Reprocessing Specialty Instruments
by Natalie Lind, CRCST, CCSMC, ACE
During the sort process, the technician should disassemble the instrument and disconnect any disposable parts that may remain with the instrument.
Anyone who is involved in reprocessing surgical instruments knows just how important that process is to the healthcare facility. Improperly processed instruments pose a significant threat to patient outcomes. Failure to process instruments correctly can lead to nosocomial infections and possible patient injuries from damaged instruments. For that reason, instrument reprocessing is one of the most important tasks that takes place within the central sterile department.
While patient safety is the primary reason for the emphasis on proper processing techniques, there are also strong financial considerations. Instruments represent a large financial investment to any healthcare facility, and the goal of every processing department must be to prolong the life of each instrument by ensuring that it receives the proper treatment during each step of its reprocessing.
For these reasons, departments constantly strive to develop instrument processing systems that protect both their patient and the facility's investment. For these systems to be effective, all employees must know the correct way to process every instrument. That is no easy task. New instruments are being introduced on a regular basis and as technology advances, the complexity of the instruments advances as well. The only way to keep up with processing requirements for complex instruments is to establish a system that specifically addresses each phase of reprocessing and the steps required for it to be successful.
Ideally, reprocessing considerations should be addressed before an instrument is selected and purchased. Part of the overall purchase decision should be the instrument's cleaning and sterilization requirements and the ability of the facility to meet those requirements. In some instances, instruments may be needed that "challenge" the facility's cleaning and sterilization capabilities. Whenever those situations arise, the facility must be prepared to allocate adequate resources to ensure that the instrument is processed correctly.
Once a decision has been made and an instrument has been purchased, a written plan should be developed that addresses the instrument's cleaning requirements. The plan should follow the manufacturer's recommendations for cleaning and should also incorporate basic scientific principles of cleaning and instrument handling. The plan should incorporate cleaning methods available at the facility, for example, mechanical washers, etc. when appropriate. This cleaning plan should also take into account the product's compatibility with chemicals used in the process and address any temperature or moisture considerations that may cause damage to the instrument.
Developing a processing plan before an instrument is put into use will eliminate confusion, reduce the chance of processing errors, and identify any processing limitations before the instrument is used. This processing plan can then be used as a training tool for technicians who will be responsible for cleaning the instrument.
Technicians assigned to the decontamination area are often anxious about the specialty instruments that they are responsible for cleaning. Oftentimes, they are told how expensive the instrument is, how it is a one of a kind instrument, or how delicate it is. With this introduction, it is no wonder that many technicians shy away from cleaning specialty instruments and may want to leave them for another shift, etc. In their hesitancy to damage the instrument, employees may even fail to clean it thoroughly. The best way to ensure that technicians feel confident about cleaning specialty instruments is to create clear, concise, step-by-step directions for each instrument. This task need not be overwhelming and is well worth the effort to protect both patients and the facility's investment.
Rather than refer to the task at hand as a decontamination process, it might be better to break the basic decontamination process down into smaller steps. Decontamination can be defined as cleaning plus a biocidal process. So, a good reprocessing procedure should begin by breaking the large task into several smaller ones. For example, the basic cleaning process can be broken down into six basic steps: sort, soak, wash, rinse, rinse with special rinse water, and dry. These basic steps can apply to cleaning almost every specialty instrument.
Sort: During the sort process, the technician should disassemble the instrument and disconnect any disposable parts that may remain with the instrument. This phase should also include a separation of items that require special processing. For example, the separation of immersible from non-immersible items, etc. When the sort process is complete, the instrument should be reduced to its simplest components. At that point, it is ready for processing.
Soak: The soak process is designed to loosen and remove gross soil. It may actually be a soak process, or it may simply be the removal of gross soil with a cleaning cloth or a rinse process. The goal should be to remove excessive soil that may impede the cleaning process.
Wash: Washing is the physical removal of soil. This process may be accomplished manually or mechanically. The goal should be to remove both visible and invisible soil and to reduce the bioburden of the instrument to the lowest level possible. By lowering the instrument's bioburden, technicians increase the chance that the upcoming biocidal process will be successful.
Rinse: The rinse process is designed primarily to flush away soil particles and detergent from the item being cleaned. The presence of either soil or detergent residue will impede the biocidal process.
Special Rinse: Many facilities use a special rinse to prevent deposits from forming on instruments. This special rinse can increase the effectiveness of upcoming processes and in some instances, may prolong the life of the instrument.
Dry: The dry phase of the basic cleaning process is often overlooked, but it is an important part of cleaning. Failure to dry an instrument thoroughly may impede the sterilization or disinfection process that is to follow.
By using this well known cleaning formula, facilities can design instrument cleaning procedures that provide good information that is easy to read and follow.
The next step in decontamination is a biocidal process. Even if the instrument is slated for a future sterilization process, this step is imperative. This biocidal process helps to lower the bioburden of the instrument, thereby increasing the chances that the sterilization process will be successful. It also makes the instrument safe to handle so that the risk of pathogen exposure is reduced for the instrument assembly technicians. Another important part of this process should be to explain why each step in the decontamination procedure is important. People are more likely to follow procedures closely if they understand the importance of each specific step. The goal should be simple: to create a cleaning procedure that makes sense.
This same approach can be used to establish protocols for disinfection and sterilization processes. Specific guidelines for chemical and temperature compatibility should be established. Simple, step by step instructions for instrument preparation should be developed. These guidelines should address the following:
Inspection: What process is used to inspect the instrument? Should it be tested? If so, how is that testing performed, and how often should it be done?
Assembly: What components are included in the set? What type of tray or pack should it be placed in? How should the instrument be placed within the set to facilitate the sterilization process?
Packaging: What type of packaging should be used? How should the package be labeled? Are special instructions needed?
Sterilization: What method of sterilization is used? Are there any special processing requirements?
Storage and Distribution: What should be done with the instrument after processing? Will it be stored in CS? If so, what is the exact storage location? Or will it be delivered directly to the user unit? Specialty instruments are often one of a kind and are almost always very expensive. For those reasons, it is important to keep close track of the whereabouts of specialty instruments at all times.
Once a specialty instrument's reprocessing protocols have been established, the next step is to communicate them to employees. This process should start by providing a copy of the newly-written processing procedures to the staff. Many departments use processing books or computer data bases to keep this information readily accessible to staff.
The next step is to provide training. There are many ways to accomplish this training from staff inservices to individual or small group demonstrations. Whatever the chosen method of training, the goal should be to provide a simple, easy to follow, breakdown of tasks. By breaking down the large task into smaller ones, it creates a more manageable process for everyone.
Many companies will provide processing education for their specialty instruments. For example, they may provide literature, videotape education programs, or they may provide a representative that will come out to inservice the staff. Requests for this type of support should be included in the initial purchase agreement.
After the initial staff training is accomplished, training resources should be cataloged and maintained for use as new employees enter the system. Taking the time to develop a specialty instrument training library can help alleviate future processing problems. As medical technology increases, the number of specialty instruments will also increase. Complex instruments will become an even greater part of every reprocessing system. As this takes place it is important to remember some important guidelines.
Develop Solid Processes: Use sound infection control theory and basic foundations of decontamination and sterilization to build procedures that protect the patient, employees, and the instrument.
Provide Adequate Training: Provide adequate training when a new specialty instrument is introduced into the system and provide ongoing training as new technicians enter the workforce to ensure that reprocessing standards are met.
There are No Shortcuts: Complex instruments require more time to process and the staff members assigned to specialty instrument reprocessing will require more training than they do for simple instrument processing. As technology increases, adequate resources must be allocated to meet the needs that these instruments create.
Specialty instruments serve patients and healthcare providers by allowing advanced technology to play a greater role in healthcare. Their use will increase in the future. Specialty instruments pose a challenge to reprocessing departments as they strive to keep up with change and meet the demands of new processing protocols. By taking the time to develop a system that addresses these protocols, departments can better prepare themselves to meet their patients' needs and to protect their facility's financial investment.
Natalie Lind, CRCST, CCSMC, ACE, is the Director of the Health Systems Processing Programs at Northwest Technical College (East Grand Forks and Moorhead, Minn).
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