Cleaner and Greener

Fear can be a tremendous motivator. It can drive innovation, push new processes forward and often provide complimentary benefits that weren’t initially considered.

This appears to be the case when looking at ways that the surgical community has embraced and continues to improve instrument cleaning and sterilization. So, it would seem, that fear can also be very positive.

“As surgical instruments become more minimally invasive, they also become more complex and difficult to clean,” offers Medisafe’s Tina Cole.” Chris Antonucci, a senior marketing manager at STERIS agrees. “One of the most significant challenges healthcare professionals face today is the reprocessing of heat-sensitive devices that are intricate in design and can prove challenging for cleaning, high-level disinfection or sterilization,” he offers.

So with this in mind, here are some of the key elements to remember and embrace when evaluating and improving instrument sterilization approaches. The CDC states that thorough cleaning is required before high-level disinfection and sterilization because inorganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes.

“The steps before and after the high-level disinfection of your probes are extremely important,” offers Rosina Feser, marketing manager at PCI Medical. “If pre-cleaning is done improperly, your high-level disinfection will fail. That’s why it’s recommended to always use probe manufacturers’ guidelines for pre-cleaning. Additionally, the American Institute of Ultrasound in Medicine (AIUM) offers general steps for pre-cleaning2.”

In addition to the actual cleaning, the internal processes should also be examined for ways to improve. Cole adds, “Creating an automated process to achieve internal and external cleanliness is essential. The most important obligation any facility has is reprocessing surgical instruments thoroughly in a repeatable process. Cleaning the inside and outside of surgical instruments prior to sterilization not only protects the staff when handling the instruments but also the patients. We all know ‘It can’t be sterile if it’s not clean’”.

When assessing ways to improve cleaning approaches and investing in new products, here are some best practices to consider:

Look at whether or not the speed promised by newer disinfectants mesh with the needs of your facility and the equipment currently in place.

Be aware of small things like storage practices can impact cleanliness levels. The Joint Commission recommends storing probes upright in a clean, dry environment to help protect against contamination.

Examine all of the costs associated with the process – the purchasing price, material costs and the time and labor attached to these functions. Alisandra Rizzolo of Stryker’s instruments division points to factors that impact long and short-term benefits. “Total cost of ownership consists of evaluating the cost to implement and maintain the supplies, as well as end-of-life management, including refurbishing or donating used equipment. Partnering with an equipment service provider is one way that facilities can look to maximize their capital investments. Oftentimes a simple repair can save thousands of dollars in replacement costs. Additionally, preventative maintenance helps equipment usability and minimizes downtime due to unanticipated repairs. When hospitals can step back and consider how to maximize their capital investments, they gain control of their costs without sacrificing quality patient care.”

Establishing a standard of practice helps to consistently deliver the same level of care to all patients. However, just as important as establishing these instrument sterilization SOPs, is updating them as part of continuous improvement programs. This allows for making adjustments to compensate for new or emerging safety, material compatibility, device validation or reprocessing time concerns.

As is the case with all things going into and out of the OR, new technologies will also play a role. In particular, Cole and Antonucci point to developments focused on removing the most challenging contaminants.

“Sonic irrigators provide a repeatable, thorough process. Sonics break up the bioburden and irrigation removes it from difficult crevasses and joints, which must be achieved prior to handling and sterilization,” states Cole. “When looking for a higher standard of reprocessing and care, healthcare professionals have choices for rendering devices free from all microorganisms,” offers Antonucci. “Liquid chemical sterilization with peracetic acid can be an option for heat sensitive devices and in handling instruments with a wide range of material compositions.”

Proper steps before and after will help keep your patients and staff healthy, and your facility compliant.