Healthcare Hygiene magazine December 2019 | Page 12

IAHCSMM insider for the SPD
By Julie E. Williamson
Proactive Device Care Helps Eliminate
Biofilm Threat, Aid Cleaning Process
P
reventing contaminated instruments from being used in
a subsequent procedure should be a priority for every
professional in sterile processing (SP), the operating room
(OR) and other end-user departments. Any bioburden that
remains on an instrument can cause devastating, potentially
deadly infections if that contaminated device or piece of
equipment is used on another patient. It’s important that all
caregivers and reprocessing professionals understand that
instrument contamination can’t always be detected with the
naked eye, and that proactive instrument care is a shared
role that must be consistently and diligently performed.
Biofilm is an often-invisible threat to patient safety and
its presence can rapidly progress to a significant problem if
not promptly and properly addressed. Biofilm is a collection
of microorganisms that attaches to surfaces and itself to
form a colony 1 that then produces a protective gel matrix
on device surfaces. This matrix cannot be easily penetrated
with detergents and disinfectants – an especially important
fact considering instruments that are not thoroughly cleaned
cannot be effectively high-level disinfected or sterilized.
Wava Truscott, BS, MBA, PhD, of Truscott MedSci Asso-
ciates, explained there are six stages of biofilm development
and each stage is increasingly difficult to eradicate. 2 Stages
1 and 2 can be easily removed, however, any biofilm that
remains quickly sends out a signal to multiply further. Stages
3 and 4 are even more resilient and resistant to eradication,
and Stage 5 is very mature biofilm that is especially difficult
to destroy. Stage 6, the highest level, is when biofilm
becomes hardened on devices such as endoscopes that have
undergone reprocessing. In this stage, the biofilm builds upon
itself and forms what Truscott describes as a matrix fortress.
“When bacteria determine that the surface they landed
on has an organic food supply and is physically a good place
to construct a biofilm, they signal other bacteria to join them.
The favorable response also triggers its ‘appendages’ to
attach to the surface and to other bacteria, while physically
enhancing the strength of the attachments’ grip,” she
explains, adding that endoscopes, catheters and narrow tubes
and channels are just some of the places where bacteria can
hide and quickly multiply.
Biofilm is designed to survive and thrive, so proper
proactive instrument care and treatment is vital for preventing
its development and proliferation. Although instrument and
equipment cleaning, high-level disinfection (HLD)/sterilization
takes place in dedicated reprocessing areas, point-of-use
care is necessary for preventing blood, tissue, secretions
and other types of bioburden from drying on surfaces.
Dried bioburden makes cleaning in the SP department and
other designated reprocessing areas far more challenging.
Point-of-use treatment should begin immediately
following the procedure. This treatment involves wiping
12
gross blood and bioburden from instruments and keeping
devices moist with an approved wetting agent, all the way
through transport to the dedicated decontamination area.
If moisturizing products are unavailable, instruments should
be covered with a water-moistened towel (saline should
never be used, however, because it can corrode or otherwise
damage instruments). Note: A single surviving bacterium can
multiply to 2 million in just seven hours, so it is imperative
that devices be transported to the decontamination area as
soon as possible following the procedure. 2
The latest industry standards and guidelines, including
those from AAMI, AORN and AST recommend point-of-use
instrument care to remove gross debris and aid the cleaning
process. ANSI/AAMI ST79:2017, Comprehensive guide to
steam sterilization and sterility assurance in healthcare
facilities, Section 6.3.1, states that instruments should “be
wiped throughout the surgical and invasive procedure, as
needed, with sterile moistened surgical sponges to remove
gross soil. Cannulated or lumened instruments should be
irrigated with sterile water, as needed.”
Once contaminated devices enter the decontamination
area, proper cleaning tools and application are essential.
Cleaning brushes should be neither too small (which
can scratch or gouge instruments and create a place for
microorganisms and bioburden to hide and thrive) or too
large (which prevents the bristles from cleaning properly).
Using proper pressure while brushing is also key because
too rigorous brushing can damage instrument surfaces
and too-gently brushing can prevent proper removal of
bioburden. Water quality also factors into reprocessing
outcomes. Contaminated water can cause infection and
water with high mineral concentration or the presence of
organic matter can cause buildup on instruments that can
make disinfectants and sterilants ineffective. Truscott reminds
us that faucet aerators also provide an opportune location
for microorganisms and biofilm to hide and flourish. 2
Facilities that fail to follow the latest industry standards
and guidelines are jeopardizing patient safety and increasing
the odds for citations and fines from surveyors such as those
from the Joint Commission and CMS who are well versed
on the latest standards and guidelines and are looking to
ensure that facilities are following them. 
Julie E. Williamson, BA, is IAHCSMM’s communications
director and editor.
References:
1. International Association of Healthcare Central Service Materiel
Management. 2016. Central Service Technical Manual, Eighth Edition.
2. Truscott W. April 2019. Biofilm Housing Development: Work Surfaces, De-
vices, Cleaning Equipment. Session at the 2019 IAHCSMM Annual Conference.
december 2019 • www.healthcarehygienemagazine.com