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The Patient Safety & Decontamination Relationship

Where does the decontamination process begin in sterile processing?  First, we have to understand what decontamination is and how important decontamination is to the patient, to the operating room, the clinics, and physicians using the instruments and to sterile processing.

The IAHCSMM definition of decontamination is “to make safe by removing or reducing contamination by infectious organisms or other harmful substances; the reduction of contamination to an acceptable level.”

Suboptimal reprocessing can mean that instruments that have gone through Sterile Processing are returned to the end users with human tissue, bone or other organic material in or on the treated instruments, this is known as re-work in the sterile processing industry.  To prevent re-work of an item, the item must be processed correctly the first time.  The steps to decontamination are:

  1. Moistening and removing gross soil at the point of use (generally the operating room)
  2. Pre-Cleaned at the Point of Use
  3. Manually cleaned in decontamination (three sink method)
  4. Ultrasonic cleaner or sonic irrigator (if IFU states)
  5. Washer/Disinfector
  6. Prep/Pack for inspection (if clean processed for sterilization)
  7. Prep/Pack for inspection (if dirty returned to decontamination for reprocessing)

The Emergency Care Research Institute (ECRI) and other reporting agencies, including the Food and Drug Administration (FDA), have received numerous reports of dirty instruments that were not cleaned adequately by staff in sterile processing before they underwent disinfection or sterilization.  Some of these instruments, but not all of the contaminated instruments were detected before they reached the patients.  Soiled instruments used during patient procedures place the patients at risk for postoperative infections, such as surgical site infections and the possibility of contracting a potentially deadly infectious deadly infectious agent that causes diseases such as hepatitis C, HIV, and tuberculosis.

There is no question this is happening in healthcare; the question is why is it happening?  Experts are all agreeing there is an increase in the number of improperly cleaned instruments that make it to our operating rooms and to the end users.  But how does this keep happening?  One of the main problems in sterile processing today is the complexity of the instruments and the changes in technology.  Today, with the complexity of the instruments, the manufacturing guidelines have changed significantly. There are more movable parts to disassemble, and narrow channels to clean with various metal types to have to worry about compatibility of the metals.

Mistakes can be avoided by implementing some of the following:

  • Hire a skilled qualified leader to run their sterile processing department and one who can recognize a skilled qualified technician or an individual with the capability of becoming a skilled qualified technician upon hire.
  • Evaluating staffing and determining staffing requirements, space requirements, and additional equipment requirements to meet the staffing needs.
  • Ensuring there is enough instrumentation to meet the operating room scheduling needs and demands and allowing adequate time to process these instruments and making sure the sales representatives bring their loaner trays in within the guides lines established by the facility (generally 48 hours prior to the surgery).
  • Standardizing the procedures in all of the reprocessing areas following manufacturing guidelines.
  • Supporting continuing education for sterile processing technicians and encouraging certification for employees in states that don’t required sterile processing technicians to be certified.
  • Working collaboratively with the operating room in developing a bridge between the operating room and sterile processing to encourage positive teamwork and cohesiveness.

The first step to decontamination begins at the point of use (the operating room, the clinic, the emergency room, etc.).  The AORN states, “Instruments should be cleaned and decontaminated as soon as possible after use.”  AORN also recommends “moistening and removing gross soil at the point of use can help prevent organic material and debris from drying on instruments.” Moistening of the instruments should be done with sterile water while in the operating room.  If normal saline is used on the instruments for wiping them clean, over a period of time, causing possible pitting and corrosion.

Removing the gross soil as soon as possible helps to reduce the number of microorganisms on the item; reducing the nutrient material that might support microbial growth, and reduces the damage to instrumentation from such substances such as blood, saline, iodine, and various dyes.  This is an area where working collaboratively with the operating room can not only benefit the staff in sterile processing by making it easier for cleaning of instrumentation, it can also protect and prolong the life of instrumentation for a healthcare facility.  In addition, this will help a facility maintain their accreditation with The Joint Commission.  The Joint Commission surveyors use the AAMI standards as their guides and are very familiar with these guides, therefore, compliance is necessary.

The question is:  Who are looking at these infections? Everyone is watching for these infections, you’re state and federal regulators, the Center for Disease Control (CDC), National Healthcare Safety Network (NHSN), The Joint Commission and your even national and local news agencies.

Have your department properly trained and do it right the first time.  Eliminate the Re-Work process and keep your patients safe and coming back to your facility.

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