Improving Sterilization Techniques
By Mary Ellen Fortenberry
Improving sterilization techniques has never been more important than it is today. With the complexity of instrumentation and equipment, the sterilization process has never been more suspect. Ever-increasing public and governmental scrutiny has forced us to reexamine our current practices and how we will clean and sterilize in the future.
Opportunity exists daily to improve the sterilization techniques; however, taking the time to examine all aspects of the process takes time that few of us have. Yet this begs the questions: Can we afford not to take the time? Will someone else take the time for us?
With the ever-changing healthcare environment, it stands to reason that the instrumentation used in today's operating rooms also would change. With surgical technology advancing quickly so is the type and complexity of the surgical instrumentation. It would make sense that the instrumentation investment be protected through process monitoring and improvement. The longevity of an instrument is in direct proportion to the care, use/handling it receives during its life cycle. The operating room staff and the central service technicians must understand the function and assembly of thousands of surgical instruments, with the number growing daily.
Our customers are increasing their knowledge and expectations of the sterilization process. It is our role to help ensure that accurate information is available and presented to our customers. Do you have enough confidence in your techniques/processes that they could stand up in a court of law? Can you unequivocal state the same process is followed every time? Do you really clean that instrument the same way each time it is processed?
When you begin to examine your techniques you need to guarantee that you have the appropriate information. The manufacturer should supply you with handling, cleaning, maintenance, and sterilization recommendations. Though they are often in small print, this is the first place to start. If the information is vague or unclear they should clarify any questions in writing. Who better to make recommendations then the manufacturer? If they cannot supply the information, how can you process the instrument and ensure sterility? First, find another vendor, second, notify your customer of the problem and why you need to find another vendor, because you cannot afford to use an instrument that was not properly processed. Again, will the process stand up in a court of law? Can you or your customer take the stand and defend a process that did not exist?
In a good purchasing process you will be involved in the manufacturer selection of instruments and equipment. Using the team approach in instrument/equipment selection will help ensure all aspects of the process and utilization are met for each team member. The team should include purchasing, sterile processing, biomedical engineering, and the customer. Without all the interested parties participating from the start, the process will be doomed to fail before it begins. With all concerned parties involved from the beginning, reasonable expectations can be set for instrument processing. How often have you been asked to "turn" a set of instruments in an hour? Can you really disassemble and clean those properly in accordance with the manufacturers recommendations?
Handling and transporting
The first step in a good process is proper handling and transporting of the instruments. How do you transport your instruments? Are they protected? Should they be in a presoak until they can be cleaned? Often the mishandling of instruments can lead to costly and unnecessary repairs.
As the old saying goes "If it isn't clean, it isn't sterile." It has never been more difficult to ensure that your instruments are clean before they are sterilized. With the complexity of instruments and the varying materials you must take extra time to ensure this process is not over looked. The choice of cleaning will depend on the instrument and the material. This could be a manual disinfection and cleaning or machine disinfection. For a manual preparation the instruments should be immersed in a disinfecting solution as early as possible. Instruments with narrow lumens (e.g., suctions, cannulas) are extremely difficult to clean and prepare for reuse. High-powered air/water guns used in conjunction with cleaning brushes are most helpful in this process.
Microsurgical instruments must be handled with the utmost of care when cleaning and assembling them for reuse. They can be damaged easily by rough handling and aggressive cleaning.
Determining how to set up a maintenance program for instrumentation can be simple or quite complex, depending on the recommendations and the use of the instrument. Maintenance can be defined by the number of uses or misuses. How many times have you sent laparoscope's scissors for repair because they were used to cut a clip? Have you noticed discolorization of instruments? This indicated that they have not been properly processed or handled at some point. These instruments should be removed and cleaned if possible so not to damage other instruments in a set.
When we consistently rework our current processes to ensure that that we achieve the highest level of customer satisfaction, taking the opportunity to evaluate your instrument processing process will support your facility with improved customer satisfaction/relations, while helping maintain profitability through increased instrument life and effective and efficient utilization of capital equipment.
Continue to evaluate new technology as it becomes available as the manufacturers continue to develop and improve their systems. The areas of focus include decreasing cycle times, increasing / decreasing chamber sizes, designing automatic precleaning systems and widen the list of approved items. Use new and old technology to help you think out of the box to maximize your institutions competitive edge!
Mary Ellen Fortenberry is the director of sterile processing at Hurley
Medical Center in Flint, Mich.
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