Decontamination Due Diligence
As CSSD professionals are aware, decontamination is the single most important step in the sterilization process. If an instrument is not clean, it cannot be sterilized. Because of this step’s critical importance, never trust the decontamination or sterilization process to another facility. All items coming in from the street should be treated accordingly and taken through the entire decontamination and sterilization process in-house.
Manufacturers’ written cleaning instructions must always be followed according to AAMI ST79. Also, with the new Joint Commission standards released in June 2009, surveyors will be verifying that facilities are indeed following manufacturers’ written recommendations. Following decontamination and disinfection, loaner instruments can then move to the inspection and assembly area.
An Eye on Inspection and Assembly
When beginning the inspection and assembly process, CSSD professionals are striving for three things: cleanliness, completeness and functionality. This is the second area where a collaborative effort will pay great dividends. Working closely with the vendor, CSSD staff can have set recipe/count sheets for these sets. In-servicing will also help staff understand how and what each tray/instrument is used. If missing or damaged instruments are discovered during inspection and assembly, staff should contact the appropriate person for resolution at that time. After proper assembly, the instruments are then ready for sterilization.
Promoting Sterilization Quality
After loaner instrumentation has been properly decontaminated, inspected and assembled, it must then be sterilized according to the manufacturer’s written instructions. It is important to note that many loaner instrument sets (vendor trays) require extended exposure to steam sterilization. Always consult manufacturer recommendations before sterilizing any loaner instrumentation. It is the vendor’s responsibility to provide cleaning, decontamination and sterilization instructions to the facility prior to their use of the loaner instrumentation.
It’s also important to recognize that inadequate time from receipt to sterilization can result in increased flash sterilization rates. CSSD managers must ensure that departmental policies and procedures are developed and implemented regarding sterilization parameters that will be used in their facility. This is especially true of flash sterilization, which has come under scrutiny from the Joint Commission. The use of flash sterilization should be kept to a minimum and used in an appropriate, controlled manner. Flash sterilization should be used only when there is insufficient time to process by the preferred wrapped or container method (AORN 2007 675); Insufficient instrument inventory is no longer an acceptable reason for flash sterilization, and implantable devices should not be flash-sterilized (Garner and Favero, 1985; CDC, 2003a, 2003b). All flash sterilization cycles must be monitored, with instrumentation tracked to the appropriate patient.