Surgical instruments that aren't clean can't be sterilized, making effective decontamination the first, and perhaps most critical, step of the sterilization process. Decontamination requires the right equipment, appropriate safety measures and a solid knowledge of acceptable washing methods. Test your acumen with the questions below, and see how your protocols measure up.

1. Reprocessing staff can safely handle devices once cleaning and removal of gross soil is accomplished.

a. true
b. false

b. false

Simple cleaning and removal of gross soil is not enough to render items safe for handling by reprocessing staff during inspection and assembly, or to effectively decontaminate items that must move from a soiled utility or decontamination area to a clean assembly or work area.

After thoroughly pre-cleaning devices to remove soil and debris, a reduction in bioburden is the critical next step in the disinfection process. It is not possible to clean and disinfect without completing each step separately and properly. Pay close attention to device and instrument disinfection labels to help reinforce this concept. To achieve intended results, keep instrument and device surfaces wet for the prescribed disinfection period noted on the product label.

This can be a challenge, but ensuring proper contact time is essential. Consult a qualified infection prevention specialist when selecting the disinfection solutions that are appropriate for the instruments and devices you use.

2. Ophthalmology instruments should receive careful attention during cleaning due to _________.

a. their high replacement value
b. their delicate nature
c. the possibility of patients developing TASS
d. all of the above

c. the possibility of patients developing TASS

Follow manufacturers' instructions to the letter when cleaning and processing all instruments used in eye surgery in order to minimize the possibility of patients developing Toxic Anterior Segment Syndrome (TASS) post-operatively. Improperly processing instruments, such as using non-recommended detergents, can cause TASS. Be particularly wary of using enzymatic detergents and inadequate rinsing. Using de-ionized or distilled water in the final rinse process is highly effective in reducing TASS risks.

3. Effective instrument decontamination should include ________.

a. mechanical action producing agitation of cleaning solution and water
b. the presence of detergent or cleaning solutions during the wash cycle or process
c. a method of achieving disinfection
d. a & b
e. all of the above

e. all of the above

Decontamination requires the elements of mechanical action to produce agitation of cleaning solution and water, the presence of detergents and cleaning chemicals, and a method to achieve minimum low-level disinfection to render items safe for staff handling, whether through thermal or microbicidal processes. Perform periodic efficacy testing to help identify mechanical or chemical deficiencies in the decontamination process. Proper instrument cleaning is also essential to the sterilization process.

4. Effective decontamination of cannulated and lumened items or devices should begin with ______.

a. manual passage of an adequately sized brush to clean inner surfaces
b. ultrasonic cleaning
c. flushing of the lumens
d. mechanical cleaning

c. flushing of the lumens

Flush cannulated or lumened instruments with a sterile, water-filled syringe before placing them in an ultrasonic cleaner, which should be run prior to manual or automated decontamination. Ultrasonic cleaners send high-frequency sound waves through the tap water and solution that instruments are submerged in, which creates vibrating bubbles and ultimately a vacuum effect that pulls debris from hard-to-reach areas.

Brushing the inside walls of lumened devices — orthopedic drill bits and suction devices, for example — to help dislodge and remove debris is critical. Brushes must be passed completely through the lumened device in order for debris to be effectively removed.

Using pipe cleaners to check lumens for proper cleanliness during the assembly and inspection process is good practice. (Just be sure to flush out with compressed air any lingering pipe cleaner fibers.)

5. The decontamination process begins in the OR.

a. true
b. false

a. true

Pre-soaking soiled instruments in an enzymatic cleaner in the OR during room turnovers speeds the decontamination process and improves its results. Once instruments have been transported to the decontamination area, and before they're put through an automated washing cycle, pre-cleaning should include manual brushing and inspection of difficult-to-clean items, along with disassembly if indicated. Don't overload automated washers. Properly set up and configure washer loads to ensure maximum instrument surface exposure for cleaning. Equipment maintenance and periodic efficacy testing is vital to ensure proper machine function and overall effectiveness of the decontamination process.

6. Employee safety during the decontamination process can be maintained by practices and policies that include the following, except:

a. mandated use of proper PPE
b. removal of disposable sharps during sorting of instrument trays in the decontamination area
c. transport of instruments from the OR in water and enzymatic soaking solution
d. b & c

d. b & c

A comprehensive safety program should include the proper use of PPE (including protective gown, shoe covers, proper length decontamination gloves, mask, eye protection and face shield) while handling soiled items. Disposal of sharps (needles, sutures and knife blades, for example) should occur at the point of use (in the OR) by staff familiar with the case and the instruments used in order to avoid potential injury to the reprocessing staff. Transport contaminated instruments from the OR to the decontamination area in a closed container. Keep them wet during transport using a soaked towel or a spray or gel product designed for the task. Do not transport them in containers filled with water and enzymatic cleaner so as to avoid spillage. Use baskets or strainers to isolate or identify potential reusable sharp injury sources such as scissors and towel clips. Never reach gloved hands into sinks containing submerged reusable sharps, as that careless practice significantly increases injury risks.

7. Improper decontamination can affect multiple aspects of a surgery's center's function by __________.

a. increasing patient risk from surgical site infections due to improperly cleaned instruments and equipment
b. fostering poor surgeon relations and creating trust issues
c. increasing procedure costs when dirty instruments are discovered
d. all of the above

d. all of the above

Effective instrument decontamination is vital in preventing costly and debilitating surgical site infections. A facility that becomes linked to frequent or multiple discoveries of contaminated instruments or equipment will quickly suffer from damaged or adversely affected relationships with patients and surgeons alike. You can imagine a surgeon's frustration if he'd have to inform a patient that a wound had to be irrigated or treated with antibiotics because a dirty instrument was discovered during the procedure. In addition, removing instrument trays and supplies when dirty or contaminated instruments are discovered — and resetting the case — can be very costly for facilities.

8. Monitoring the decontamination process using chemical, mechanical and biological products is required.

a. true
b. false

b. false

While there currently is no mandated regulatory requirement to monitor the various steps of the decontamination process, professional organization standards and recommended practices now address this issue with the development, testing and refinement of various automated washer and disinfector monitoring products. Adopting a system that includes monitoring outcomes — depending on products selected — of the decontamination process is considered best practice. This can include simple mechanical checking of washer arms and baskets, assessing staff for proper loading procedures and monitoring gross soil removal through the use of various commercially available products. Record and maintain the results of any monitoring efforts, along with any action taken for unsatisfactory results. Many facilities are just beginning to implement procedures to monitor decontamination processes, so stay ahead of the curve for this important practice.

9. Critical elements of a safe and effective decontamination program include monitoring and evaluating products used by staff.

a. true
b. false

a. true ?

Along with routine and preventative maintenance of decontamination equipment, provide staff with adequate product resources to achieve optimal results and outcomes. Keep up to date on the latest in cleaning and enzymatic solutions, detergents and disinfection processes in order to support your staff's decontamination efforts and ensure consistently safe results. Try to avoid frequent product changes that may create confusion among users. Strength dilutions that differ greatly can be a problematic issue if you suddenly discover staffers are not properly mixing detergents or disinfection solutions. Be sure that ample supplies of cleaning rags or towels are available so your staff always uses clean rags and avoid cross-contamination risks from using soiled material multiple times. Dispose of cleaning brushes when they become excessively worn or damaged. Stock brushes in all lumen diameters and lengths to ensure proper cleaning.