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D E C O N T A M I N A T I O N removed. Remember, sterilization will not be effective if SEQUENTIAL STEPS If It's Dirty, How Can It Be Sterile? R eprocessing is a multi-step practice. If ing through post-cleaning inspections. 4. Seek input from reprocessing department debris remains on an instrument. 4. Ultrasonic cleaning is most effective, particularly you don't properly clean devices before staff on instrument and equipment purchases. for hinged instruments and those with moving parts. they're disinfected and sterilized, tissue, 5. Limit the operating room's dependence on The use of distilled or demineralized water is prefer- immediate-use sterilization. bone, or other able. Be sure instruments are in the open position before placing them in the ultrasonic cleaner. The full organic material 6. Establish delivery criteria for loaned instru- can remain in or ments and prohibit immediate-use sterilization of ultrasonic cycle must be completed. Rinsing after on the instru- them. cleaning is important, and changing the solution 7. Require regular competency assessments ment. ECRI of staff who reprocess instruments. Institute PSO 8. Foster collaboration and teamwork among (Patient Safety Organization) has created a MULTISTEP PRACTICE It's a mistake to believe that sterilization alone adequately prepares equipment for reuse. list of its top 10 essentials for effective instru- according to manufacturers' instructions is just as important. Another method to use is the automatic washer-sterilizer. Lubricating instruments after the last reprocessing department and operating room rinse cycle, and before sterilization, is important if staffs. using the automatic washer-sterilizer. 9. Recognize and respect the contribution by 5. When manually cleaning using stiff nylon cleaning reprocessing staff to patient safety and quality ment cleaning: 1. Provide the sterile processing department with adequate trained staff, facilities and brushes, don't reuse brushes unless indicated by the manu- care. facturer. Separate delicate instruments from general 10. Encourage prompt reporting of events or near-misses involving contaminated instruments. resources. 2. Standardize and simplify procedures in all — Gail Horvath, MSN, BS, RN, CNOR, CRCST debris, stains, and proper function and condition. 6. Cleaning instruments removes lubrication and prevents protein buildup. Water-soluble, antimicrobial lubri- areas where instruments are reprocessed. 3. Monitor the quality of instrument reprocess- instruments. Examine instrument surfaces for gross Ms. Horvath (ghorvath@ecri.org) is a patient safety analyst at ECRI Institute PSO. cating solutions such as instrument milk are preferable. After cleaning and lubricating, but before high-level disin- protein matter is difficult to remove and the possibility of residual bioburden is increased. 2. If immediate rinsing is not possible, then pretreat as soon as possible after use in an enzymatic-soak solution before the cleaning process. 3. Cleaning is the critical decontamination step after the pre-steps described above. It's during this step that debris, including dried body fluids, should be completely 4 5 SUPPLEMENT TO O U T PAT I E N T S U R G E R Y M A G A Z I N E | M AY 2013 fecting or sterilizing, instruments should be irrigated with distilled, de-ionized or sterile water. 7. The final step in decontamination includes unlocking all instruments so they're sterilized in open positions. If instruments are being stored before sterilization, be sure M AY 2013 | S U P P L E M E N T TO O U T PAT I E N T