sterile processing
By Julie E. Williamson
In Sterile Processing and Beyond, Desperate
Times Call for Most Prudent Measures
At
the time of this writing, shortages of critical supplies,
including face masks, respirators and other essential
personal protective equipment (PPE), are further compounding
the challenges. Some healthcare facilities that have been
hardest hit by COVID-19 have exhausted their supply of N95
respirators and face masks and, in a desperate attempt to
come up with alternatives, are relying on face shields from
sterile processing department (SPD) decontamination areas;
as a result, some SP professionals are being asked to disinfect
and reuse their face shields – a practice that can jeopardize
employee safety.
As epidemiologist Cori Ofstead, MPH, president and CEO
of Ofstead and Associates, shared with the International
Association of Healthcare Central Service Materiel Management
(IAHCSMM), “I’m concerned that SPD personnel may be asked
to use less PPE or reuse PPE. If that happens, they should sit
down with stakeholders and figure out how they’re going to
decontaminate the PPE before reuse. Anything used in manual
cleaning is highly contaminated and should not be reused,
unless it can be cleaned and disinfected or sterilized in ways
that do not compromise the materials. Vendor consultations
may be necessary for this.” 1
In the SP realm, COVID-19 has provided some essential
teachable moments. For starters, there is good news: with
practice due diligence, the virus can be eliminated by high-level
disinfection and sterilization. 2 As Ofstead explained, the risk is
no higher than it has always been with other serious pathogens,
and everyone will be safe if they follow the practices needed
to prevent exposure to HIV, hepatitis, bacteria and fungi. 1
Currently, OSHA recommends following SARS disinfection
practices (see section D-10) for environmental areas con-
taminated with COVID-19. Note: The CDC advises the use
of EPA-registered chemical germicides that provide low- or
intermediate-level disinfection for SARS during general use
(surface and noncritical patient-care equipment) because
these products inactivate related viruses with similar physical
and biochemical properties. Further, the CDC’s Guideline for
Disinfection and Sterilization in Healthcare Facilities, 2008 provides
information on germicides’ efficacy against coronaviruses.
SP professionals should always treat every device they
handle in the decontamination area as high risk and potentially
contaminated with microorganisms that can cause devastating,
if not fatal, infections. Every day when SP technicians enter the
department, they must understand that any device that has not
been thoroughly and properly cleaned cannot be effectively
sterilized. Also, when manually cleaning any instrument, the
devices must be fully submerged underwater to prevent
splashing and aerosolization.
Where COVID-19 is concerned, recent studies have shown
the virus can survive for hours or even days on surfaces that
www.healthcarehygienemagazine.com • april 2020
aren’t cleaned or disinfected. 3,4 Again, even taking the novel
virus out of the equation, it’s essential that – in addition to
instruments themselves -- all work areas and transport bins
must be routinely, thoroughly and properly disinfected in
accordance with the manufacturer’s instructions for use and
standards-based facility policies and procedures.
Proper training and competency testing to ensure all SP
technicians are following correct practices for handwashing
and donning/doffing of personal protective equipment (PPE)
is imperative and must be performed on an ongoing basis.
Unfortunately, both practices tend to be lacking.
“We have never been to an institution where all of the
reprocessing technicians were wearing the proper PPE in the
correct way,” notes Ofstead, adding that technicians also
rarely use proper technique when taking off PPE, which could
expose them to COVID-19 and other pathogens.
Masks and face shields are often inappropriately worn,
perhaps due to lack of hands-on training or the uncomfortable
environment in the decontamination area, which may make
their removal tempting. The top must pinch snuggly on the
nose to prevent it from migrating down and exposing the nose
or mouth, Ofstead explained. She warned against allowing the
mask to dangle around the neck and then pushing it back up
for use throughout the day – regardless of how uncomfortable
those face coverings may be.
It’s also worth noting that even though many SP
professionals may be seeing their workload diminish due to
COVID-19-related cancellations of elective surgeries, their
SPDs will be busier than ever once life begins to return to
normal, restrictions lift and hospitals and surgery centers
start rescheduling those procedures. The need for all SP
professionals to practice due diligence and avoid taking
any shortcuts will be greater than ever. It’s a message that
all should take to heart every day of the year, for every case
and every instrument.
Julie E. Williamson, BA, is IAHCSMM’s communications
director/editor.
References:
1. IAHCSMM. Conversation with Cori Ofstead Regarding COVID-19.
IAHCSMM Insights. March 25, 2020.
2. OSHA. COVID-19 Control and Prevention, Interim Guidance for Most
U.S. Workers and Employers of Workers with Potential Occupational Exposures
to COVID-19: Environmental Decontamination. https://www.osha.gov/SLTC/
covid-19/controlprevention.html#health
3. CDC. Public Health Response to COVID-19 Outbreaks on Cruise Ships –
Worldwide, Feb-March 2020. Morbidity and Mortality Weekly Report. https://
www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm6912e3_w
4. NIH. New Coronavirus Stable for Hours of Surfaces. March 17, 2020.
https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-
hours-surfaces
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