Sterile Processing

Q: Recently our facility was cited for disinfected laryngoscope blades that were found unprotected from re-contamination in storage. What is the recommended practice for these items?A: This question has many implications. CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) says laryngoscope blades are “semicritical” items, which are defined as, “Items that directly or indirectly contact mucous membranes of the respiratory tract. They should be sterilized or subjected to high-level disinfection before reuse.”  After they are cleaned according to the manufacturer’s IFU, there are several options for processing laryngoscope handles and blades. Many laryngoscope blades can be high-level-disinfected. If high-level disinfection is used (check the manufacturer’s IFU for compatible chemicals), the blade must be protected from recontamination after processing. One way of accomplishing this is to place the blade in a zip-lock bag and then apply a “Clean Not Sterile” label to the top of the bag. (Make sure that you clean your hands first.)  If anyone opens the bag, the label will be damaged indicating the blade could be contaminated. At some facilities, laryngoscope blades are sterilized, which is acceptable but not necessary (CDC, 2003). Packaging blades requires the package to be opened if nursing must test the laryngoscope bulb on the blade. This results in a blade being replaced inside an open paper-plastic pouch.  The opened pouch does not protect the blade from contaminates.

Biofilms -- formed by bacteria that stick to each other on living tissue and medical instruments, making them harder to remove -- can be tricked into dispersing with the targeted application of nanoparticles and heat, researchers have found. The University of New South Wales study, jointly led by associate professor Cyrille Boyer of the School of Chemical Engineering and deputy director of Australian Centre for NanoMedicine, appears in today's issue of Nature's open access journal Scientific Reports.

Biofilms frequently coat the surfaces of catheters, and of various medical implants and prostheses, where they can cause life-threatening infections. New research at the Sahlgrenska Academy show that coating implants with a certain "activator" can prevent Staphylococcus aureus, the leading cause of hospital-acquired infections, from forming biofilms.

Under perfect circumstances, surgical instruments are carefully handled, transported and cleaned-according to industry best practices and OEM instructions. But in a busy surgery department or facility, the rush of procedures and pressure to turn equipment around quickly can lead to shortcuts that ultimately damage surgical instruments.

Complacency in the high-level disinfection (HLD) and manual pre-cleaning of endoscopes is never an option. In order to ensure competency, an institutional quality program with written policies and procedures for endoscope processing must be established and strictly followed. These policies should be based on the Society of Gastrointestinal Nurses and Associates (SGNA) and the American Society of Gastrointestinal Endoscopists (ASGE) guidelines for the reprocessing of endoscopes.