Special Edition on Sterile Processing Imperatives Special Edition- Sterile Processing Imperatives | Page 30

Title: Surgical Instrument Point-of-Use Cleaning and Transport
Number: Version: 1
Effective:
Next Review Date:
Author:
Original Date:
Last Review:
Revision Date:
Approved by:
Purpose and Population:
Purpose: To provide guidance to perioperative, hospital, and clinic personnel for point-of-use
cleaning and transporting of surgical instruments, powered equipment, and flexible scopes in
preparation for terminal sterilization. The expected outcome is that the patient is free from signs
and symptoms of infection by meeting a standard process for all types of devices and surgical
instrumentation.
Population: All Hospital/Systems affiliated locations utilizing reusable surgical instruments that
are transported to a central location for re-processing and sterilization both on and off campus.
Definitions:
CSPD: Central Sterile Processing Department
POUC – Point-of-use-cleaning: is completed to reduce the level of visible contaminates to allow
safe handling and transport to a processing area/department.
PPE: Personal protective equipment
RED SHEET - The red sheet is used to identify contaminated bio-hazard instrumentation from
point-of-use in the perioperative (OR) setting to the decontamination processing area.
Information on the red sheet is completed at point-of-use with completion by staff at the
decontamination processing area. Only the OR, CV OR and WIS are to use the form.
Manual Cleaning; Manual cleaning is completed as the first step in processing instruments
starting at the point-of-use by the user for the removal of visible bio-burden. Further manual
cleaning is completed in the CSPD decontamination room to minimize all visible bio-burden
providing staff “safe-to-handle” devices for inspection and packaging in preparation for terminal
sterilization.
Additionally, manual cleaning is defined as a low-level process limited to devices that cannot
tolerate automated high-temperature or high impingement washing.
Manual low-level cleaning is used for non-invasive medical devices such as laparoscopic
cameras, light cords, rigid scopes, cables/cords and medical devices that cannot be processed
in an automated washer but require sterilization as a final processing method.
Manual washing includes instruments/devices that will receive only HLD processing requiring
competencies reviewed per device by staff handling such items.
Policy:
• Preparation for cleaning and decontamination of instruments will begin at the point of use.
• Cleaning and decontamination of instruments and equipment will occur as soon as possible
after instruments and equipment is used.
• Contaminated instruments will be transported to the decontamination area as soon as
possible after use in an approved transport container with a securable lid, closed case cart or
covered open cart.
May not be current policy once printed
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Surgical Instrument Point-of-Use
Cleaning and TransportForm
bulk-transport to the decontamination
area and fit into the model with the
same requirements.
The hardest part of implementing
point-of-use auditing is how SPD staff
in the decontamination area responds
to unacceptable findings in case cart(s)
received. SPD personnel must feel like
they can reject a case cart based on the
lack of point-of-use process from the OR
without reprisal. Staff also need to be
consistent with rejects so that the OR is
clear on what that is.
SPD leadership needs to be contacted
when there is an issue and the incident
reviewed by OR leadership, with potential
written follow-up of the person sending
the cart if there are ongoing events.
More importantly, the OR must
buy into the process or it will fail. The
teamwork here is critical, given the
sheer number of instruments an SPD will
reprocess on any given day, both used and
unused. The perioperative department is
comprised of both the OR and the SPD,
with both playing a critical role in the
overall patient-care and safety team.
The impact this team has on each other
impacts the success of our surgeons in
delivering safe surgery to patients.
Timothy Brooks, BS, CSPM, is director
of the Banner Health Systems CSPD
Program.
References:
Top 10 Health Technology Hazards 2020 report
for hospitals, medical practices and homecare
providers. Oct. 7, 2019.
Policies & Procedures: Instruments: Point of Use
https://www.aorn.org/.../06_instruments_pointofuse.
doc?la=en - Competency Statement
AAMI and AORN standards
Competency Verification Tool — Surgical Instrument Users
Practice: Surgical Instruments, Cleaning and Care — Point-of-Use Cleaning and Transport
Name:
Date:
Competency Statement: The surgical instrument handler/user has completed facility or health care organization-required education and competency
verification activities related to point-of-use cleaning and transporting surgical instruments. 1
1.
Guideline for cleaning and care of surgical instruments. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
Outcome Statement: Patient is free from signs and symptoms of infection. 2
2.
Petersen C, ed. Infection. In: Perioperative Nursing Data Set. 3 rd ed. Denver, CO: AORN, Inc; 2011:254-276.
Verification Method
[Select applicable code from legend at bottom of page]
Competency Statements/Performance Criteria
DEM/
DO/DA
KAT
RWM/
S/SBT
/CS
Verb
P&P
Oth
N/A
1. Keeps instruments free of gross soil at the points of use during
surgical procedure.
2. Wipes instruments as needed with sterile surgical sponges/towels
moistened with sterile water during the procedure to remove gross
soil.
3. Prepares instruments for transport to the decontamination area for
further cleaning at the point of use.
4. Does not use saline to wipe or soak surgical instrument at the point
of use.
5. Does not use saline in transport containers for soaking instruments.
Uses only sterile or potable water.
6. Irrigates instruments with lumens with sterile water as needed to
maintain clear channels throughout the surgical procedure.
7. Removes and discards disposable sharps (eg, scalpel blades,
suture needles) into the designated in-room puncture-resistant,
leak-proof containers.
8. Segregates used sharp instruments from other instruments in the
same set with a wet towel.
9. Separates used from non-used instrument(s) with a moistened
towel so that they receive immediate attention in the
decontamination area.
DEM/DO/DA
S/SBT/CS
RWM/P&P
N/A
=
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s)
Not Applicable
Not Met
(Explain why)
KAT =
Verb = Knowledge Assessment Test
Verbalization
Oth Other: ____________________________________________________
=
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