By Mary Ellen Fortenberry
Improvingsterilization techniques has never been more important than it is today. Withthe complexity of instrumentation and equipment, the sterilization process hasnever been more suspect. Ever-increasing public and governmental scrutiny hasforced us to reexamine our current practices and how we will clean and sterilizein 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 ushave. Yet this begs the questions: Can we afford not to take the time? Willsomeone else take the time for us?
With the ever-changing healthcare environment, it stands to reason that theinstrumentation used in today's operating rooms also would change. With surgicaltechnology advancing quickly so is the type and complexity of the surgicalinstrumentation. It would make sense that the instrumentation investment beprotected through process monitoring and improvement. The longevity of aninstrument is in direct proportion to the care, use/handling it receives duringits life cycle. The operating room staff and the central service techniciansmust understand the function and assembly of thousands of surgical instruments,with the number growing daily.
Our customers are increasing their knowledge and expectations of thesterilization process. It is our role to help ensure that accurate informationis available and presented to our customers. Do you have enough confidence inyour techniques/processes that they could stand up in a court of law? Can youunequivocal state the same process is followed every time? Do you really cleanthat instrument the same way each time it is processed?
When you begin to examine your techniques you need to guarantee that you havethe appropriate information. The manufacturer should supply you with handling,cleaning, maintenance, and sterilization recommendations. Though they are oftenin small print, this is the first place to start. If the information is vague orunclear they should clarify any questions in writing. Who better to makerecommendations then the manufacturer? If they cannot supply the information,how can you process the instrument and ensure sterility? First, find anothervendor, second, notify your customer of the problem and why you need to findanother vendor, because you cannot afford to use an instrument that was notproperly processed. Again, will the process stand up in a court of law? Can youor your customer take the stand and defend a process that did not exist?
In a good purchasing process you will be involved in the manufacturerselection of instruments and equipment. Using the team approach ininstrument/equipment selection will help ensure all aspects of the process andutilization are met for each team member. The team should include purchasing,sterile processing, biomedical engineering, and the customer. Without all theinterested parties participating from the start, the process will be doomed tofail before it begins. With all concerned parties involved from the beginning,reasonable expectations can be set for instrument processing. How often have youbeen asked to "turn" a set of instruments in an hour? Can you reallydisassemble and clean those properly in accordance with the manufacturersrecommendations?
Handling and transporting
The first step in a good process is proper handling and transporting of theinstruments. How do you transport your instruments? Are they protected? Shouldthey be in a presoak until they can be cleaned? Often the mishandling ofinstruments can lead to costly and unnecessary repairs.
As the old saying goes "If it isn't clean, it isn't sterile." Ithas never been more difficult to ensure that your instruments are clean beforethey are sterilized. With the complexity of instruments and the varyingmaterials 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. Thiscould be a manual disinfection and cleaning or machine disinfection. For amanual preparation the instruments should be immersed in a disinfecting solutionas early as possible. Instruments with narrow lumens (e.g., suctions,cannulas) are extremely difficult to clean and prepare for reuse. High-poweredair/water guns used in conjunction with cleaning brushes are most helpful inthis process.
Microsurgical instruments must be handled with the utmost of care whencleaning and assembling them for reuse. They can be damaged easily by roughhandling and aggressive cleaning.
Determining how to set up a maintenance program for instrumentation can besimple or quite complex, depending on the recommendations and the use of theinstrument. Maintenance can be defined by the number of uses or misuses. Howmany times have you sent laparoscope's scissors for repair because they wereused to cut a clip? Have you noticed discolorization of instruments? Thisindicated that they have not been properly processed or handled at some point.These instruments should be removed and cleaned if possible so not to damageother instruments in a set.
When we consistently rework our current processes to ensure that that weachieve the highest level of customer satisfaction, taking the opportunity toevaluate your instrument processing process will support your facility withimproved customer satisfaction/relations, while helping maintain profitabilitythrough increased instrument life and effective and efficient utilization ofcapital equipment.
Continue to evaluate new technology as it becomes available as themanufacturers continue to develop and improve their systems. The areas of focusinclude decreasing cycle times, increasing / decreasing chamber sizes, designingautomatic precleaning systems and widen the list of approved items. Use new andold technology to help you think out of the box to maximize your institutionscompetitive edge!
Mary Ellen Fortenberry is the director of sterile processing at HurleyMedical Center in Flint, Mich.For a complete list of references click here