Outpatient Surgery Magazine

so the decontamination process that follows is more efficient and effective. • Transport. Instruments should be transported in a closed container to prevent spills. They should also be pre- treated with an approved enzy- matic foam and kept moist. They must be labeled with a biohazard label. There shouldn't be any holes in packs and wraps, and no missing or dam- aged container filters. 2. Decontamination documentation. Surveyors will ask to see instrument manufactur- ers' instructions for use (IFU). They'll want to know that you're following those detailed guide- lines on disinfection, cleaning and inspection, and ask you to describe and demonstrate how you're reprocessing in accordance with those written instructions. You should have a 3-basin sink — one for soak- ing, one for washing and one for rinsing. Remember that the third basin should incorporate either deion- ized or reverse osmosis treated water. Adding a treatment to the rinse helps to ensure that you are compliant. It will also help your instruments have a longer life. Surveyors also want to see an ultrasonic cleaning machine for use after the devices are washed in the sink and before they go to the washer-disinfector. Hint: Make sure you follow device manufacturers' IFUs in the ultrasonic cleaner. Be sure to monitor the temperature of the water in the sink. Device manufacturers' IFUs will provide a temperature range. Also monitor how much enzy- matic solution you put in the water. The manufac- turer of the ultrasonic cleaner will provide a pump that will dilute the water, so you don't have to worry about manually pumping the solution into a gallon of water. Be sure to test the pump daily to ensure that it's working properly. Surveyors will check for adequate lighting near the sink and observe your reprocessing techs don and doff personal protective equipment to ensure they do it properly. Do you test your ultrasonic and washer- disinfectors daily? The inspectors will review your daily logs, so make sure you document the test- ing. Finally, do you know how to change the cleaning times on the ultrasonic cleaner? Typically, they are pre-set to 5 or 6 minutes, but device manufacturers might want items cleaned for 15 minutes or longer. 3. Instrument inspection and assembly. Make sure cutting devices are cutting, and clamps are clamping. Sounds simple, but not all surgical facilities do that, which is bad during an inspection or otherwise. The goal is to make sure all of the instruments are working properly. Some other things to consider when inspecting instruments: • Proper lighted magnification. If you don't have a magnifying glass with a light, get one. And if you have one, or when you get one, use it! I'll often go to departments where they have one, but don't use it. • The right inspection tools. Instruments often don't get inspected the way they should because of time constraints and a lack of adequate instrument inventories. Ensure that your department has the proper tools to test your instruments, particularly cutting devices. Ask your instrument manufactur- ers what you should be using to test their devices. They will be more than happy to help you. Also, ask them to provide education for proper inspec- tion and testing. Once you've inspected instruments, follow their IFUs — whether you put them in a peel pack, blue wrap or a container. Keep the following in mind while reassembling instrument sets: • Peel packs. Don't double-pack unless the man- ufacturer says you can. Place instruments in an open position, not a ratcheted one, into the pack. Is the proper chemical indicator in the pack and is the pack properly sealed? Visually inspect and test the pack's heat sealer. • Blue wrap. Fold it as the instructions say, and tape and label it appropriately. • Containers. Are the correct filters in place? Are the gaskets intact and not damaged? Are con- 7 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9 Inadequate inventory of instruments is not an acceptable reason to flash.

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