Make Instrument Precleaning a Priority

Infection Prevention

By: William DeLuca

Published: 12/10/2020

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Point-of-use care improves surgical efficiencies, staff collaboration and patient care.


The buck stops with sterile processing techs, who are ultimately the ones responsible for returning complete instrument sets to ORs on time and properly sterilized. With increasing caseloads, more instrumentation needed for complex procedures and a constant emphasis on maintaining overall efficiencies, the job has never been harder.

Surgical teams can help out their colleagues by wiping down dirty instruments with sterile water or treating them with an enzymatic spray to prevent blood, fat or tissue from developing into a layer of bioburden that's difficult to remove. Industry guidelines clearly state that immediate point-of-use precleaning is a critical first step in helping to prevent bacterial film from forming on instrument surfaces.

Precleaning makes instrument decontamination easier, allowing reprocessing techs to turn around trays faster and send them back to ORs in a timely fashion. When pre-cleaning takes place in the OR, instruments arrive with less bioburden, making the decontamination process easier and faster. The risk of sending a potentially dirty tray back to the OR decreases dramatically, thus lowering a patient's risk of developing a surgical site infection. Pre-cleaning really makes for better —and safer —patient care.

The proper cleaning of instruments keeps patients safe from infection and helps to reduce the cost of instrument upkeep. If your reprocessing techs consistently perform a lackluster job cleaning and sterilizing instruments, surfaces will become stained —which can lead to pitting and rust —and the tools will eventually break. The cost to replace instruments varies, but can range from $20 to as high as $1,800. Unfortunately, the instruments that are harder to clean tend to be more expensive.

On the same page

CLEAN START When surgical teams wipe down instruments in the OR, sterile reprocessing techs have less bioburden to remove.   |  William DeLuca

Emphasizing the importance of instrument precleaning sounds simple enough, but it can be a struggle to make sure it's done consistently and effectively. That's where strong leadership comes into play. Your OR directors and sterile processing managers need to develop a good working relationship. They both need to understand how long it takes to reprocess instrument trays, the steps involved and why cutting corners at any point in the process can negatively affect patient care. They also need to understand the risks involved if reprocessing steps are skipped.

Building a relationship between these two departments will also create accountability among members of the surgical team, because they'll understand the importance of precleaning instruments, appreciate how long it takes to reprocess trays, realize that the job can't be rushed and realize it's best to let sterile processing techs do their job to keep things moving along at an efficient pace.

Getting both groups to work in concert demands clear communication and a willingness to cooperate, and building that bond isn't something that happens overnight. The OR and SPD speak different clinical languages, which can often cause misunderstandings. It's important that team members in both areas learn to communicate clearly and constructively. It's a two-way street: The OR needs to fully understand the processes in place in sterile processing, and reprocessing techs need to understand how instruments are used in the ORs and the importance of returning the tools to surgical teams as quickly as possible.

Both groups are constantly under a lot of pressure and it pays to remain calm, cool and collected. If the OR is giving off high-strung, stressed-out energy, reprocessing techs need to stay as relaxed as possible and filter out the noise to make sound, proper decisions. If they're stressed out and give into that stress, they could skip an important instrument reprocessing step, which could jeopardize safe patient care. Everyone in your facility must have the patient in mind at all times.

One thing I always tell my reprocessing staff is that no matter how much pressure they might be feeling from the OR to reprocess instruments quickly, they must not skip the critical step of putting instrument trays through an automatic washer. If the OR needs a tray to be reprocessed immediately, a frazzled reprocessing tech might quickly handwash the instruments and soak them for a minute or less —or maybe not at all. The tray would get manually scrubbed down, rinsed off and then pushed through to techs who'd ready it for sterilization, rather than getting run through an ultrasonic cleaner —which uses mechanical vibrations to agitate a cleaning solution to aid in the removal of soil from the surfaces of surgical devices —and soaked for several minutes.

If you have good, strong surgical leaders who understand what goes into reprocessing instrument trays, they will likely pass this knowledge along to the rest of the OR staff. But sometimes, seeing and experiencing what goes on in the sterile processing department is the education surgical teams need to get on board with properly precleaning instruments. OR staff are frequently amazed at how long it takes to reprocess even a basic instrument tray, and seeing reprocessing techs in action gives them a better appreciation of the pressures their colleagues face on a daily basis. When OR staff members come down to our sterile processing department, they've actually said, "Oh, my gosh, I had no idea you had to walk this far!" and "I can't believe the phone rings that much!"

You never know what your coworkers are going through until you're in their shoes. The OR will often schedule cases back to back to back, even though there's only one instrument tray available for all three cases. When the day of surgery comes, the surgical team is asking the SPD why the tray isn't ready, unaware there is only one tray and it takes four hours to reprocess. They're frantically calling the department manager, saying the patient is on the table and the surgeon is upset. As soon as the OR mentions the patient, members of the reprocessing team start to feel an enormous amount of pressure to get the tray back to the OR as quickly as possible. These types of situations can be prevented if both departments learn to work with, not against, each other.

Total team effort

Educating providers on the importance of point-of-use cleaning is essential. It allows reprocessing techs to do their jobs more efficiently and effectively, which impacts many aspects of surgical care and, most importantly, patient safety.

Creating that awareness helps the OR staff become more invested in the precleaning process, but fostering teamwork between the two departments does take time and effort. Instituting a program where OR staff and reprocessing techs rotate through the other department to observe their colleagues in action creates a better understanding of the responsibilities team members face in each area and ultimately leads to greater workplace harmony and improved instrument care. OSM

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