Noteworthy Developments ST79:2017 includes a wide variety of changes and updates. One of the most significant, Coss says, concerns the use of critical water rather than utility water for reprocessing. Criti- cal water is treated to remove bacte- ria whereas utility water is untreated tap water. “Critical water should have reverse osmosis/deionization (RO/ DI) filtration as part of its final rinse cycle,” she says. “The RO removes organic matter and DI takes minerals and metallics out of the water.” Adding an RO/DI system can prove difficult for ASCs. They tend to be large and bulky, Landry says, so finding a good location for them is not always easy. They also can be quite expensive. “But they serve a very important safety purpose, so you will need to determine how to accommodate the system,” he says. The good news for ASCs, Coss says, is that smaller system options are available. Another significant change in ST79 speaks to ultrasonic cleaning equip- ment, Landry says. “ST79 states this equipment should be cleaned with fresh cleaning solution after each use.” What constitutes a “use” should be defined in an ASC’s policies. His expe- rience suggests that most ASCs either clean after a single use or when the water appears cloudy or dirty, he says. Moving to a more frequent cleaning schedule could create a challenge for an ASC, Landry adds. “It takes a lot of time to drain an ultrasonic cleaner, fill it, get it up to its required temperature and degas for use. ASCs should consider how cleaning timing affects their processes.” ST79 now mandates that cleaning


verification of mechanical processes should occur daily, Coss says. “When I perform gap analyses, this is an area I often find still needs improvement. Weekly testing is no longer acceptable.” O’Connell says the guide includes additional language concerning clean- ing and washing equipment testing.


For example, ultrasonic equipment should now be tested for cavitation. “Not all tests address cavitation,” she says. “If we want to test for tempera- ture and chemistry, we certainly can, but the minimum is now cavitation. ASCs need the appropriate indicator products to perform this test.” They should also follow manufacturers’ instructions for use to monitor clean- ing equipment efficacy.


On a smaller scale, Karen Owens, RN, director of clinical education for Steris, strongly advises ASCs to pay attention to changes concerning point-of-use (POU) treatment. Any device that will be reprocessed now requires some form of POU treatment when the procedure is completed. “It is not acceptable to remove a device from a patient and send it wherever it needs to go—whether that be another floor or building—without perform- ing this step first,” she says. “ST79 identifies the different ways to meet this standard, which can be over- looked if you do not understand that the requirement covers all devices.” Also deserving of greater scrutiny: cleaning brushes. “You must use med- ical-grade cleaning brushes, which cannot be purchased at a commercial retail outlet,” O’Connell says. “If you purchase reusable brushes, there is


some very specific guidance concern- ing proper disinfection and following instructions for use.”


ST79 discusses cleaning and disin- fection products and using the appro- priate chemicals for specific items. “The products you use should not come from your local retail or grocery store,” she says. Rather, they should be specifically designed for use on medical devices.


A change in ST79 that Landry says might not be getting the atten- tion it deserves concerns staff com- fort, specifically, ergonomic consid- erations. “This standard talks about designing work surfaces and consid- ering employee height when doing so. Our facility has started making these adjustments, and it is a huge staff sat- isfier. The changes have also improved our workflow and how quickly we can get items through processing.” Not all revisions to ST79 provide


more guidance for ASCs. “In the case of environmental control, AAMI no longer includes clear guidelines for temperature and humidity in the areas of your facility,” Owens says. “Rather, you are directed to follow building codes from the American Society of Heating, Refrigerating and Air-Conditioning Engineers.”


ASC FOCUS JUNE/JULY 2020 | ascfocus.org 13


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