Healthcare Hygiene magazine January 2020

sterile processing By Julie E. Williamson Terminal Cleaning in the SPD: A Critical Step in Infection Prevention E nsuring that surgical instruments are cleaned, disinfected/ sterilized and safe for patient use involves many steps, processes, check and balances. One critical step is making certain surfaces are properly disinfected and other house- keeping tasks are routinely performed in accordance with guidelines, standards and facility policies and procedures. Sterile processing departments (SPDs) must be routinely cleaned to minimize microbial population; the cleaner the work area(s), the more likely the items prepared in the SPD will be safe for use in a sterile environment. 1 Reaching that important goal is often a shared respon- sibility of environmental services (EVS) personnel and sterile processing (SP) professionals, with facilities determining the appropriate cleaning tasks and schedules for each. While EVS often bears much of the actual terminal cleaning responsibility, SP professionals often routinely clean sterile storage cabinets, carts and racks. 1 SP professionals must also ensure they and their colleagues don’t further contaminate work areas or engage in practices that can lead to cross-contamination or contribute to healthcare-associated infections (HAIs). Contaminated items and surfaces, including door handles, faucets, light switches, keyboards, telephones, work tables and more, can transmit infection-causing bacteria called fomites; therefore, work areas should be routinely and thor- oughly cleaned – and SP professionals must aim to minimize the amount of contaminants throughout the departments. The presence of dust, lint and bacteria on devices that need to be high-level disinfected or sterilized may negatively impact those critical processes, and particles or bacteria that make their way into a sterile set may enter the patient’s body and cause an infection. 1 Microorganisms can survive on surfaces for long periods of time. For example, Clostridium difficile can survive from weeks to months and Staphylococcus aureus can survive for months on a dry surface.2 If surfaces are not properly cleaned and disinfected, these organisms can become a continuous source of contamination. A study of 23 acute care hospitals found that, on average, only 49 percent of surfaces that were believed to have been properly cleaned actually were. 3 All fixtures and furnishings in the SPD must be made of materials that can be cleaned and disinfected on a regularly scheduled basis. Sterile storage areas may have either open racks or closed cabinets; however, closed cabinets are best for high-traffic areas. Open shelving should have a solid bottom, so items stores on lower shelves are protects from contaminants during housekeeping tasks. 1 Corrugated cardboard boxes and external shipping containers should not be allowed in storage areas or other parts of the SPD because they may harbor microorganisms and introduce other contaminants to the areas.4 If anti-fatigue floor mats are www.healthcarehygienemagazine.com • january 2020 used in the department, they must be designed to withstand daily cleaning and disinfection and should be discarded when they show visible wear or breakdown that can inhibit proper cleaning or introduce particles into the environment. Terminal cleaning and disinfection of the SPD should not be performed while instruments are being cleaned and sterilized/high-level disinfected. Also, clean-to-dirty flow should always be followed, beginning with sterile storage, then moving to preparation and packaging and, finally, to the decontamination area to reduce the risk of spreading contaminants from “dirty” areas to “clean” areas of the department. Cleaning should also be approached with a “top-down” method and some facilities may also adopt a left-to-right method to ensure no items are missed during the cleaning process. Floors should be cleaned at least daily with a damp mop; dry sweeping or mopping should not be done because dust and other contaminants will become airborne and can land on instruments, work tables and other surfaces. 1,4 Contaminants on sterile packages can fall onto package contents upon opening and jeopardize patient safety. Separate and dedicated cleaning equipment, such as mops and buckets, should be used for the decontamination area, which is the dirtiest area of the SPD. This cleaning equipment should never be used elsewhere. Horizontal work surfaces should be cleaned daily or, preferably, at the end of each shift. Walls, cabinets, shelving or other surfaces should also be regularly cleaned, at an interval determined by the facility, and as needed. Any individual with cleaning responsibilities requires targeted, ongoing training to ensure departmental policies and procedures are consistently followed; this includes ensuring that proper personal protective equipment is being used during departmental cleaning, proper chemical dilution rates and contact times are being followed in accordance with manufacturers’ instructions for use, and surface compatibility is taken into consideration. 4 Julie E. Williamson, BA, is communications director/editor for the International Association of Healthcare Central Service Materiel Management (IAHCSMM). References: 1. IAHCSMM. Central Service Technical Manual, Eighth Edition. Chapter 6. 2016. 2. Kramer, et al. How Long Do Nosocomial Pathogens Persist on Inanimate Surfaces? A Systematic Review. BioMed Central. 2006. 3. Carling, et al. Identifying Opportunities to Enhance Environmental Cleaning n 23 Acute Care Hospitals. Infect Control Hosp Epidemiol. January 2008, 29(1): 1-7. 4. Huber L. Surface Disinfection and Departmental Housekeeping in Central Service. CIS Lesson Plan 253, Communiqué. Jan./Feb. 2016. 37

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