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The Essentials: The Foundation of Top-Quality Instrument Care
By: Jared Bilski | Editor-in-Chief
Best practices in the tracking, repair and maintenance of surgery’s most critical tools.
From proper cleaning at the bedside to managing a trying maintenance and repair schedule, properly caring for the surgical instruments your surgeons and OR staff use each day is paramount to the success of your facility.
It’s also complicated and demanding, so sometimes it’s just a good idea to get your sterile processing department (SPD) leaders to bring the team together and revisit the basic elements of top-quality instrument care. Here are four cornerstones of this critical practice:
1. It all starts at the bedside. We’d be remiss if we published an article about instrument care without stressing the importance of bedside precleaning. In fact, we’ve written plenty of instrument care articles that focus exclusively on this critical practice. “One of the most basic tenets of instrument care is making sure precleaning takes place at the bedside by OR staff,” says Frank Myers, MA, CIC, FAPIC, director of infection prevention and clinical epidemiology at University of California, San Diego Health. “They should be removing gross debris and organic matter in the OR, and the instruments should be wet when they make it back to the SPD.”
As important as this step is, it is often skipped by busy surgical techs. What’s worse, SPD tends to get blamed. This mishap is a prime opportunity to revisit communication between SPD and the OR, as Mr. Myers points out. “Often when organic material is discovered on instruments, institutional leaders will turn to the sterile processing team and want to know how it happened,” he says. “Don’t ask SPD — ask your surgical techs.” Mr. Myers adds that this discussion is a great opportunity to uncover issues with the workflow. “You need to have a discussion with techs and find out how and why the precleaning was missed,” he says. “Maybe it’s just ignorance or not knowing, but maybe there’s a bigger issue. Maybe the techs are multitasking too much and need to let leadership know, ‘I’m running three ORs and...’”
Precleaning is so important to the longevity of your instruments when you consider dried blood on instruments is corrosive and causes pitting, rusting and metal fatigue. But there’s an important methodology to point-of-use cleaning (POU) that SPD leaders want to impress upon those who handle the precleaning of the instruments. A simple but often overlooked practice here centers around what your OR staff uses to wipe down the instruments.
“Wiping down the instruments at the point-of-use should be done without saline,” says Casey Czarnowski, BA, CRCST, CSPDT, CIS, CER, sterile processing educator at Stanford Health Care in the San Francisco area. “When it comes to instrument care at the bedside, you really should get rid of saline and only wipe with sterile water.” Mr. Czarnowski points out that although virtually all the major professional associations — HSPA, AORN, AAMI — support this best practice, saline is sometimes still used, in many cases because surgeons don’t want to do away with it.
2. Index to perfection. While instrument tracking systems and manual indexing are focused so heavily on where trays and instruments are in relation to the workflow cycle — and rightfully so — they also serve a critical function in terms of keeping track of the routine maintenance and repair schedules of surgeons’ most valuable tools. “It all comes back to instrument tracking, but you also need to keep track of sharpening and preventive maintenance for instruments like scissors,” says Mr. Czarnowski, who adds that SPD staff should always take the extra step when it comes to testing instruments for performance, functionality and defects. “You want to test your scissors for sharpness every time,” he says. Excessive? Not when you consider what could happen if you allow subpar instrumentation to get through. “It may seem like a tiny thing, but if you’re at a small facility and a surgeon keeps getting dull scissors, that could be the final straw that causes them to walk away,” says Mr. Czarnowski, who adds that conducting those regular functional inspections — like laparoscopic insulation tests — is another essential element of instrument care. These tools help SPD techs to detect pinholes and tears in the insulation of laparoscopic instruments. If present, those damaged instruments will immediately be taken out of service and sent out for repair — as even the smallest defects can allow blood and/or other fluids to enter under the insulation.
When it comes to instrument care at the bedside, you really should get rid of saline and only wipe with sterile water.
Casey Czarnowski, BA, CRCST, CSPDT, CIS, CER
3. Regular Instructions For Use (IFU) reviews. SPD staff are expected to clean and sterilize a lot of complex instruments and devices that are attached to equally complex IFUs. That’s why Mr. Myers recommends scheduling regular reviews of the IFUs in small chunks every four weeks or so. “IFUs change over time, so every month SPD leaders should review about one-twelfth of them with staff,” he says, citing the instructions to robotic platforms as a perfect example of why regular review of IFUs is so important. “There’s a magnification requirement on da Vincis that most places don’t even know about,” says Mr. Myers. “You can catch these types of things when you really go through the IFUs.”
Another best practice Mr. Myers advises SPD leaders to employ: Regularly going to the manufacturers’ website or having a service that directly sends you the most up-to-date IFUs. “Go to the web,” he says. “You don’t want to keep paging through those giant binders — the paper binders have become obsolete.”
4. Find the right repair company. SPD leaders need to forge a solid relationship with a reputable repair company they can trust, and it doesn’t hurt to review and revaluate those partnerships now and again. “Every SPD leader needs a repair company they can trust and turn to often,” says Mr. Czarnowski. “It doesn’t matter who, as long as they’re a provider, but you need to get a service contract.” For newer leaders who are unsure of what to look for in a repair company and where to start, Mr. Czarnowski recommends going to HSPA’s website and looking for companies with a CCSVP (Certified Central Service Vendor Partner) designation: osmag.net/vendorcheck
“A CCSVP designation is a good place to start, and a good indication that you’re dealing with a reputable company,” he says. OSM
The sterile processing department (SPD) is where the unsung heroes of surgery play an essential role in protecting patients from harm and preventing surgical site infections. It’s also the subject of the final event in the first run of OR Excellence Webinars, sponsored by Outpatient Surgery Magazine and AORN. Hear from Jig Patel, ST, CRCST, CHL, CIS, CER, a seasoned SPD leader who currently serves as sterile processing educator/quality assurance manager for UCLA Health in Los Angeles, about how to improve communication between your ORs and SPD, and ways to ensure hardworking sterile processing techs have the tools they need to ply their trade efficiently and safely. You’ll walk away from this informative presentation with tips you can use immediately to implement best practices in decontamination and sterilization and optimize the flow of instruments in your facility. The webinar will take place on June 13, 2023, at 1 p.m. ET. Register here: osmag.net/instrumentcare.
—Outpatient Surgery Editors
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