Defining cleaning within the sterile processing department.
Successful sterilization can only occur if primary steps are taken to clean the medical devices and surgical instruments used on all patients receiving care. While cleaning in the public sense is defined as making something or someone free from dirt, marks or mess by washing wiping or brushing, there are some differences when you talk about the world of sterile processing. We can see there are similarities in the context of the definition, especially the wiping or brushing part, this is critical indeed. More importantly, there are 2 main components to address when cleaning items or things that have been contaminated with bodily fluids. Manual cleaning in the sense of a surgical reprocessing team can be described as; the physical removal of all visible soil or gross debris from an item to render that item safe for handling, and safe for the next step in the reprocessing cycle.
Avoiding Cross Contamination
Having a dedicated unidirectional workflow within the sterile processing department is critical in helping to avoid any cross contamination incidences, meaning; something that has gone through the cleaning process, flows from dirty to clean in its reprocessing pathway to minimize the risk of becoming contaminated again. This is obviously the best way to move inventory through the cycle, after it has been used on a patient, and will be needed again. It also helps reduce any re-work steps, backlog, and safety risks for patients and staff members. Incorporating a structured and consistent method for handling contaminated items, clean items, and sterilized items and preparing a pathway that is constant is just as vital as the cleaning and sterilization steps.
Traffic control is imperative due to the potential for exposure to dirt, debris, and bloodborne pathogens to anyone who is entering the processing environment. The location of the decontamination area should consider the need to transport devices from the point of use, with limited travel distance if possible and be a dedicated pathway to minimize the exposure risk to employees within the organization and visitors. CSSD professionals assigned to the area should be aware of processes and safeguards used to facilitate the cleaning and reduce the spread of microorganisms to ensure their co-workers, themselves and patients are safe.
When should instruments be cleaned?
1. After use on patients
Anytime a medical device, piece of equipment, transportation tool, or surgical instrument is used on a patient it is required to achieve a level of reprocessing. Depending on the type of device as well as the classification based on CDC guidelines, will determine the level of reprocessing required.
2. After they have been opened, placed on the sterile field, but have not been used
Instruments that have gone through a reprocessing cycle, and achieved a level of disinfection or sterilization are provided to the surgical suite, they are intended to be used so they are opened and received onto the sterile field, these must be treated as if they were used, to eliminate the risk of contamination and to ensure the next patient receives the same level of sterilization and cleanliness.
3. When new instruments are purchased and received at the healthcare facility
New medical devices are purchased to help support the high volume of surgical and patient procedures, anytime these items come from the manufacture they must go through the hospitals reprocessing cycle from beginning to end to ensure a quality product is ready for use each and every time.
4. When instruments return from repair or refurbishing
Because of the nature of medical devices in todays’ healthcare, each instrument at some point may require a bit of sharpening, refurbishment or upkeep. Whether this process takes place inside of the healthcare organization or by an outside provider, the instruments must go through the same routine cleaning cycle as defined in the CSSD policy and procedure.
5. When instruments are pulled from back up stock or storage
Each CSSD is very unique, based on the type of patients and procedures they support, that means an inventory of back up instrumentation has to be available. Due to the high volume of instruments, most CSSD’s will keep a predetermined par level of back up stock available for use, these instruments require a cleaning process to take place before sending through the sterilizer. The storage shelves, bins or containment devices should also be cleaned routinely.
6. When instruments are inadvertently contaminated
Anytime a surgical instrument is faced with the potential for re-contamination it should always be cleaned. If the cleanliness is questionable, treat it as if it was dirty and send it back through the entire process to support a quality outcome each and every time.
7. When instruments or devices are loaned or borrowed
Due to the high cost and vast intricacies of medical devices in today’s surgical world, most departments are required to loan specific and specialized instruments to support a variety of surgical procedures. These devices may be loaned long term, on consignment or as a trial basis, regardless of the length of time, each loaner set received must go through the CSSD’s reprocessing cycle from beginning to end unless it is a one-time use product, that was sterilized by the manufacturer, as the IFU defines.