M A Y 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 4 1
needed back ASAP. This only made the reprocessing department's already diffi-
cult job all the more challenging — both in terms of reprocessing instruments as
they should be and getting them back to the OR when they should be. Here are a
few truths I tried to drill into the OR team's mind:
1. Preparation for instrument decontamination begins at the point of use. Don't wait for
the procedure to end to start cleaning instruments. The scrub person should
remove gross soil from instruments by wiping the surfaces with a sterile surgi-
cal sponge moistened with sterile water during the surgical procedure.
Removing gross soil as soon as possible reduces the amount of microorganisms
on the instruments. Besides being highly corrosive to instrument surfaces,
blood, organic material, debris, and saline can also result in corrosion, rusting
and pitting when allowed to dry on surgical instruments. This in turn reduces
the efficacy of the subsequent sterilization process.
Hint: It helps to have a basin of sterile water on the field. In some cases, a larger
basin in a ring stand may be necessary for larger instruments like broaches or
reamers that collect large amounts of bone and tissue. Another hint: Make sure
you use sterile water and not saline to wipe down instruments, as prolonged
exposure to saline can cause rusting, corrosion and pitting on stainless steel
instruments.
2. Periodically irrigate lumens with sterile water. As we've said, biofilms can form on
almost any surface in a short amount of time. And once biofilm forms, you need
direct friction and oxidizing chemicals to remove it. Biofilms are especially prob-
lematic in lumens because we can't see inside of most lumens, making it difficult
to adequately remove biofilms once they've formed. The simple solution:
Periodically irrigate lumens with sterile water (not saline) throughout the surgical
procedure in order to remove gross soil and reduce the risk of biofilm formation.
Irrigation of lumens throughout a procedure merely requires an extra vessel
