Infection prevention
instructions, not thoroughly inspecting instruments prior or post reprocessing, and not storing sterile items in a separate, controlled area.
As such, reusable medical instruments pose
inherent concerns regarding their maintenance, storage and repeated use. Single-use devices, on the other hand, are sterilised, individually packaged, disposable instruments that eliminate the risks that reusable instruments pose, as well as saving the time and cost involved in reprocessing procedures.
Cleaning and decontaminating The preferred method of decontaminating surgical instruments is by mechanical cleaning with a detergent solution, followed by thermal disinfection and then drying. Typically, a washer- disinfector will be utilised to automate the process. This is considered a time-efficient and a cost-effective way of cleaning medical devices, but hard to clean instruments usually require manual cleaning with particular attention to the cleaning of internal surfaces. During manual cleaning, staff must brush, wipe, jet wash or hand spray the item to try to remove debris from the instrument. Medical devices can pose significant
hazards to patients if they are inadequately or inappropriately reprocessed. A key step in the reprocessing cycle of any reusable medical device is inspection after cleaning and many decontamination departments rely on simple visual inspection in order to determine whether an instrument is clean. If an instrument cannot be cleaned, then it
cannot be effectively sterilised or disinfected; therefore, it is critical to check that all biological material has been correctly removed from a medical device before the item is passed for packaging and sterilisation. Where instruments are not cleaned properly, organic debris or biofilm can prevent the disinfectant or sterilant from having contact with the instrument, and may also bind and inactivate the chemical activity of the disinfectant. A report by the Healthcare Safety
Investigation Branch – which aimed to help improve patient safety in relation to the decontamination of surgical instruments – recently shed light on this issue. The report highlighted an incident involving a patient who had a procedure to remove a kidney stone and became exposed to another person’s dried blood during surgery.5 The instrument used during the procedure
was removed from its sterile wrappings and looked clean when inspected by the nurses. However, during the procedure foreign material was seen coming out of the end of it, which was later identified as dried blood. The report highlights that the set had been
through a decontamination cycle but several of its cleaning brushes were missing, which prevented it from being cleaned in accordance with the manufacturer’s instructions for use, and that the importance of the brushes was not understood by operating theatre staff. This highlights the utmost importance of getting each step (no matter how big or small) right, including instruments being cleaned exactly as per the manufacturer’s instructions, and ensuring staff are properly trained to do so.
Difficult to clean instruments While visual inspection is an effective
element in the reprocessing of many medical devices, difficulties occur when the device has hidden surfaces and parts which are not easily accessible for thorough cleaning and inspection. Several healthcare organisations and researchers worldwide have examined public health issues associated with reusable medical devices that are difficult to clean and have reported that infectious outbreaks have been linked to unclean medical devices, but the evidence is scant.6 The design of the instrument or medical
device is a key determinant of whether the decontamination process will be effective. Design configurations such as matted surfaces, sharp angles, rough surfaces, rough edges and complex jaw assemblies are likely to trap germs and complicate the cleaning process. Narrow-lumened instruments and endoscopes also present some of the biggest reprocessing challenges and are notoriously difficult to clean, as it is impossible to access or visualise the entire surface that needs cleaning. Many of the difficult to clean medical devices listed are also cannulated, which often have a narrow lumen or channel, and the surface of which cannot be inspected, presenting another problem when it comes to cleaning. If the lumens and channels of endoscopes
are not properly cleaned, instruments cannot be disinfected or sterilised to a high-level and can cause dangerous consequences. When reusable brushes are used to clean the lumens, they themselves have to be effectively cleaned and disinfected or sterilised between each case, and they also need to be in good condition. This is why single-use items, such as single- use lumen brushes, are now commonly used in Central Sterile Supply Departments (CSSD) to clean instruments, as they eliminate the risks of infection. They can be discarded after each use with the additional benefit that their
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www.clinicalservicesjournal.com I February 2023
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