Strive to Standardize

Proper high-level disinfection demands consistent training, clear policies and a keen eye toward all potential dangers.

Most experts believe high-level disinfection (HLD) activities should be standardized but not centralized. “Centralization of disinfecting activities — especially with scopes — is not a good idea,” says Casey Czarnowski, BA, CRCST, CSPDT, CIS, CER, a sterile processing educator and consultant. “When you’re processing flexible endoscopes, this activity should start near the point of use of the scope.”

Power of policy

To standardize correctly, staff must be trained in a consistent fashion on anything that involves HLD. Most importantly, this means writing policy that covers how to clean, disinfect, dry and store a flexible endoscope. Then, conduct annual competency assessments with all staff who work with the scopes to make sure everybody is doing the same thing, consistently, no matter which step they play in the process.

“You could certainly centralize these operations, but to do it right, in my view, you’d have to buy a system that includes an entire range of products, including rigid trays, covers, liners and carts, which is a significant capital expense,” says Mr. Czarnowski. “And then you must train everyone who participates in every step of the process in how to use it. That’s why I think a decentralized concept for treating these instruments near where they are used is often the best way to go.”

That concept emphasizes the cleaning that should take place before instruments are high-level disinfected and how it impacts the HLD process. “Flushing that scope at the point of use with a bedside kit with detergent, a sponge, a syringe and a basin is a critical step in the subsequent high-level disinfection of that instrument and is incredibly important,” says Mr. Czarnowski.

Transporting fragile and expensive flexible scopes, explains Mr. Czarnowski, is not easy to do without damaging them. Always keeping them near where they are used reduces the likelihood that you’ll damage them during transport or storage. Hanging the scopes near their point of use is also helpful, because immediately placing them into a nearby drying cabinet reduces the amount of time the scope was wet inside after reprocessing, which decreases the potential for formation of biofilm. The drying and storage components of the process that take place after HLD are important. “We can’t be storing these devices in a basic office filing cabinet, which I’ve seen done,” says Mr. Czarnowski. “It must be a dedicated and IFU-provided cabinet, ideally with an active drying component, not something you bought at your local big-box hardware store.”

Prepared for chemical spills?

The patient safety element inherent in proper high-level disinfection is clear, but staff safety is also a critical aspect that SPD leaders must never lose sight of.

“When working with high-level disinfectants, we encounter a variety of chemicals requiring careful management to ensure safety,” says David Jagrosse, CRCST, CHL, president of David Jagrosse Consulting in Daytona Beach, Fla., and past president of the Healthcare Sterile Processing Association. “A crucial part of this process is having Safety Data Sheets (SDSs) readily available as part of your Hazard Communication Program (HazCom) or Chemical Safety Program.”

The safety sheets to which Mr. Jagrosse refers provide vital information on chemical exposure limits and spill-response protocols and must be accessible to all staff. The SDSs cover a lot of ground, all of which is critical information for facilities and their SPD staff. Mr. Jagrosse says Section 6 and its information about adequate spill-response preparation is especially important for HLD. “This section provides detailed guidance on handling chemical spills, including specific cleanup materials and procedures,” he says.

There are several key considerations facilities must factor into their spill-response preparation plan. Mr. Jagrosse stresses the importance of paying close attention to details such as the materials that a spill kit contains. “For example, if you store eight gallons of a chemical, your spill kit should be able to address a spill of equal volume,” he says. “Beware of off-the-shelf kits that may only cover minor spills, and check expiration dates on kit components regularly. HLD chemicals often require a deactivation and subsequent product to remove and dispose of the materials.” OSM