Best Practices from SPD Experts

A few members of the International Association of Healthcare Central Service Materiel Management (IAHCSMM) share their advice for dealing with some of the tougher issues encountered in the sterile processing department (SPD).

Instrument Sterility Assurance/Maintenance

By Lisa Huber, CRCST, ACE, FCS

How do we know if the packages of instruments that are opened on a sterile field are actually sterile? Technicians can be as certain as possible if all instruments have been cleaned and disinfected effectively, assembled and packaged properly and loaded and unloaded from a sterilizer cart carefully. Using biological, chemical and mechanical indicators to monitor the sterilization process, technicians can be assured that the items that are loaded on to case carts or put into sterile storage are safe for patient use.

However, how closely are technicians monitoring the events in the life of a sterile package? Event-related sterility maintenance does not mean that a package will remain sterile forever – no matter what. It means that the events that take place in the life of a package can work together to shorten its “sterile life.”

Each time a package is handled is, in and of itself, an event. How a package is stored is an event. A package that is stored in a closed cabinet has a much longer life expectancy that one stored in a drawer that is constantly opened and closed, or on open shelving. Humidity levels in the storage area must be monitored because humidity that is too high or too low is considered an “event.”

While most of us are not constrained by having to check for out-dates each month, a good practice is to periodically check storage areas for package integrity. This could prevent an incident that could have an adverse effect on a patient.

Lisa Huber, CRCST, ACE, FCS, BA, is sterile processing director at Anderson Hospital in Maryville, Ill.

Cleaning, Disinfecting and Sterilizing Cannulated Instruments

By Sharon Greene-Golden, CRCST, FCS

The cleaning, disinfection and sterilization of cannulated instrumentation is a problem worldwide in hospital and outpatient surgery centers. Cleaning the instrument cannulations is imperative for proper function and care of the instruments. It has happened more than once that a tray is opened only to find a cannulated drill bit or tap filled with bone and blood debris. This contamination ends with a delay in the surgical case, as the surgical table has to be completely redone and the tray cleaned and reprocessed.

Those of us in the industry have to be more cognizant of our responsibility to the patient to prepare a product that meets the requirement of clean and sterile. We have the resources and guidelines to effectively clean and process cannulated instruments.

To meet industry standards, the used cannulated instrument should be flushed at point of use. Companies sell cleaning stylets and brushes that can be cleaned and sterilized on the tray. This allows the instrument to be cleared intraoperatively with the stylet, thus preventing the accumulation of bone and blood debris. It is important that manual cleaning, brushing and rinsing steps are properly carried out so that protein debris can not harden and lead to formation of biofilm on the surgical instrument.

As professional sterile processing technicians we must be aware of the industry standards for cleaning cannulated instruments. We are the unseen patient advocates who daily work to ensure that all instruments are clean and sterile. It is important that when a tray with cannulated instruments is opened it be free of debris, allowing that surgical case to be successfully completed.

Sharon Greene-Golden, CRCST, FCS, is manager of sterile processing at Bon Secours Mary Immaculate Hospital in Newport News, Va.

Instrument Repair

By Lisa Huber, CRCST, ACE, FCS

The care of surgical instrumentation can be costly and time-consuming but it is a very necessary component of providing surgeons with the tools they need for optimal patient outcomes. There are several steps that can help to ensure that a facility has a thorough and cost-effective program:

Training: Staff, in both the operating room and sterile processing, must be trained to inspect and identify when instruments are in need of repair. Repairs range from scissor sharpening to need for replacement, and all instruments must be inspected and sent for adjustment at some point during their useful life.

Supplies: Different instruments require different testing materials that can include tongue depressors, cardboard and facial tissue. Each department should be equipped with proper lighting and a magnifying glass so that technicians can easily see the details in the instruments they are inspecting. Many departments are now equipped with a microscope for instrument inspection.

Partnership: Instrument repair companies are not all the same. Make sure yours is one that offers not only the best pricing and a highly trained service technician but also provides services such as record keeping, quick turn-around times and loaner instrumentation. A partnership such as this can save both time and money, while providing surgical instrumentation in the best possible working condition.

Lisa Huber, CRCST, ACE, FCS, BA, is sterile processing director at Anderson Hospital in Maryville, Ill.