The Other Pandemic :
The Fight Against Antimicrobial Resistance
By Mary Olivera , MHA , CRCST , CHL , FCS
Centers for Disease Control and Prevention ( CDC ) predicts that these superbugs and bacteria will kill 10 million people per year by the year 2050 if left unchecked .
At present , hospitals are drivers of the increasing rates of AMR infections and are doing so at great cost to their own bottom lines ; hospital-acquired infections ( HAI ) cost the American healthcare system an estimated $ 10 billion per year . And while no area of the hospital is immune to AMR organisms , one study from
Loyola University Health System estimates that a full 20 percent of HAI can be classified as surgical site infections ( SSI ).
But all is not yet lost : in 2018 and 2019 , the CDC launched the Antimicrobial Resistant Challenge Initiative to raise awareness of the issue and to engage healthcare organizations , local governments , and private international companies in the fight against AMR . The AMR Challenge encouraged a “ one health ” approach , which recognizes that the health of people is inextricably linked to the health of animals and the environment . The initiative challenged participants to focus on some or all of five commitment areas that are essential components of AMR defense : tracking and data , infection prevention and control , more strategic antibiotic use , improved sanitation , and treatment for AMR including vaccines , therapeutics , and diagnostics .
Though set forth as part of a lofty international initiative , these commitment areas are just as crucial to the everyday work of hospital staff , and particularly to those in the sterile processing department ( SPD ). The below lays out how some of these commitment areas can be adapted for the sterile processing department and how , when armed with a steely resolve to adhere to a facility ’ s protocols and procedures and the right approach to these commitment areas , sterile processing ( SP ) professionals can do their part to combat deadly superbugs .
● Tracking and data . If you do not know the source of infection , you are powerless to stop it so the SPD must make traceability paramount throughout its process . Tracking should begin in the decontamination area , where the tech documents the date and time the item was cleaned or disinfected , the mechanical or manual process used to render the item safe to handle , the types of chemistries used , the methodology used to test for residual soil , the type of mechanical equipment used to clean the device , and the results of the efficacy tests performed on the mechanical equipment . Each package processed in the preparation area should also receive a lot control identifier that indicates a list of contents , the tech who assembled the set , the sterilization date , and the sterilizer used in the process . There should also be a release of products protocol in place to document evidence of product conformity and begin the traceability process to the end user . The date and type of procedure and the patient ’ s name should also be recorded . All this information and data can easily identify potential cases in the event of process failures or microbial contamination , and this level of tracking and traceability is also invaluable in the case of equipment failure or manufacturer recalls .
● Infection prevention and control . The key goal of an SP professional is to help to reduce the spread of resistant microorganisms by performing disinfection , decontamination , sterilization and processing tasks consistently and according to manufacturers ’ instructions for use . The overall process must be completed in sequence to be effective .
● Decontamination . Step one , in which gross soil and debris is removed from contaminated instrument trays in the decontamination area . Technicians must be trained on the correct and best techniques to scour and decontaminate surgical instruments , channels , lumens , and hard-to-reach areas . The cleaning process requires the use of manual and mechanical processes to render an item safe to handle in the preparation area and specific steps are necessary to thoroughly remove blood , bioburden , and tissue from the medical device . The tools used for cleaning are equally important , because only the right size cleaning brushes combined with properly mixed chemistries and adherence to the device instructions for use ( IFU ) can promise a fully sterilized instrument ready for its next procedure .
• Mobile Patient Equipment ( MPE ) disinfection . In many healthcare facilities the SPD is responsible for the cleaning , disinfecting , and dispensing of mobile patient equipment like hypothermia machines , DVT pumps , feeding pumps , and other life-saving devices . All too often though , disinfection of MPEs plays second fiddle to the more time-sensitive processing of surgical equipment .