Marcia Patrick, RN, MSN, CIC, an infection prevention consultant and a member of the Association for Professionals in Infection Control and Epidemiology's board of directors, discusses six fundamentals for maintaining a safe and effective sterile processing department in ambulatory surgery centers.
1. Evaluate each product before purchase. Ms. Patrick says a new instrument or machine "may seem like the best thing since sliced bread," but administrators should calculate how the equipment will impact efficiency prior to purchase.
"Before an ASC purchases anything that requires sterilization or [deep] high-level disinfection, administrators need to carefully measure cleaning time. One instrument may take five hours to clean, and in a busy operating room, that's just not practical," she says. "In addition to top-level evaluation, administrators should also receive input on individual purchases from staff members."
2. Schedule education for staff members. After evaluating and purchasing a product, administrators and infection control leaders should be educated on sterilization and disinfection by company representatives. Ms. Patrick suggests double-checking that the representative's information is consistent with the manufacturer's recommendations. "Representatives may not necessarily have the background to totally understand the processing of a particular product, so we just want to be sure that what he or she is teaching is consistent with the manufacturer's instructions."
3. Keep the manufacturer's recommendations handy. With the explosion of new types of medical instruments, devices and equipment, ASCs must keep a current copy of the manufacturer's recommendations for sterilization and disinfection for each item. This may mean creating a printed log of the manufacturer's recommendations or uploading that text into a computer. ASCs can also print instructions for each phase and post them around the reprocessing department.
"If the primary processing staff member happens to be on vacation, it's important that the back-up staff member is able access those materials and become familiar with the reprocessing of a device," Ms. Patrick says.
4. Lay out the processing area in an efficient and safe manner. Simple things, like the physical lay-out of the processing area, can hamper reprocessing and waste time. Ms. Patrick says ASCs can solve this dilemma by labeling each phase of the reprocessing area. This way, clean instruments are never crossed over to dirty areas and infected with bacteria. The flow of instruments should be uni-directional and start with soiled receiving, then cleaning and rising, then high-level disinfection or sterilization.
"Any staff member who walks into the reprocessing department should be able to know what phase of cleaning that instrument is in, whether it is still soiled, has gone through cleaning/washing or has gone through drying and is ready to be placed in the autoclave," Ms. Patrick says.
5. Properly maintain:
Sterilizers. The machines that sterilize instruments and other devices need to be cleaned too. Racks inside desktop sterilizers should be removed and the sterilizer cleaned at least monthly. Ms. Patrick says ASCs should run spore tests to ensure sterilization is occurring.
High level disinfection products. Although the manufacturer's recommendations will explain how often to change the liquid chemicals for high level disinfection, ASC staff should also "dip stick" the liquids before each use so that the liquids retain the correct potency for killing bacteria.
Ms. Patrick says the supply purchasing and reprocessing departments should communicate regularly to prevent an infection outbreak. "ASC reprocessing departments want to make sure they are aware of which [sterilization of high level disinfection] product they are using because sometimes the purchasing department will substitute items for cost savings," she says. "Although the cost savings is beneficial to the ASC, if different processing times are not followed, it can lead to devastating results for patients."
6. Avoid immediate-use steam sterilization. Immediate-use steam sterilization, formerly known as flash sterilization, should not replace a full sterilization cycle, Ms. Patrick says. In fact, nursing advocacy and accrediting bodies, including APIC, the Association of periOperative Register Nurses and AAAHC, say healthcare facilities should have a sufficient number of devices and instruments prepared for anticipated surgical volumes, rather than relying on immediate-use steam sterilization. However, ASCs do not need to prepare trays for every procedure.
"If an ASC, for example, has 10 cases for one day, they need to have four to six sets so they have enough instrumentation to efficiently complete each procedure and allow for enough time to conduct a full-cycle processing in between cases," Ms. Patrick says.
7. Don the proper personal protective equipment. ASCs must ensure their employees, including those working in reprocessing departments, are adequately protecting themselves against infection. Personal protective equipment, such as waterproof gowns, aprons, gloves and masks, can reduce the risk of bacterial transmission. "Sometimes, healthcare workers don't perceive the risk," Ms. Patrick says.
1. Evaluate each product before purchase. Ms. Patrick says a new instrument or machine "may seem like the best thing since sliced bread," but administrators should calculate how the equipment will impact efficiency prior to purchase.
"Before an ASC purchases anything that requires sterilization or [deep] high-level disinfection, administrators need to carefully measure cleaning time. One instrument may take five hours to clean, and in a busy operating room, that's just not practical," she says. "In addition to top-level evaluation, administrators should also receive input on individual purchases from staff members."
2. Schedule education for staff members. After evaluating and purchasing a product, administrators and infection control leaders should be educated on sterilization and disinfection by company representatives. Ms. Patrick suggests double-checking that the representative's information is consistent with the manufacturer's recommendations. "Representatives may not necessarily have the background to totally understand the processing of a particular product, so we just want to be sure that what he or she is teaching is consistent with the manufacturer's instructions."
3. Keep the manufacturer's recommendations handy. With the explosion of new types of medical instruments, devices and equipment, ASCs must keep a current copy of the manufacturer's recommendations for sterilization and disinfection for each item. This may mean creating a printed log of the manufacturer's recommendations or uploading that text into a computer. ASCs can also print instructions for each phase and post them around the reprocessing department.
"If the primary processing staff member happens to be on vacation, it's important that the back-up staff member is able access those materials and become familiar with the reprocessing of a device," Ms. Patrick says.
4. Lay out the processing area in an efficient and safe manner. Simple things, like the physical lay-out of the processing area, can hamper reprocessing and waste time. Ms. Patrick says ASCs can solve this dilemma by labeling each phase of the reprocessing area. This way, clean instruments are never crossed over to dirty areas and infected with bacteria. The flow of instruments should be uni-directional and start with soiled receiving, then cleaning and rising, then high-level disinfection or sterilization.
"Any staff member who walks into the reprocessing department should be able to know what phase of cleaning that instrument is in, whether it is still soiled, has gone through cleaning/washing or has gone through drying and is ready to be placed in the autoclave," Ms. Patrick says.
5. Properly maintain:
Sterilizers. The machines that sterilize instruments and other devices need to be cleaned too. Racks inside desktop sterilizers should be removed and the sterilizer cleaned at least monthly. Ms. Patrick says ASCs should run spore tests to ensure sterilization is occurring.
High level disinfection products. Although the manufacturer's recommendations will explain how often to change the liquid chemicals for high level disinfection, ASC staff should also "dip stick" the liquids before each use so that the liquids retain the correct potency for killing bacteria.
Ms. Patrick says the supply purchasing and reprocessing departments should communicate regularly to prevent an infection outbreak. "ASC reprocessing departments want to make sure they are aware of which [sterilization of high level disinfection] product they are using because sometimes the purchasing department will substitute items for cost savings," she says. "Although the cost savings is beneficial to the ASC, if different processing times are not followed, it can lead to devastating results for patients."
6. Avoid immediate-use steam sterilization. Immediate-use steam sterilization, formerly known as flash sterilization, should not replace a full sterilization cycle, Ms. Patrick says. In fact, nursing advocacy and accrediting bodies, including APIC, the Association of periOperative Register Nurses and AAAHC, say healthcare facilities should have a sufficient number of devices and instruments prepared for anticipated surgical volumes, rather than relying on immediate-use steam sterilization. However, ASCs do not need to prepare trays for every procedure.
"If an ASC, for example, has 10 cases for one day, they need to have four to six sets so they have enough instrumentation to efficiently complete each procedure and allow for enough time to conduct a full-cycle processing in between cases," Ms. Patrick says.
7. Don the proper personal protective equipment. ASCs must ensure their employees, including those working in reprocessing departments, are adequately protecting themselves against infection. Personal protective equipment, such as waterproof gowns, aprons, gloves and masks, can reduce the risk of bacterial transmission. "Sometimes, healthcare workers don't perceive the risk," Ms. Patrick says.
