To Separate or Not - Instruments Returning to Sterile Processing

I pose whether or not to separate contaminated instruments from clean instruments returning from the operating room. The reason I ask is, do we know what is soiled or not?

There is a multitude of reasons to separate instruments in the decontamination room. Sharps and delicate instruments need to be handled differently from general instruments. Ophthalmic instruments need to be reprocessed separately because of the potential for toxic anterior segment syndrome (T.A.S.S.) to affect patient care. Broken or single-use instruments need to be removed from the sets.

There are at least two conventional thoughts on the transportation of instruments to the Central Sterile Supply Department (C.S.S.D.). One is to separate clean from soiled and the other to combine all instruments. I think we can almost all agree that instruments that belong to a set need to be kept together, but that is a separate discussion altogether. We know, often, they return from the OR co-mingled.

How do you know what instruments are soiled or not? One of the critical control measures that have come out of the current pandemic is social distancing. Studies have concluded that staying at least 6 feet apart allows for droplets to fall to the ground before reaching another recipient. It is not much different in the OR. Splash and splatter, as well as aerosols from OR instruments, can travel six feet or more. Biofilm development is initially undetectable by the naked eye, and the handling of instruments post-procedure can and will soil them, too.

Separating supposedly clean instruments from soiled instruments can increase productivity in C.S.S.D. However, the final state of cleanliness may be altered. Instruments separated as clean often undergo different steps in decontamination than soiled instruments. When validating quality assurance checks for instrument cleanliness in prep and pack determine how the instrument was returned to decontamination. Was it separated as clean or not? If so, was it handled differently than the other instruments? Knowing so, may lend an eye to your processes and help you determine what the best practice for your facility is.

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.