Special Edition on Sterile Processing Imperatives Special Edition- Sterile Processing Imperatives | Page 28

Contaminated Instruments
Point-of-Use
Instrument Prep and
Cleaning: Building a
Model for Success
DATE
By Timothy Brooks, BS, CSPM
T
here have been several papers addressing the impor-
tance of point-of-use prep and cleaning of surgical
instruments in the operating room (OR) over the past few
years. However, it’s no longer just for the OR, it’s for every
hospital department, including facility-owned clinics or
ambulatory surgery centers – they have a similar responsibility
to complete the same process.
This includes transportation of devices and instruments
to and from facilities that must content with ever-growing
volume and market changes. Reduction of bioburden and
time are key factors. The longer that bioburden — of any
volume — remains on the surface of a surgical instrument,
visible or not, the more critical the point-of-use process
needs to be.
Adding to the pressures is the renewed focus and attention
from the Joint Commission during hospitals surveys, whose
surveyors may question your organization’s ability to reduce
the risk of infections associated with medical equipment,
devices and supplies.
Recently, the ECRI Institute issued its 2020 annual list of
the top 10 health technology hazards, with sterile processing
errors coming in at No. 3 for ambulatory settings, including
medical and dental offices.
As the ECRI Institute noted, the challenge associated with
sterile processing concerns is, “failure to consistently and
effectively sterilize contaminated items can lead to patient
infections.” The question here is: Have these healthcare
providers been exposed to point-of-use, have a process,
and understand the issues?
The Association of periOperative Registered Nurses
(AORN) and the Association for the Advancement of Medical
Instrumentation (AAMI) both say that the effectiveness of
cleaning and decontamination is greatly improved when scrub
technicians maintain clean instruments at the point-of-use.
However, in today’s busy sterile processing department (SPD),
the single most important step starts with the user, regardless
if that is in the OR as they move to decontamination for
further disinfection.
The complexity of today’s surgical instruments and the
need to maintain consistent room turnover put even more
stress on the process, and a great deal of pressure on the
scrub technician in the OR and all users supported by the
SPD. Surgical instrument inventories are generally too low
to keep up with demands, resulting in overbooking, process
failures and shortcuts.
When the scrub technician maintains clean instruments
during a procedure and stays to a standard practice of keeping
28
Area Not
Met in
Decon
Mark All
That Apply
Cover Open Carts When Transporting
SURGEON
ROOM#
OR - END TIME
Required Point-of-Use Steps
CART #
Initial Legibly
Before Sending Cart to Decontamination
Protect Delicate Instrument – Rigid and Flexible Scopes, Cameras, Delicate Instruments
Used and Unused Instruments - Separated and Cover with Wet Towel in Original Set
Visible Bio-burden Reduced/Wiped
Sharps Removed/Protected/Angled Down
Instruments Unlocked/Disassembled
Transport Sprayed Used
Covered with Moistened Towel(s)
Scrub
Tech
RN
Circulator
ATTENTION: CSPD Decontamination STAFF:
DO NOT PROCESS UNACCEPTABLE TRAYS UNTIL ALL POINTS ARE CORRECTED
RECEIVED AS:
Notify OR When Unacceptable:
√ Select One
Acceptable
Unacceptable
Condition of Cart and Contents
Corrected by - Initials
Date - Time
Revised: 01/2020 – Print on Red Paper
Call Front Desk for Follow-up Support
CSPD
SUPERVISOR - LEAD
CHARGE RN
DATE: ____________________ DATE: ________________
TIME: ____________________ TIME: _________________
Name: _______________________ Name: ___________________
Person Completing
Person Completing
instrument within sets together, they make the job in SPD
safer, easier and quicker. The use of a moistened towel
as part of the process needs further education as this has
benefits in maintaining moisture/humidity and separation
of used and unused instrument in a set.
When SPD staff in the decontamination area see the wet
towel covering the instruments, they know that these items
were used, received point-of-use cleaning, and require more
attention then the unused instruments. This also needs to
be addressed in a formal institutional policy.
Unknowingly, the scrub technician and users from
hospital departments and clinics have a greater impact on
instrument repairs and operating expense for the replacement
of surgical instruments. By maintaining the cleanliness of
surgical instruments at the point of use, there is an unseen
ripple effect in the management and processing of surgical
instruments — it’s called operational cost savings. But, even
more important, is patient safety and surgeon satisfaction.
Managing surgical instrumentation correctly truly
starts at the point-of-use and moves through the process,
whose components include containment, transportation,
and moisture/humidity management with lasting effects,
regardless of where that is.
Building this culture isn’t as easy as it sounds, and requires
several steps supported by an official institutional policy.
Rarely do you find a policy that is solely directed to managing
point-of-use cleaning, but that is only the beginning. Let’s add
in properly designed tracking forms, to include a biohazard
Sterile Processing Imperatives 2020 • www.healthcarehygienemagazine.com