Steps you can take
Is this a problem that
calls for us to focus our
attention on fixing flaws
in the cleaning process?
Or are we faced with a
systemic problem involv-
ing the limitations of the
current standards of
cleaning and disinfec-
tion? All that's certain is
that any disinfection
process is doomed to fail if cleaning is inadequate.
The good news is you can remove nearly all of the dangerous bacte-
ria before you sterilize or decontaminate. Here are a few tips to elimi-
nate opportunities for biofilm to start forming.
• Pre-clean at the patient's bedside. Pre-cleaning begins in the OR
or procedure room and continues through transport with solutions
that prevent soils from drying. During a procedure, keep instruments
wiped clean of all bodily substances as much as possible so they don't
dry and harden. For endoscope point-of-use pre-cleaning, for exam-
ple, wipe the outer surface of the scope with an enzyme pre-cleaning
sponge and suck the irrigation solution into the scope.
• Use an enzymatic detergent. The detergent you use as a pre-
soak or for manual cleaning should contain enzymes that break
down organic and inorganic soils, residues, films and deposits. If
the detergent action is not efficient against biofilm matrix, bacteri-
al biofilm can resist high-level disinfection. And if you don't get rid
of biofilm when you clean your instruments, you'll lose the fight.
After all this cleaning, be sure to rinse instruments very thoroughly
5 8 • O U T PA 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 8
• BIOFILM TO BLAME? You can almost always blame biofilm when surgical
instruments are suspected of causing an infection outbreak.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
