Best practices call
for the reprocessing of soiled instruments as soon as possible and
recommend that the process begin at the point of use where gross soil
is wiped from soiled instruments. Hospital policies and procedures
should be developed and implemented that will facilitate the expedient
cleaning and decontamination of soiled devices. You should always
consult the manufacturer of any chemicals, enzymes, or detergents that
you utilize. They will provide instructions for use for their
products. You also need to obtain cleaning and reprocessing
instructions from your instrument manufacturers. Users should always
follow the manufacturer’s instructions. Many manufacturers’
instructions state the maximum amount of time that instruments should
be allowed to soak. Aside from the microbial and biofilm formation
concerns, in some incidences, excessive soaking could be damaging to
instrumentation or other medical devices. If the manufacturer of your
enzyme or detergent states instruments can remain soaking for
specified extended periods of time and will prevent the formation of
biofilms and/or the procreation of micro organisms then you can follow
their instructions for such use. However be certain the instrument
manufacturer’s instructions allow for extended soaking periods. An
option to soaking instruments to keep them moist prior to processing
or transit to CPD would be to place a water moistened towel over the
instrument tray and place the tray in a plastic bag and secure shut.
Q
I recently started a new job as the Nurse Manager over the Sterile Processing
Department at a very large medical center. I was appalled to discover the manner
in which the OR breaks down cases and returns items to SPD for reprocessing. The
bloody instruments are stacked in piles and dumped into instrument trays and/or
basins. The case carts are overloaded with waste; full suction canisters and the
sets are stacked on each other. Instrument damage is a major problem. I have had
some success in making some improvements in this process – however the OR
director will not endorse my request that gross soil be removed from instruments
and that an enzyme foam be applied to the soiled instruments, nor will she
assist in efforts to have dirty case carts returned to SPD on a more timely
basis throughout the day. She does not feel that her nurses or other OR staff
should have to get involved in pre-cleaning and be concerned with returning
items to SPD. Are you aware of any regulations or guidelines that I might use to
support me in my efforts to initiate change?
A
You will find the support you are looking for in the AAMI ST 79 6.3, 6.4, 6.5
documents which address pre-cleaning protocols, removal of gross soils at point
of use, containment and the rapid transportation of soiled goods to the
reprocessing area. AAMI 7.5.6, Cleaning of Instruments, clearly states that
instruments should be kept free of any gross soil during surgical procedures and
that the cleaning and decontamination process should begin as soon as possible
following use. The guidelines further address issues of separating, and sorting
instruments for proper handling and reprocessing e.g. the separation of
utensils, delicate instruments and medical devices. AORN Recommended Practices
for Cleaning and Care of Surgical Instruments and Powered Equipment also support
that cleaning and decontamination should occur as soon as possible after use.
AORN recommends that preparation of instruments for decontamination begin at the
point of use. AORN (PNDS: I70, I98) states, "Removing gross soil and moistening
soil at the point of use improves the efficiency and effectiveness of
decontamination."
Q
Our hospital has a van that transports people, mail, supplies and equipment
between buildings and sometimes to other hospitals. Is it acceptable to use this
van to deliver sterile supplies to offsite clinics and to collect used supplies
for reprocessing?
A
There are very specific guidelines and recommendations for transporting sterile
and contaminated items via vehicles between buildings and roadways. AAMI ST 79
6.5 addresses transport guidelines, and recommendation 6.5.5 specifically
addresses transportation between buildings. When you use a vehicle on public
roadways to transport contaminated materials such as medical devices soiled with
organic matter there are very stringent Department of Transportation (DOT)
regulations which you must follow. Such materials are considered Bio Hazardous.
DOT regulations are very specific regarding the packaging and transport of
contaminated bio hazardous materials. You will need to refer to and comply with
your state and local DOT regulations. General considerations include the
following;
• Dedicated vehicle allowing for complete segregation between clean, sterile
and contaminated items
• Enclosed, secure, leak proof, containment devices and/or carts
• Temperature and humidity controlled vehicle
• Locking device on vessels to prevent movement in transit
• Proper labeling
• Use of appropriate PPE as needed
• Trained personnel on proper handling of sterile and contaminated goods
• Bio hazard spill kit availability
• Thorough cleaning and decontamination of vehicle and all carts and
containment vessels between loads.
