against staining by reducing the levels of impurities in the water used
in instrument washers and autoclaves. New and improved detergents
and enzymatic cleaners can also be less harsh on instruments.
Finally, it pays to be proactive. "You don't have to wait until staining
causes a patient care issue to start an instrument staining reduction
project," says Mr. DeLuca. "Controlling stains should be an ongoing
goal. Be creative and come up with ways to start auditing instrument
trays. Then, when you observe instrument staining, perform a root
cause analysis to find the problem and attack it."
Trust, but verify
As much as you'd like to think you can control how clean instruments
get during reprocessing, that's not always the case. "Damage to a
device, such as a cracked seal, can prevent reprocessing staff and
equipment from completely removing bioburden, even if every single
recommended step in the cleaning process is performed correctly,"
says Jimmy Henderson, materials manager at the Outpatient Surgery
Center of Jonesboro (Ark.).
However, what your reprocessing staff can control is whether a con-
taminated device is returned to the ORs. Borescopes can be used to
visually inspect the working channels of endoscopes to ensure inter-
nal components are free of bioburden. Adenosine triphosphate (ATP)
tests are useful for detecting residual protein and bacteria on the sur-
faces of instruments and inside the channels of lumened devices.
"Cleaning verification tests can be used after reprocessing to detect
the presence of very low levels of bioburden such as protein, carbohy-
drates and hemoglobin that can cause infections," says Mr.
Henderson.
Verification tests have helped his facility identify when scopes aren't
sufficiently cleaned during reprocessing or need to be sent out for
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