamination area with sterile packages and unopened
instrument sets on top of the case cart. Do you think that anything
and everything that comes into the decontamination area needs to be
discarded and or opened and completely reprocessed, cleaned and
resterilized?
A
Your hospital should have a policy and procedure in place which
deals with the disposition of all goods returned to CPD from the OR
and other clinical departments. Established policies and procedures
need to be followed and enforced. Factored into these procedures
should be the manufacturer’s instructions relative to reprocessing,
cleaning and sterilization. I do know that many hospitals have a
blanket policy which states anything that enters the decontamination
area must be discarded and or completely reprocessed. I may be a bit
of a renegade but I am not in favor of such a rigid blanket policy.
While I do support and believe in the principle of "when in doubt
throw it out" I also believe in a rational approach which allows one
to apply sound knowledge of the basics of microbiology. We know that
for a package’s contents to become contaminated organisms must be
able to permeate the package. Certain events such as moisture,
tears, punctures and other such events can compromise the package’s
sterile integrity. One must use microbial common sense; micro
organisms don’t have legs or wings, so they cannot land on sterile
packages without your assistance; they don’t have teeth and can’t
chew their way through sterile packages and contaminate the
contents. Packaging materials and packaging techniques are not all
equal. Some are more easily contaminated such as linen, cellulous,
and some other synthetic textiles and materials. Others are less
prone or impervious to moisture contamination such as sterilization
containers, plastics, Tyvek, polypropylene, liquid shield
synthetics, and dust covered packages. The outside of all sterile
packages are contaminated. Just because a sterile package enters the
decontamination area doesn’t mean the contents have been
contaminated. One must consider the type and method of packaging and
the protection it offers. A visual inspection of impervious
packaging and or containers can reveal if the package’s sterile
integrity has been compromised and or damaged. The outer surface of
certain packaging such as plastic and containers can actually be
wiped clean without compromising the sterile integrity of the
contents. Many commercially prepared devices are packed in
impervious packages and can maintain sterility unless opened,
punctured, torn or damaged in some other way. Most commercially
sterilized devices can not be reprocessed. It would be economically
irresponsible to discard such items just because they entered the
decontamination area.
Q
We do not have a night shift and the sterile
processing department closes from 10:00 PM until 8:00 AM is it
alright to leave surgical instruments soaking in the sink submerged
in an enzyme detergent overnight?
A
It is not a good idea to leave soiled
instruments soaking overnight in an enzyme detergent. Enzymes break
down organic soils to make their removal easier during the cleaning
process. The enzymes complete their job within a few minutes so
extended soaks have little to no value. In other words, soils will
not be broken down any further. Enzymes are proteins - as are
organic soils - and left standing the protein will multiply in the
soak bath and instruments can become a greater source of
contamination. The enzymes can cause or form a biofilm on the
instruments which will be very difficult to eliminate and may
adversely affect the sterilization process.
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.
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