September 14, 2023



‘Culture’ Change Boosts Scope Safety Monitoring

ATP Testing Provides Additional Assurance

Intelligent Solutions for Infection Control Offers a Safe Patient Experience - Sponsored Content

Cleanliness Assurance Requires Interdepartmental Collaboration

How Clean Is ‘Clean’?



‘Culture’ Change Boosts Scope Safety Monitoring

When a health system switched from culturing to rapid cleaning verification (RCV) tests, both reprocessing errors and testing costs declined.

CultureQUICK CONFIRMATION A health system that switched from culturing reprocessed endoscopes to using rapid cleaning verification tests says the process is faster and less costly while enabling on-the-spot corrective education for techs who face massive manual cleaning workloads.

A decade after the CDC, FDA and others first stressed that more attention should be paid to the dangers of improperly reprocessed endoscopes, such errors remain frequently cited by The Joint Commission.

Marc Coulombe, RN, BSN, CIC, an infection preventionist with WakeMed Health & Hospitals in Raleigh, N.C., described how his organization has been working to avoid those errors for quite some time during a presentation at the Association for Professionals in Infection Control and Epidemiology’s 2023 Annual Conference & Exhibition in June. He also revealed a recent tactical change that improved the system’s results.

Prior to August 2022, infection preventionists monitored the situation at one of WakeMed’s three endoscopy departments by culturing four patient-ready scopes there once a month. Each culture cost $27 for supplies and required two infection preventionists to perform. Between 2016 to 2021, the positive culture rate was consistent at 12.9%, according to Mr. Coulombe.

In August 2022, however, WakeMed eschewed scope culturing in favor of rapid cleaning verification (RCV), a 90-second process that uses test strips to identify residual contaminants without the need for lab testing. “If there is a failure, staff are immediately re-educated, the scope recleaned and RCV repeated,” reports Mr. Coulombe. Because RCV tests are quicker and not as expensive as culturing — supplies cost only $2.50 per scope and the test requires only one infection preventionist to complete rather than two — it is now employed on a monthly basis at all three of WakMed’s endoscopy units.

When WakeMed first rolled out the new testing regimen, 14 scopes were tested. Four failed initial cleaning tests and three passed a second test after staff re-education. The fourth scope failed twice more and was removed from service. A month later, in September 2022, 15 scopes were tested. Three failed their initial cleaning test, but all passed retesting after staff re-education. The following month, only one scope failed initial testing and passed retesting following staff re-education.

Mr. Coulombe concludes, “Compared to culturing, RCV validation combined with ‘just in time’ staff education results in fewer improperly reprocessed scopes, reducing the risk of patient pathogen exposure. Staff skill and engagement is increased because they receive immediate feedback. Expense and labor burden is decreased due to lower supply costs and the use of only one infection preventionist, resulting in more monthly scope tests.”

ATP Testing Provides Additional Assurance

Verifying the actual cleanliness of your instruments not only keeps patients safer, but also can extend the tools’ lifespans.

ATPNorthwell Health
BEYOND THE EYE TEST ATP testing can supplement and confirm sterile processing technicians’ visual inspection of instruments for residual bioburden.

Reprocessing techs already deal with a lot of steps in their workflow, but adding one more can do a lot to confirm that they’re doing excellent work — or alert them that they might be falling short in their efforts to ensure every instrument they sterilize is returning to the ORs free of bioburden.

“Although we didn’t have an issue with bioburden or infection rates, we were running up to five surgical suites each day that performed cases in a range of specialties, says Annissa Cromer, MPH, BSN, CNOR, PHN, LCDR, NC, USN, depart¬ment head for the sterile processing department (SPD) at Naval Hospital Camp Pendleton in Oceanside, Calif. “Because our SPD decontaminates and sterilizes such a wide range of instrumentation, ATP testing to validate that instruments are properly cleaned before being sterilized seemed like a worthwhile addition.”

ATP testing employs premoistened swabs that, within 30 seconds, can detect the presence of microscopic biologic material such as blood and tissue on an instrument to confirm decontamination efficacy. LCDR Cromer says that adding ATP testing into SPD workflow requires both flexibility and attention to detail.

“When trays full of a variety of difficult-to-clean tools arrived in decontamination, we randomly selected instruments to test and noted the specific locations that were swabbed,” she says. “We didn’t inform reprocessing techs which tools were selected to ensure they didn’t make an extra effort to clean those instruments. We wanted them to maintain their normal practice of manual decontamination.”

Instruments were swabbed and documented at four successive points in the SPD process: upon initial receipt; after vigorous manual decontamination; after completion of a 15-minute ultrasonic bath cycle; and after completion of a 36-minute washer-disinfector cycle.

At every stage, swabs were placed in a handheld device that displays ATP readings in relative light units (RLUs). Zero through 100 RLUs was a passing mark, while 101 RLU or greater was a failure. “A failure of any instrument required that instrument, as well as the other instruments in its tray, to be sent through the decontamination process again,” says LCDR Cromer, whose team found that amounts of bioburden dropped significantly from initial receipt to the time after instruments were manually cleaned by SPD techs. Swabs after the ultrasonic bath usually resulted in RLUs of less than 10.

“Considering our initial swabs generally resulted in readings in the 1,000s or even 10,000s, achieving a mark like this before the decontamination process was finished was outstanding,” she says. “We swabbed instruments one last time after the washer-disinfector cycle, which lowered readings even more.”

LCDR Cromer says another benefit of ATP testing is its potential to prolong the life of your instruments. “Tools that have been properly decontaminated will remain free from rusting and pitting corrosion, which can happen when residual bioburden remains on instruments during terminal sterilization,” she says. “Any proven adjunct method will both extend the life of the instrument and ensure surgical tools are free of the microscopic bioburden that could ultimately harm the patient. If your staff recognizes this, chances are they will understand the importance of ATP testing, regardless of the extra steps it adds to their workflow.”

Intelligent Solutions for Infection Control Offers a Safe Patient Experience
Sponsored Content

Instrument care and infection control are keys to successful surgeries and consistently positive outcomes.

The cleaning verification of instruments is perhaps one of the single most important tasks to keep patients – and the facility’s staff – safe. It sounds like an easy enough goal, but leaders who stress infection control with a total team effort know it simply is not. It takes collaboration and innovative tools to accomplish the daily safety steps that prevent infections as well as control the availability of clean instruments that are part of any patient’s surgery, no matter the complexity or type of procedure.

Many times the residue and particles that can’t be seen easily can cause the most problems. SPD teams and OR staff consistently work to identify these problem areas during the careful steps taken to clean their instruments. Having tools at their disposal that act as an independent check on the ultimate cleaning performance in the automated washers that are used to clean instruments are indispensable for successful infection prevention protocols.

Healthmark offers a family of products under their Proformance™ Cleaning Verification system that verifies the cleaning process and encompasses objective tests that lead to the comfort level needed to proceed with instrument utilization. Among them is SonoCheck™ and TOSI® The LumCheck™, which are especially designed as an independent check on the cleaning performance of pulse-flow lumen washers.

When the ultrasonic cleaner is supplying sufficient energy and conditions are correct, SonoCheck™ will change color. Problems such as insufficient energy, overloading, water level, improper temperature and degassing in the washers will increase the need for the color change. In case of major problems, the SonoCheck™ will not change color at all.

The hidden areas of instruments that collect residual protein and blood are targeted by TOSI®, the easy-to-use blood soil device that directly correlates to the cleaning challenge of surgical instruments. In fact, TOSI® is the first device to provide a consistent, repeatable and reliable method for evaluating the cleaning effectiveness of the automated instrument washer.

TOSI® LumCheck™ has been designed to offer an independent check on the cleaning performance of pulse-flow lumen washers. How is this done? Embedded on the stainless steel plate is a specially formulated blood soil, which includes the toughest components of blood to clean. This allows the user to go beyond what they can see with all-in-one detection kits for blood or protein residue. As part of the system, HemoCheck™ is simple to interpret and indicates blood residue down to 0.1μg. The ProChek-II™ measures for residual protein on surfaces down to 0.1μg.

Taken together, HemoCheck™ & ProChek-II™ SonoCheck™ and TOSI® The LumCheck™ are all designed as a valuable independent check that provides healthcare professionals with the security and comfort that their cleaning protocols and equipment are doing the job every time. Especially for the surgery centers that have high-volume caseloads, this extra measure goes a long way to provide safety for patients and peace of mind for OR leaders.

For more information go to

Cleanliness Assurance Requires Interdepartmental Collaboration

Communication between SPD and EVS staff can eliminate critical gaps.

The old saying “cleanliness is next to godliness” wasn’t about a surgery center’s sterile processing department (SPD) — but it may as well have been. After all, forgetting even a minor step in the cleaning process could potentially affect the sterility of your instruments and trays, which of course has huge patient safety implications.

Recognizing that a better schedule in its SPD was needed to help environmental services (EVS) avoid cleaning lapses, SPD leaders at NorthShore University HealthSystem in Chicago started working more closely with EVS, and specifically took a look under the hood of EVS’ cleaning processes. What it uncovered was disconcerting to say the least: The SPD wasn’t cleaned daily and, when it was, the cleaning was inconsistent.

When these issues were pointed out by SPD leaders, EVS staff didn’t receive the feedback as punitive. Instead, the two departments collaborated to improve cleaning processes, with the goal of better ensuring that cleaning was performed as effectively and consistently as possible.

In a poster they displayed at the 2023 Healthcare Sterile Processing Association Annual Conference titled “Cleanliness Assurance: Sterile Processing and Environmental Services,” representatives from NorthShore’s SPD and EVS teams outlined how their two departments communicated, collaborated and, ultimately, improved cleaning of the SPD. After conducting training and investing in extra materials, NorthShore improved its SPD cleaning process by:

  • Correcting cleaning workflow;
  • Identifying a specific time for cleaning, including specific areas that needed to be cleaned on a schedule, such as behind the sterilizers and high dusting of air filters and cabinets;
  • Creating a routine maintenance log check that specifies each area on a daily, weekly and monthly basis, and
  • Discussing ways to sustain improvements and continued development in areas that need further attention.

The teams reported that, through this collaborative project, the relationship between the two departments was strengthened, with weekly follow-up conversations held.

To ensure compliance with the schedule the team had developed, the facility added an electronic logging device to track cleaning data such as date and time performed. “With continued measurement and focus, metrics should only improve as variations are identified and addressed immediately,” according to the poster’s authors. “With continued collaboration between the OR and SPD, our impact [on] patient care and safety is limitless.”

How Clean Is ‘Clean’?

Used properly by trained reprocessing techs, cleanliness verification tools can shed light on potential failures in the sterile processing pipeline.

It’s a common scenario at surgical facilities: Reprocessing techs busily rushing through their work, even forced sometimes to cut corners behind the scenes as the day’s packed OR schedule begins to back up. As a result, patients can be put at increased risk for surgical site infections.

To combat these situations, adding a way to verifying the cleanliness of instruments in the reprocessing pipeline is vital. Many facilities and their sterile processing leaders are increasingly relying on cleanliness verification technologies such as chemical indicators, biological test strips, borescopes, lighted magnification, water testing and instrument-tracking systems to ensure their instruments truly are clean.

However, while these technologies are extremely useful, surgical leaders advise also focusing on the entire decontamination process, as well as confirming that training for sterile processing techs is up to snuff. “Train your team and then test using different products and methods that will show that the team and equipment are doing what they need to do for patient safety,” says Damien Berg, BS, BA, CRCST, AAMIF, vice president of strategic initiatives for the Healthcare Sterile Processing Association (HSPA).

A key to effective use of cleanliness verification products is to bring vendors in to train your staff on them. “Lean on those vendors to help make sure your reprocessing techs fully understand how to use the product properly,” says Monique L. Jelks, MSOL, BA, CRCST, clinical educator, sterile processing, with WellStar Health’s Cobb, Vinings, Paulding and Douglas Hospitals in Georgia, and president of HSPA’s Board of Directors. “Sometimes this is an additional cost. However, a one-time training session, along with an identified champion user of the product to continue the education annually for the ASC’s sterile processing technicians, would help retain knowledge.”

Experts advise that surgical facilities should prioritize instrument cleanliness — and thus, patient safety — as much as they do procedural volume and growth. “ASCs should invest in their sterile processing technicians by providing educational opportunities, including participation in local and national conferences, to obtain and maintain knowledge of current processes,” says Ms. Jelks. OSM

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