September 28, 2022

Instrument Reprocessing and Care

By: Outpatient Surgery Editors

Published: 9/27/2022

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THIS WEEK'S ARTICLES

Take Special Care of Instruments

Ensuring the Sterility of Your Microsurgical Instruments

Taking Care of Microsurgical Instruments Every Time - Sponsored Content

Pretreating Instruments in the OR Is Vital

A Go-To Reference for Reprocessing Intraocular Instruments

 

Take Special Care of Instruments

Protecting valuable tools throughout the entire reprocessing cycle extends their lifespan and keeps them in top working order.

Green TagGretchen Steelman
HIGH PRIORITY Green tags in instrument trays indicate to reprocessing techs that the set needs to be sterilized and returned to the OR as quickly as possible.

Surgical teams expect to work with instruments that are sterilized correctly, in pristine condition and arrive in the OR in time for cases to begin as scheduled. Making sure that happens requires streamlining workflows and rationalizing trays of often-used tools.

Placing a green placard in instrument trays that require special attention is an easy way to alert reprocessing technicians that the tools need extra care or must be fast-tracked. "The disposable placard indicates the tray needs to go to the front of the line in decontamination or that it contains specialized instrumentation that must be handled with extra care," says Gretchen Steelman, MBA, BSN, RN, CNOR, supply chain category manager at the University of North Carolina Health System in Durham. "It's a simple cue that can be used for critical sets that are limited in number or contain delicate instruments."

Additionally, Ms. Steelman's efforts to right-size the number of instruments that UNC's sterile processing department (SPD) must care for has helped to maintain the quality of tools that are in constant rotation. She and her team removed more than 10,000 instruments from 40 trays used during high-volume procedures, an effort that saved about 800 staffing hours and $10,500 in staffing costs in a year. They also repurposed 950 instruments removed from standard rotation to fill gaps of need across the health system.

She recommends tracking usage of high-volume sets that contain at least 40 instruments to determine which tools are used most often and which are used less frequently and therefore could be removed from the regular rotation. Surgeons should also be consulted to identify tools that can be removed, says Ms. Steelman. When updated, streamlined trays are created, the changes should be communicated to physician champions, sterile processing representatives, clinical managers and liaisons between the ORs and SPD to achieve buy-in and ensure the updated sets are used consistently, she adds.

"Given the increasing cost constraints in health care, we found that instrument tray reduction was an untapped resource for cost savings," says Ms. Steelman. "We continue to look into instrument rationalization for our other service lines and plan to consolidate some trays that could create even more cost improvements."

Ms. Steelman also points to the benefits of using rigid sterilization containers, which offer increased protection and are a better option for keeping tools organized than standard blue wrap. Some sterilization containers come with optional baskets and inner liners with slots designed to house individual specialized instruments.

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Ensuring the Sterility of Your Microsurgical Instruments

Adenosine triphosphate (ATP) testing can make all the difference.

ATPNorthwell Health
CONFIRMING CLEANLINESS Adenosine triphosphate (ATP) testing provides added assurance that residual biologic materials are no longer present on an instrument.

Would you add another step to your decontamination process if it provided reassurance that every reprocessed microsurgical instrument will return to the OR without lingering bioburden?

Annissa Cromer, MPH, BSN, CNOR, PHN, LCDR, NC, USN, department head for the sterile processing department at a U.S. Navy medical treatment facility, decided to utilize adenosine triphosphate (ATP) testing, a bioluminescence technology that detects the presence of biologic material such as blood and tissue, for this purpose. "We did not have an issue with bioburden or infection rates, but we still wanted that comfort of knowing we were getting every instrument sterile and ready for the next case," she says.

To test the effectiveness of ATP swabs, she selected microsurgical instruments by their appearance of visible soil when instrument trays arrived in the decontamination area. "I picked random instruments from the set and made sure to write down which instrument was selected and the specific location on the instrument of where it was swabbed," she says. "I did not inform any of our surgical technologists which instruments were involved so they would not make any extra effort in addition to their normal practice of manual decontamination," she says.

The microsurgical instruments were swabbed at four testing points: initial receipt prior to manual decontamination; after vigorous manual decontamination; after completion of a 15-minute cycle in an ultrasonic bath; and after completion of a 36-minute washer-disinfector cycle. The premoistened ATP swabs are easy to use and provide results in less than 30 seconds, says Ms. Cromer.

ATP test results were displayed on a handheld device as Relative Light Units (RLU) and documented after each of the four testing points. "RLU results that yielded zero through 100 were noted as ‘passed' while those that yielded a result of 101 or greater were noted as ‘failure,'" she says. "A failure of any instrument would allow that tool, along with the other instruments in that tray, to be immediately reprocessed through all decontamination steps."

Ms. Cromer swabbed 118 microsurgical instruments in total. All rendered a RLU reading of less than six, indicating that all the tested instruments passed. "This process demonstrates that our decontamination practice is being performed to standard," says Ms. Cromer. This simple test can be performed at any eye surgery center as a quality control measure.

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Taking Care of Microsurgical Instruments Every Time - Sponsored Content

Trusting the reprocessing process and getting everyone on board to follow the best practices is key to successful instrument care.

SinkYour hardworking reprocessing staff's efforts should be bolstered by the rest of your surgical team.

It takes a team of dedicated healthcare professionals to follow best practices in microsurgical instrument care each time that these delicate instruments are used in surgery. The goal is to keep the patient safe and the instruments in the best possible condition. What does that take? It takes reemphasizing the key steps in proper instrument care for everyone involved in the process to help ensure the job is done right every time.

The proper cleaning and sterilization of microsurgical instruments is an essential part of safe patient care, but sometimes its importance can be overlooked by busy surgeons and frontline staff. Numerous protocols need to be followed to make sure the tools are sterilized according to regulatory standards.

Checklists are helpful for the individuals who are involved in this process, which can take hours to complete. The reprocessing techs in charge need the proper amount of time to make sure that all protocols are followed. But even before the techs work on these instruments, the surgical team also needs to take preliminary steps to keep them moist and remove the most visible debris off their surfaces.

It takes training and retraining of staff members to make sure that everyone involved understands their role as these instruments go through the process of proper instruments care. Staying abreast of best practices is critical as staff members come and go in a facility, so it is up to the leaders to keep an eye on this significant component of the surgical journey.

Good communication between the surgical team and the sterile processing department will go a long way to avoiding costly errors and keeping important instruments in excellent working condition. If there are challenges along the way, communication among all the individuals involved is key in preserving the microsurgical instruments that are so critical for successful and safe patient care.

Note: For more information please go to www.synovismicro.com.

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Pretreating Instruments in the OR Is Vital

Instrument care should begin immediately after surgery.

Observers of surgeries around the country report that the best practice of pretreating instruments in the OR as soon as a procedure is complete is still applied too inconsistently. "It's an area some facilities could improve upon, usually because of a lack of knowledge about the practice," says infection control consultant Linda Spaulding, RN, CIC.

Scrub techs should keep instruments clean between uses throughout surgery and moisten them when they are no longer needed to avoid bioburden from drying and coating surfaces, which can cause moving parts to stick and make crevices more difficult to clean in decontamination. Stubborn residual bioburden requires more cleaning time and effort from reprocessing techs in order to ensure an instrument can be properly sterilized.

Point-of-use treatment in the OR not only can speed reprocessing times but also extend the life of instruments due to damage from the intensive cleaning required by dried bioburden. "Substances such as blood and saline can break down the devices' protective finish," says Ms. Spaulding. "Soil and debris that dry on instruments become harder to remove from lumens and crevices, causing further damage to the instruments. Over time, dried blood and bodily fluids can cause instruments to stain, pit, rust or become dull."

She suggests keeping soiled instruments moist in the OR by spraying or soaking them in an enzyme solution or water or placing a moist towel over them until they are ready to be sent to the sterile processing department. "It's best to begin cleaning instruments within 15 minutes to one hour after a procedure," says Ms. Spaulding.

After cleaning and before being packaged for sterilization, techs should carefully inspect instruments for cleanliness, proper functioning and alignment. "They should be checked for corrosion, rust, pitting, nicks, cracks and chips," says Ms. Spaulding, who adds that it can be difficult to see bone, tissue or blood wedged in crevices.

All told, just a small amount of conscientious care for soiled instruments in the OR can make life easier for reprocessing staff while prolonging the lifespan and integrity of the tools. The end result is reduced costs, increased patient safety, quicker reprocessing and a higher likelihood that cases remain on schedule.

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A Go-To Reference for Reprocessing Intraocular Instruments

Task force says general sterile processing guidelines don't always apply to eye instruments and could even endanger patient safety.

When eye centers are in doubt on how to reprocess intraocular surgical instruments, they can refer to a comprehensive guideline created by a task force staffed with experts from three professional societies.

The guideline from the Ophthalmic Instrument Cleaning and Sterilization (OICS) Task Force was crafted to assist ASCs in their efforts to provide safe patient care by adopting appropriate cleaning and sterilization practices. The task force included surgeons, nurses and technicians at outpatient ophthalmic surgery centers and consisted of members of the American Society of Cataract and Refractive Surgery, the American Academy of Ophthalmology and the Outpatient Ophthalmic Surgery Society.

The guideline was originally authored in 2007 to help ASCs prevent rare but potentially devastating occurrences of postoperative infectious endophthalmitis and toxic anterior segment syndrome (TASS), each of which are potential complications of cataract and other intraocular surgery. It was updated in 2018 to reflect new research and enhanced cleaning practices based on the latest manufacturers' instructions for use.

"The small volume of the eye and its sensitivity to minute amounts of chemical or microbial contaminants means that improper instrument cleaning or sterilization practices might pose a significant risk to patients," states the evidence-based guideline.

The task force considers the guideline important because many sterile reprocessing guidelines attempt to cover all surgical disciplines, many of which are far different from intraocular surgery. "All-inclusive broad guidelines attempting to cover surgery from head to toe could sometimes include inappropriate, or even risky, practices for ophthalmic cases," it notes.

For example, cataract surgeries are short in duration and a high volume can be performed each day. The instruments involved are small and often not heavily soiled from tissue or bacterial contamination. On the other hand, the smallest amount of detergents or chemical contaminants used to clean them, while well tolerated in other body cavities, could cause severe intraocular inflammation when introduced into the eye. "These characteristics might differentiate optimum cleaning and sterilization procedures for cataract surgery from those required for many other types of surgery," states the task force.

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