Healthcare Hygiene magazine September 2020

Sterile Processing professionals (SPs) have long been at the frontlines of protecting patients from cross-contamination from used operating instruments and other hospital equipment, but their intimate knowledge of virus transmissions risks, decontamination techniques, and processing protocol has never been as critical as it is during the age of coronavirus. And though SPs already adhere to an array of strict guidelines like the CDC’s Cleaning and Sterilization guidelines, regulatory standards from federal and state agencies, and their own facility’s protocol when cleaning, reassembling, and sterilizing operating instruments prior to the next procedure, there’s no time like a pandemic to review, refresh, and even strengthen sterile processing protocol to protect patients, doctors, and other hospital professionals.

Just as all of today’s doorknobs, keyboards, and other high-touch surfaces should be viewed as a potential transmitter of coronavirus, any and all items and instruments arriving in the Sterile Processing Department (SPD) should treated as contaminated even if they “look” clean. The same universal precautions and fundamental cleaning and disinfecting steps must be followed to prevent transmission of any infectious disease, including COVID-19.

Below you’ll find an overview of processing protocol to keep your team and your patients safe.

SPD Basics

  • Wear Appropriate PPE. All technicians working in the decontamination area must be equipped with full personal protection equipment (PPE) regardless of how simple the task may be. Full PPE means hair covering, face shield and mask, gloves appropriate to the task, gown, and shoe covers.
  • Adequate Tools for Cleaning. SPs must apply the best cleaning techniques and use the appropriate cleaning tools to remove all soil residues from lumens and hard-to-reach areas of the instrument. Use the right size cleaning brushes for lumens based on the medical device’s instructions for use (IFU) and the correct tools to remove contamination and debris.
  • Test Your Reprocessing Equipment Regularly. Regularly test your facility’s automated cleaning equipment’s efficiency and efficacy to confirm that the promised cleaning is taking place. Maintain your facility’s equipment according to the manufacturer’s specifications.
  • Cleaning Chemicals/Detergents. Be sure to have the proper cleaning chemicals and detergents on hand at all times, as water alone is an ineffective decontamination agent.
  • Following IF Adhere to manufacturers’ IFUs when mixing and using cleaning solutions and be sure to factor in water quality and temperature for the most effective solution. Most, if not all, products will detail the following:
    • Contact time: How long the solution should remain wet on the contaminated surface
    • Dilution rate: The ratio of water to detergent
    • Temperature: The water temperature that will yield the most effective detergent/disinfectant solution
    • Storage temperature: Some chemicals degrade when exposed to temperatures that are too high or too low. Store your cleaning solutions at each one’s correct storage temperature to maintain efficacy.

Collaborate

Contamination begins in the operating room, when the hardworking operating team does what it’s meant to do: operate. It’s natural for instruments to be contaminated during procedures—that’s what they’re there for--but SPD leadership should join forces with OR leadership to ensure that OR team members abide by stringent procedures to prevent contamination during transport to the SPD.

Marilyn Main, MSN, RN, CNOR, VP of Surgical Services AT WHICH HOSPITAL?, shared her approached for successful collaboration with the SPD and the OR. “The only way to achieve compliance is to educate the staff on evidence-based practices and set performance expectations. Engage the staff in auditing current practice to foster open communication and process correction. Leader audits are key to discovering perceived barriers and communicating any process changes. Utilize information and technology to collect, collate, and communicate data. Display outcomes and communicate findings to the team during shift huddles as well as coaching individual staff. Safe practices minimize the risk of harm to patients and providers through system effectiveness and individual performance.”

In short, a facility will perform better on all metrics when teams are collaborating, sharing information, and being upfront about outcomes and findings.

At a loss of where to start collaborating? Begin in the OR, where the scrub nurse/technician, garbed in full PPE, begins the transport process. S/he should adhere to the following protocol for a smooth transport to the SPD.

  • Place items back into the appropriate leak-proof transport containers and segregate all sharps and delicate instruments. Remove all blades and disposables.
  • Flush all lumens and ports with water.
  • Restring the instruments to be sure they’re open. Place all scopes back in the original containers with cords coiled loosely to prevent damage.
  • Spray all instruments with a wetting agent to prevent drying during transport.
  • The leak-proof transport container or case cart must have a visible “biohazard” label and instruments should be placed in the correct container. Neither the container nor the case should be left unattended. The top of the case carts and container handles should be wiped with a disinfecting wipe before transport to prevent cross contamination.
  • Remove gloves and perform hand hygiene before transporting the case cart to the designated area. Contaminated gloves are a source of transmission when touching other surfaces along the way like the doorknobs, elevator buttons, and push open plates.

Meticulous Procedures in Decontam

Cleaning operating instruments and tools requires meticulous processes and unyielding attention; there is no room for error when you’re eradicating infectious microorganisms and bioburden from lifesaving instruments. In the SPD, technicians must be laser-focused while:

  • Determining the category instruments fall into: are they delicate? Can they be submersed? Are there even more specific cleaning procedures? It’s crucial to separate sharp items before they pierce PPE. Case carts also need to be emptied and processed for cleaning.
  • Preparing manually. Prepping the right detergents, at the right dilutions and temperatures, to clean the instruments and tools. Thorough hand-cleaning and disinfection is performed on items that cannot go through mechanical washing.
  • All items processed in the decontamination area must be inspected to ensure the cleaning process was successful. Use visual and chemical aides to detect bioburden. If bioburden is detected, clean the items again.
  • Mechanically cleaning. Often times, multiple-level trays must be separated and instruments must be disassembled to ensure that the cleaning action of the mechanical washer touches every instrument surface. A tech must take care with this disassembly for a thorough clean.

Cross Contamination in the Decontamination Area

The decontamination area will become soiled and contaminated over the course of a day as instruments and tools are brought through for processing. As such, we must follow the appropriate procedures to sterilize the decontamination area in between processes. How?

  • Disinfect sinks after each tray is cleaned to limit the transfer of loose bioburden/contamination to the next item. All cleaning tools such as brushes, cleaning sponges and cloths should be cleaned after each use following the manufacturer’s instructions for use. Disposable tools should be discarded.
  • Change linen between processings and dispose of soiled linen in the appropriate receptacles.
  • Separate “clean” and “dirty” spaces so there is no cross contamination after processing.
  • Clean surfaces regularly with hospital-approved disinfectant. Clean surfaces when they become visibly soiled. Thoroughly clean the outside of equipment and clear any clogged drains that may prevent water circulation or promote bacteria growth. Floors, walls, and vents must be on a regular housekeeping schedule to minimize microbial growth in the environment.
  • Wipe water faucets and handles, doorknobs, phones, equipment panels, tables, and case carts after each use.
  • Automate disinfection processes on mechanical equipment.
  • Don and doff PPE in the proper order and perform proper handwashing procedures before and after removing PPE.

Infectious diseases such as COVID-19 are of a great concern not only for healthcare workers but for the population in general. Consistent procedures, performance expectations, process audits, collaborative teams, and open communication all create a culture of safety and minimize the risk of harm to patients and healthcare workers.