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 (Central Sterile) industry. To prevent re-work of an item, the item must be processed correctly the first time. The steps to decontamination are:
The Emergency Care Research Institute (ECRI) and other reporting agencies, including the Food and Drug Administration (FDA), have received numerous reports of dirty surgical instruments that were not cleaned adequately by staff in Sterile Processing before they underwent disinfection or sterilization. Some of these surgical 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 (SSI), and the possibility of contracting a potentially 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 surgical 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 surgical 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 the compatibility of the metals.
Mistakes can be avoided by implementing some of the following:
The first step to decontamination begins at the point of use (the Operating Room, the clinic, the emergency room, etc.). The Association of periOperative Registered Nurses (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, will cause 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 surgical instrumentation, it can also protect and prolong the life of instrumentation for a healthcare facility. In addition, this will help a facility maintain its accreditation with The Joint Commission (TJC). The Joint Commission surveyors use the Association for the Advancement of Medical Instrumentation (AAMI) standards as their guides and are very familiar with these guides, therefore, compliance is necessary.
The question is: Who is looking at these infections? Everyone is watching for these infections, your 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 Sterile Processing 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.