By Gail Horvath , MSN , RN , CNOR , CRCST , and Margaret Miller , BS , MT ( ASCP ) M , CIC , FAPIC
Best Practices in Sterile Processing to Reduce Surgical Site Infections
Having a robust sterile processing department
( SPD ) creates a strong first link in the chain of infection prevention , especially utilizing the following best practices .”
What are the most common contributing factors to surgical site infections ( SSIs ) in your organization ? Certainly , sterile processing practices would make the list . It is reported that SSIs account for 20 percent of all hospital-acquired infections and that half may be preventable with implementation of evidence-based strategies . 1 Having a robust sterile processing department ( SPD ) creates a strong first link in the chain of infection prevention , especially utilizing the following best practices .
Point of use care of instruments
Care and cleaning of surgical instruments is a shared responsibility between the SPD and the area where the instruments are used . Gross soil should be removed at the point of use to :
• Reduce the number of microorganisms on the item
• Reduce the nutrient material that might support microbial growth
• Reduce the potential for environmental contamination by aerosolization or spillage
• Minimize damage to devices from such substances as blood , saline , iodine , and radiological dyes .
Transport of instruments
Establish and implement standardized sterile processing procedures and measures for oversight of all aspects of processing and transport , including when transporting between facilities . When transporting instruments to the operating room ( OR )/ procedure area , contain sterile items in a closed system to protect items from contamination , damage , or tampering . When returning instruments to the SPD post-procedure , contain contaminated items in a closed system and transport to the decontamination area as soon as possible .
If transporting instruments off-site , the facility must comply with applicable Department of Transportation and state regulations . Clean and contaminated items should be separated to prevent cross-contamination during transport . Transport vehicles that are loaded and ready for transport should not be left unattended in unsecured areas .
In the SPD , use lighted magnification to inspect instruments . Test insulated equipment for current leakage and remove defective instruments from service . Instruments should be thoroughly dry before assembly and packaging .
In the OR , confirm the following prior to placing instruments on the sterile field :
• Integrators have turned
• Biological for the load was negative
• Integrity of the container was not compromised
• No holes were present in wrapped trays
• No visual bioburden or debris was present
Ensure vendors provide manufacturer instructions for use ( IFUs ) for instruments and that they are delivered with adequate time for on-site decontamination and sterilization prior to the scheduled case .
Water and steam quality and monitoring
Water quality is an important consideration in all stages of medical device reprocessing . Poor water and steam quality may damage surgical instruments . It is best practice to use critical water — water that is extensively treated by a multi-step treatment process that usually includes a carbon bed , softening , deionization and / or reverse osmosis — for the final decontamination rinse and for steam generation . Routinely monitor water quality ( bacteria , pH , chloride , hardness , conductivity , endotoxins ) and share the results with infection prevention and control as well as SPD leadership .
Immediate use steam sterilization ( IUSS )
Formerly called “ flash sterilization ,” IUSS is described by The Joint Commission as “ the shortest possible time from the item being removed from the sterilizer to the aseptic transfer onto the sterile field .” IUSS items are not intended to be stored for future use . Acceptable conditions to use IUSS :
• The item will be used immediately
• Terminal sterilization is not an option
• The device manufacturer ’ s written instructions for cleaning , cycle type , exposure times , temperature settings , and drying times ( if recommended ) are readily available and followed ; and include instructions for IUSS
• The IUSS rigid sterilization container manufacturer ’ s written IFUs are followed
• IUSS should not be used for mere convenience , or due to limited instruments or equipment for the number of cases / procedures performed .
Event-related sterility Event-related sterility is based on the premise that items that have been properly decontaminated ,