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KSR Publishing, Inc.
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         Clinical intelligence for supply chain leadership

 

INSIDE THE CURRENT ISSUE

December 2014

CS Solutions

 
 


 

Questions can be sent editor@hpnonline.com
called in to Valerie Dimond 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.

Ray Taurasi

Passing the buck on contaminated instruments, steam outages, washer placement

by Ray Taurasi

I am currently in a conflict with operating room (OR) leadership at my hospital in regard to how medical instruments are being returned to Decontamination for reprocessing. They believe it is fine to just randomly stack soiled, bloody instruments in an instrument basket or basin and put it in the case cart for return. They do not feel it is the function or responsibility of "professional nurses" to get any further involved in preparing soiled instruments for return to CS. I, however, believe that instrument reprocessing should begin at the point-of-use. Can you provide me any information or advice on how instruments should be coming down to sterile processing from the OR? Do you think bloody, unstrung, mixed instrument sets are appropriate?

All recommendations from professional and educational entities*, such as AAMI, AORN, CBSPD, IAHCSMM and AST state that instrument reprocessing should begin at the point-of-use, which is important for instrument protection and for effective cleaning. Since you are dealing with the OR, I would refer them to the AORN recommendations, which is their professional entity and the source they most commonly refer to. The AORN document, "Recommended Practices for Cleaning and Care of Surgical Instruments and Powered Equipment," provides excellent advice for the care, handling and reprocessing of surgical instruments, including the following:

  • Care and removal of gross soil during surgery

  • Care and handling of instruments at case break down including removal of gross soil and the prevention of blood and other organic from drying

  • Commencing the cleaning process as soon as possible following an instrument’s use

  • Preparation and protection of instruments for and during transportation, including the use of instrument stringers

  • Following manufacturer’s IFUs (instruction for use)

  • Management and care of loaner instrumentation

  • OSHA considerations, sharp safety, blood borne organisms

  • Water conditions for reprocessing

  • Environmental conditions

  • Facility, work flow and environmental control

  • Processing equipment and essential cleaning tools

Every Sterile Processing department should have a copy of the AORN recommendations in their library and utilize and reference them often in the development of their policies and procedures.

For the second time in two months we have had unanticipated steam shutdowns. Is it necessary to revalidate and verify the sterilizer’s performance before putting the sterilizers back in use?

The need to verify the sterilizer’s proper function after a steam outage would depend on the reason for the steam shutdown. If the steam service was interrupted due to a major repair, such as the replacement of the boiler, plumbing, water source, etc., then retesting is recommended. This would include running three consecutive Bowie Dick Tests and three consecutive tests using PCDs with a biological indicator (BI). All test results would need to be satisfactory. Steam outages for other reasons (e.g., routine maintenance, emergency testing, etc.) would not require you do testing prior to reuse of the sterilizer. It is important you know the nature/reasoning for the interrupted steam service and act accordingly. If you are ever in doubt then you should definitely do the testing before placing the sterilizers back into full service.

We are doing some renovations in our Sterile Processing area and replacing our processing equipment. I have always had two ultra-sonic washers — one in the decontamination area and one on the clean side to re-clean any instruments that are found dirty after visual inspection. I was planning to continue having two washers but our equipment consultant said the work volume doesn’t warrant purchasing two new machines. If I can only have one machine, where do you suggest it should it go?

The way I have always answered this question was to ask, "What does an ultra-sonic washer do?" The answer, of course, is it cleans devices. The next question I ask is "Where is cleaning done in sterile processing?" And the answer I get is in the decontamination area … therefore the ultra-sonic belongs in the decontamination area. It is a piece of cleaning/decontamination equipment and it belongs in the appropriate, controlled environment.

* AAMI (Association of Medical Instrumentation), AORN (Association for periOperative Registered Nurses), CBSPD (Certification Board for Sterile Processing and Distribution), IAHCSMM (International Association of Healthcare Central Service Materiel Management) and AST (Association of Surgical Technologists).

I received several questions this month relative to processing items used on suspected Ebola patients. See guidelines below.


Guidelines for handling Ebola-contaminated instruments

The International Association of Healthcare Central Service Materiel Management (IAHCSMM) information compiled from a variety of sources, including the Association for periOperative Registered Nurses (AORN) and the Centers for Disease Control (CDC), on how to properly handle medical instruments that have been in contact with the Ebola virus (http://www.iahcsmm.org/resources/ebola-resources.html).

AORN issued a press release On Oct. 14, 2014, that included the following statement:

"Contaminated instruments should be placed in puncture and leak-proof containers and transported to the decontamination area as soon as possible after completion of the procedure. Sterile processing team members should follow standard precautions and wear personal protective equipment (PPE), including:

  • fluid-resistant gown with sleeves

  • gloves (i.e., general purpose utility gloves with a cuff that extends beyond the cuff of the gown);

  • mask and eye protection or a full face shield; and

  • shoe covers or boots designed for use as PPE.

Amber Wood, MSN, RN, CNOR, CIC, CPN, is a perioperative nursing specialist in the nursing department at AORN, recommends a review of AORN’s Recommended Practices for Cleaning and Care of Surgical Instruments and Powered Equipment for detailed guidance for the safe handling and decontamination of soiled surgical instruments. According to Wood, all perioperative team members should limit the amount of surface contamination with blood and body fluids from the patient and follow AORN’s Recommended Practices for Sharps Safety to minimize the risk of injury from a contaminated sharp device.

The CDC issued a statement on Oct. 6, 2014, "Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals," which provides the following guidance on handling patient care equipment:

  • Dedicated medical equipment (preferably disposable, when possible) should be used for the provision of patient care.

  •  All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and hospital policies.

The document is available at: www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html.

The CDC also issued an interim guideline on Oct. 3, 2014, Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus, which states:

"Use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection.

Although there are no products with specific label claims against the Ebola virus, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to disinfect hard, non-porous surfaces. In contrast, non-enveloped viruses are more resistant to disinfectants. As a precaution, selection of a disinfectant product with a higher potency than what is normally required for an enveloped virus is being recommended at this time. EPA-registered hospital disinfectants with label claims against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) are broadly antiviral and capable of inactivating both enveloped and non-enveloped viruses.

The document is available at: http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html

*The CDC and AORN stress that the information compiled by IAHCSMM may be updated and subject to change.

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.