4 6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E M A Y 2 0 1 5
tion success to find out.
1. Proper cleaning
Sterility assurance, regardless of what method is used, is based on proper clean-
ing and decontamination. The gold standard for sterility assurance level is 10
-6
,
meaning there is a 1 in 1,000,000 chance of a device not being sterilized after it's
run through a cycle. That optimal level assumes you're dealing with normal
bioburden levels in the device being reprocessed. If pre-cleaning and cleaning
are inadequate, and the bioburden level is higher, you can no longer obtain a
10
-6
sterility assurance level. The instrument might achieve sterilization today,
but inadequate cleaning allows biofilm to build up, which jeopardizes steriliza-
tion during future reprocessing cycles.
Pre-clean instruments and devices at the point of use to ensure they're ready for
low-temp sterilization. Wipe the outside of the devices and flush lumens. Maintain
the device in a moist environment — lay a damp towel over the top or place it in a
specially designed bag to keep it from drying — until it can be cleaned manually
and mechanically. Residue that's allowed to dry on the surfaces of an instrument
or device is incredibly difficult to remove.
Transport items to the decontamination room in a closed container or bag.
Remove heavy soil during gross manual cleaning, flush lumened channels and
run items through an automated cleaning process, ideally one with features
designed for the particular device you're cleaning.
Visually inspect items before packaging them for sterilization. Look to see if
devices are clean, but also perform cleaning verification testing to see if your
decontamination processes are effective. Most sterilization processes require
that instruments are put back together after cleaning, but that's not always the
case, so check the specific recommendations of individual instrument manufac-
turers.
2. The optimal sterilant
There is no sterilant that's considered better than another; the available options
