Reducing surgical site infections starts in the decontamination area of the Central Sterile Supply Department. Aseptic technique in the operating room manages the operating field, but without good management of instrumentation in CSSD, it can fail to keep the patient safe. Patients are often given additional antibiotics to ward of infection when failures occur. The proper management of instrumentation during the decontamination process is critical.
Policies and Procedures/ Instructions for Use
Policies, procedures, and IFU's need to be readily available to the staff working in the decontamination area. Electronic document versions are preferable over paper documents. The utilization of network document folders works well for the management of documents. Instrument tracking systems can also be leveraged by adding IFUs and procedures that allow staff to access the reprocessing content by scanning the item being processed. Job aids are also a great way to communicate proper cleaning procedures.
Chemicals for Cleaning
Chemicals used during the cleaning process should be reviewed for compatibility. A review of the IFUs should include the manufacture's recommendations for instruments and mechanical cleaning devices such as washer/disinfectors and ultrasonic devices. Also, as a part of the review, dilution ratios should be verified for proper use.
Separation of Instrumentation
Delicate and sharp instruments should be separated before the manual cleaning process. Separating delicate instruments reduces opportunities for damage. Separating sharp instruments reduces the chance of injuries during the cleaning process.
Pre-Soaking of Instruments
To help remove bioburden, instrumentation should be pre-soaked before manual cleaning. A visual breakdown of organic substances is the determining factor for how long instrumentation should be soaked. Never exceed the manufacturer's guidelines for soaking instruments; extended soaking can damage instrumentation.
Manual Cleaning of Instrumentation
Gross removal of bioburden is accomplished by using a combination of proper chemicals, water temperature, and the utilization of the proper cleaning implements. Utilization of correct brushes in type, design, and condition is paramount to removing organic and inorganic materials.
Bristles come in stainless steel, brass, nylon, and polypropylene, to name a few. Each type of bristle is design for particular applications. Some bristle heads even had tip protectors to reduce the chance of damaging the instrument. Handles also come in various designs and applications. Handle applications are designed for general cleaning, channel cleaning, and specialty cleaning applications like port cleaning, reamers, or burrs. For channel cleaning, handle materials vary in style and come in twisted stainless steel or flexible plastic. Most other styles of handles are made from heat-resistant plastics.
Cleaning of Lumens
An important factor for utilizing brushes in CSSD is to have the right size brush diameter, style, handle style, and material. There are french size/brush gauge tools that can help in selecting the proper brush size. Selecting the proper size is important when cleaning lumen devices; if the brush's diameter is too small or too large, you will not be able to clean the instrument effectively.
For getting into those hard-to-reach areas on instruments, the ultrasonic cleaner is your tool of choice. Microscopic bubbles are created during the cleaning process, which implode, creating a suction that aids in removing bioburden. The cleaning solution captures the debris to allow for free rinsing without recontaminating the instrument.
Rinsing of Instrumentation
Critical water, such as RO (reverse osmosis), should be used to rinse instrumentation, especially during the final rinse. Critical water has been treated to removed minerals, organic and inorganic substances.
Verification of the Cleaning Process
A key step in the cleaning process is to make sure your mechanical and manual cleaning processes are working well. AAMI recommends daily testing of mechanical cleaning equipment when in use. Instruments should be inspected visually with the aid of magnification. Borescopes should be used to view internal channels that the naked eye can not see. Several tests such as ATP (adenosine triphosphate), hemoglobin, and protein help verify your cleaning processes are working well.
Proper management of instruments during the decontamination process reduces organic and inorganic soils. Each step in the process increases the odds of sterilization. Soils impede the sterilization process. Create safer instrumentation by managing your decontamination process.