Healthcare Hygiene magazine September 2020 September 2020 | Page 32

Courtesy of Mary Olivera/OSPECS Consulting, LLC
When the Stakes are
Even Higher, Sterile
Processing is Ready
By Mary Olivera, MHA, CRCST, CHL, FCS
Sterile processing professionals (SPPs) have long been at the
frontlines of protecting patients from cross-contamination from
used operating instruments and other hospital equipment, but their
intimate knowledge of virus transmissions risks, decontamination
techniques, and processing protocol has never been as critical as
it is during the age of coronavirus. Although SPPs already adhere
to an array of strict guidelines such as the CDC’s Cleaning and
Sterilization guidelines, regulatory standards from federal and
state agencies, and their own facility’s protocol when cleaning,
reassembling, and sterilizing surgical instruments prior to the next
procedure, there’s no time like a pandemic to review, refresh and
even strengthen sterile processing protocol to protect patients,
doctors and other hospital professionals.
Just as all of today’s doorknobs, keyboards, and other high-touch
surfaces should be viewed as a potential transmitter of coronavirus,
any and all items and instruments arriving in the sterile processing
department (SPD) should treated as contaminated even if they
“look” clean.
The same universal precautions and fundamental cleaning and
disinfecting steps must be followed to prevent transmission of
any infectious disease, including COVID-19. Precise adherence to
these basic principles is required when coming into contact with
contaminated devices.
Following is an overview of basic processing protocols to keep
your team and your patients safe.
SPD Basics
●Wear appropriate PPE. All technicians working in the decontamination
area must be equipped with full personal protection
equipment (PPE) regardless of how simple the task may be. Full
PPE means hair covering, face shield and mask, gloves appropriate
to the task, gown, and shoe covers.
●Adequate tools for cleaning. SPPs must apply the best
cleaning techniques and use the appropriate cleaning tools to
remove all soil residues from lumens and hard-to-reach areas of
the instrument. Use the right size cleaning brushes for lumens
based on manufacturers’ instructions for use (IFU) and the correct
tools to remove contamination and debris.
●Test your reprocessing equipment regularly. Regularly test
your facility’s automated cleaning equipment’s efficiency and efficacy
to confirm that the promised cleaning is taking place. Maintain your
facility’s equipment according to the manufacturer’s specifications.
●Cleaning chemicals/detergents. Be sure to have the
proper cleaning chemicals and detergents on hand at all times,
as water alone is an ineffective decontamination agent. Water
quality and temperature must also be considered according to
the detergent specifications to provide adequate conditions for
cleaning and disinfection.
●Following IFUs. Adhere to manufacturers’ IFUs when mixing
and using cleaning solutions and be sure to factor in water quality
and temperature for the most effective solution. It is important to
select the correct detergent or disinfectant for the task at hand
and review the steps the manufacturer validated to render a device
cleaned or disinfected. It is crucial to follow the product:
• Contact time: How long the solution should remain
wet on the contaminated surface
• Dilution rate: The ratio of water to detergent for
highest efficacy
• Temperature: The water temperature that will yield the
most effective detergent/disinfectant solution
• Storage temperature: Some chemicals degrade when
exposed to temperatures that are too high or too low.
Store your cleaning solutions at each one’s correct storage
temperature to maintain efficacy.
Collaboration Between the SPD and the OR
Decontamination begins in the operating room. When
the hardworking operating team does what it’s meant to do:
operate, it’s natural for instruments to be contaminated during
procedures—that’s what they’re there for -- but SPD leadership
should join forces with operating room (OR) leadership to ensure
that OR team members abide by stringent procedures to prevent
contamination during transport to the SPD.
Marilyn Main, MSN, RN, CNOR, a former vice president of
surgical services, shared her approached for successful collaboration
with the SPD and the OR: “The only way to achieve compliance is to
educate the staff on evidence-based practices and set performance
expectations. Engage the staff in auditing current practice to foster
open communication and process correction. Leader audits are key
to discovering perceived barriers and communicating any process
changes. Utilize information and technology to collect, collate, and
communicate data. Display outcomes and communicate findings to
the team during shift huddles as well as coaching individual staff.
Safe practices minimize the risk of harm to patients and providers
through system effectiveness and individual performance.”
In short, a facility will perform better on all metrics when teams
are collaborating, sharing information, and being upfront about
outcomes and findings.
At a loss of where to start collaborating? Begin in the OR,
where the scrub nurse/technician, garbed in full PPE, begins the
transport process. S/he should adhere to the following protocol
for a smooth transport to the SPD.
●Sort. Place items back into the appropriate leak-proof transport
containers and segregate all sharps and delicate instruments.
Remove all blades and disposables.
●Squirt. Flush all lumens and ports with water.
●String. Restring the instruments to be sure they are opened.
Place all scopes back in the original containers with cords coiled
loosely to prevent damage.
●Spray. Spray vigorously all instruments with a wetting agent
to prevent soil from drying during transport.
●Contain within leak-proof transport. All contaminated
medical devices and sharps must be transported in a leak proof
container. The container or case cart must have a visible “biohazard”
label and neither the container nor the case cart should be left
32 september 2020 • www.healthcarehygienemagazine.com