Updated: Mar 10, 2022
Point of use care for surgical instrumentation continues to be a contentious subject during the Center for Medicare and Medicaid Services (CMS) inspections, with OR staff, and even within the Central Sterile Supply Department (CSSD) workspaces. Interpretations of what point of use care looks like and what it means vary from individual to individual.
Point of use care, as stated, means, in the case of surgical/medical instruments, that at the area of use, the instrumentation is treated to reduce contamination. One misconception is that it is often believed that point of use care means to free the instrumentation of all contamination. That is not the case. Gross bio-burden reduction is the goal.
How instruments are managed during use is where the greater focus should be applied. Surveyors, which include both external and internal members, tend to review instrumentation as it is either leaving the place of use during transportation or as it arrives in CSSD for reprocessing. Recommendations on how to manage the instrumentation do not begin at the end of use but during the life of the use of the instrument. The Association for Surgical Technologist (AST) recommends in it's Standards of Practice for the Decontamination of Surgical Instruments that "The CST in the first scrub role should keep the instruments free of debris and blood during the surgical procedure." AST also recommends that "that soaking soiled instruments begin in the OR at the completion of the procedure. The instruments can be placed in a basin containing a mixture of sterile water and enzymatic detergent. Refer to the manufacturer's instructions for the correct amounts of sterile water and enzymatic detergent to be mixed." Without going into the varied offerings of enzymatic and wetting agents available on the market, I will leave this paragraph by stating that the instruments need to be kept moisture during transportation and until reprocessing begins in CSSD.
Point of use care, however, is not just a practice that should be utilized in the operating room setting. The application of removing gross bio-burden and maintaining moisture during storage and transportation, and until the instruments begin reprocessing, should be practiced in each area that utilizes instrumentation for medical procedures. Outpatient locations that transfer instrumentation to CSSD for reprocessing and sterilization are included in these recommendations. I will recommend that outpatient areas should complete the cleaning process to reduce transportation problems that come with utilizing courier services for the handling of contaminated instrumentation.
At Evolved Sterile Processing, our consultants have a greater focus on sterile processing. With our decades of experience, we will help you develop better processes and educational resources for your staff.