The following article is written by Matt Smith, marketing analyst for Healthmark Industries Co.
There is nothing more challenging to effective cleaning than receiving instruments in the decontamination area that have dried blood on them. Reducing this concern has always been an issue.
Though it is recognized that contaminated surgical instruments should be cleaned immediately after use, it is observed that this is not always practical. However, dried blood does represent a great challenge to the cleaning of patient used instruments (AAMI ST 79:2010 7.5.2). Many professional groups recommend that the processing of instruments should take place in 30 minutes or less after they are finished being used; any longer could cause possible damage to the instrument.
Keeping instruments or equipment moist is only one of the issues. The other major issue is how to safely transport the dirty moist items. Both the 3rd edition of "The Basics of Sterile Processing" by Sterile Processing University and the "IAHCSMM 7th Edition Central Service Technical Manual" stress that items being transported should be clearly marked with a biohazard label according to OSHA guidelines.
So the issues are safely transporting instruments that are moist and processing them as quickly as possible after use. If you cannot quickly process the items at point of use, you must mark them as a biohazard and try to keep them as moist as possible until they can be properly decontaminated.
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How long can an instrument wait after its final surgical use before the cleaning process begins? This wait period could be called decontamination holding time (DHT). The user of the instrument plays a key role in the condition of the instrument based upon how the instrument is sent back (i.e., gross soil still present). Failure to properly prep instruments (i.e., taking measures to keep instruments moist during transport) will add time to the process. The fact that DHT could be minutes to hours and even days in some cases is of concern.
Transporting and keeping instruments moist after use so they can be more easily cleaned involves four factors:
- Where are instruments used and how are they taken care of at the site of use during and after usage?
- How will instruments be transported to the decontamination area for cleaning in a manor that protects all staff?
- How long is the DHT?
- How will instruments be kept moist?
Perkins states in his book "The Principles and Methods of Sterilization in Health Science" page 237, "...Instruments must be cleaned as soon as possible after use, to avoid rusting or pitting, and to remove soil before it can dry and harden in the serrations and crevices. If stainless steel instruments are permitted to lie around for several hours before cleaning they may acquire a tarnish, which is difficult to remove…therefore, immediately after use the instruments should be rinsed in cold water…." Staff should not use saline to keep instruments moist because saline can damage instruments. When in doubt about how to keep instruments moist, refer to the instructions for use supplied by the manufacturer of the instruments.
There are three common ways to keep instruments moist:
- Wet towel
- Spray on enzymatic
- Moistening technology
The placing of a wet cloth over instruments after surgery to keep them moist has been the traditional method of keeping instruments moist. It can be quite effective for relatively short periods of time (say, up to an hour).
Spray-on solutions are typically enzyme formulations designed to break down blood soil and protein, as well as delay drying of organic soils. These solutions will keep instruments moist longer than the traditional wet towel method, providing moisture for a couple of hours. For the exact recommended duration, check with the solution manufacturer's instructions for use.
There are moistening technology devices manufactured from a low-linting, highly absorbent material sandwiched between two layers of a transparent film laminate. The transparent layers enable observation of the materials kept in the pouch. Water is added to the absorbent material and soiled instruments are kept in the pouch, which is then sealed. This creates a humid environment where the instruments remain in a moist state until taken for cleaning. These devices are the optimal choice if an extended time (two or more hours) is needed before instruments can be reprocessed. Studies have demonstrated that instruments placed in these devices, such as the Humipak (developed by my company, Healthmark Industries Co.), will remain moist for up to three days.
Learn more about Healthmark Industries Co.
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