Reducing the Risk of Cross Contamination

The sterile processing (SP) environment requires personnel to be exposed to various potentially hazardous situations and risks during their employment. Each SP professional’s goal is to provide safe and high-quality products to the patients receiving care in procedures and surgical operations. Through the steps of intense cleaning, disinfection, and sterilization practices, it is critical to keep the items that are cleaned clean, and items that are sterilized sterile. The department can become a dangerous place if not accurately assessed and appropriate workflows put into place, to ensure that the staff are able to complete their duties and keep patients safe. Because of the high volumes of personnel, and contaminated items that pass through the SPD, it is important to practice safe and structured processes to ensure the environment and surfaces are not contaminated.

Physical Design, Workflow and Layout

Sterile processing professionals are expected to understand the conditions that favor the growth of microorganisms and recognize that even though we cannot see microorganisms with the naked eye, they are present in our environment (IAHCSMM, 2016). The surgical instruments, equipment, and utensils processed by a sterile processing department (SPD) are contaminated with microorganisms that could pose a threat to patients, CS professionals, and other facility personnel.

Because the SPD is the central location for the delivery of both used medical devices, which are considered soiled, and the distribution of clean and sterile items, it is critical to have a proper workflow in place to ensure safety. A unidirectional workflow of items and materials from the decontamination area to the clean processing area and onto sterile storage and distribution is required. When designing or changing an SPD department special consideration must be considered to include walls and physical barriers to segregate the functional areas of the department. When physical walls and barriers are not possible very explicit policies and procedures must be in place to guide the staff members and make sure that all practices still adhere to a unidirectional flow. The physical layout of the department, as well as the cleaning equipment used, must meet the appropriate standards of governmental agencies and the recommendations of professional organizations, such as AAMI. Practices must be in place to minimize injury and exposure to pathogens for the SPD personnel as well as everyone located in the facility including patients, visitors, and all staff.

Avoiding Cross Contamination Risks

Separating the clean and dirty areas can help limit environmental contamination and the amount of bioburden, dirt or dust that settles on devices that are to be sterilized. Adherence to functional design recommendations helps prevent cross contamination or recontamination of the items flowing through the unit. Here are a few examples of practices that help avoid cross contamination risks.

Written policies and procedures regarding traffic controls are available that define and limit access to restricted areas, specific criteria for movement within the processing areas, attire and dress code, and responsibilities of visitors and vendors.
Walls constructed of a non-particulate or non-fiber shedding material that can withstand frequent cleaning.
All surfaces in work areas should be regularly and thoroughly cleaned to control contamination and eliminate accumulated dust or debris within the unit.
Doors should be made of durable materials that can withstand impacts from tables, case carts, or moving transport cats, can be cleaned frequently and opened easily, allowing for ease of use, and adherence to the uni-directional workflow.
Dedicated hand washing stations located near all areas in which instruments and devices are decontaminated or where instruments are handled.
Physical enclosure of the decontamination area to contain aerosols, droplet nuclei and dust particles from being carried from the dirty to clean area by air currents.
The use of a dedicated sterilization area with dedicated cooldown area that is low traffic and not located near any potential source of contamination such as a sink, hopper, or hand wash station.
A dedicated breakout room located near the department that allows staff to remove items from external shipping cartoons or cardboard and located at a safe distance from the sterile storage space.
If a pass-through window is used, a strict adherence to opening and closing practices to minimize the risk of air currents from decontamination flowing to clean assembly.
Access to cleaning materials and tools at each workstation that supports a dust and dirt-free clean space where assembly and inspection is taking place.
Frequent and routine cleaning of all surfaces that includes automation, transport carts, unloading equipment, instrument racks, back up inventory storage bins and prep stations.
Dedicated disposal areas for hazardous waste that includes sharps bins, biohazard waste containers and occupational safety and hazard association (OSHA) approved color-coded bags or leak-proof containers for transport of contaminated items.
Monitored and maintained air pressure levels to control air movement, preventing the flow of bacteria and dust from the soiled to the clean areas.
The use of temperature and humidity controls to help keep the sterile storage environment safe and eliminate the damage to packaging of sterile goods.
Staff are trained and educated on their facility’s exposure control plan and protocols are in place on how to address needle sticks, disposal of sharps and exposure practices.
Training of all staff members on the bloodborne pathogens standard and safe practices of handling contaminated items, following the OSHA 1910.1030 standard.

No matter what your role is in supporting the reprocessing of medical devices and serving patients who are in need, proper management of the environment and use of safe practices is always required to eliminate the risk of cross contamination. Each reprocessing professional should adhere to policies and procedures that are in place and work towards keeping their departments clean and safe, and take pride in caring for the environment they work in.

References:

ANSI/AAMI ST79: 2017 Comprehensive Guide to Steam Sterilization and Sterility Assurance in Healthcare Facilities.

International Association of Healthcare Central Service Materiel Management (IAHCSMM), Central Service Technical Manual, Eighth Edition, 2016.

International Association of Healthcare Central Service Materiel Management (IAHCSMM), Central Service Leadership Manual, Third Edition, 2020.