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CS SOLUTIONS
Disinfecting dropped instruments, Cleaning verifi cation - essential for cannulated medical devices
by Ray Taurasi, MBA, CRCST, CHL, FCS, ACE, Principal, Healthcare CS Solutions
comes to the issue of an instrument being dropped on the fl oor in the assembly process and what should be done with it. We have a 50/50 split between sending the instrument back to the decontamination area to be cleaned or wiping it off with a disinfecting wipe. Can you help shed some light on this matter?
Q
The best practice would be to return the instrument to the decontamination area for complete cleaning and reprocess- ing. Aside from contamination, an instrument dropped on the fl oor also could be damaged, and therefore should be carefully inspected for damage and proper functioning. You would not want to wipe the instrument off with a disinfectant wipe for the following reasons:
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• The chemical disinfectant may not be compatible with the instrument material or fi nish and could damage the instru- ment.
• Cleaning is ALWAYS a prerequisite to disinfecting, so the instrument needs to be thoroughly cleaned with a detergent prior to disinfecting.
• To be effective, disinfectants must remain moist on all sur- faces of the item being disinfected for a prescribe period of time according to the manufacturer’s instructions for use (IFU), thus the use of disinfectant wipes is not necessarily a faster process.
• Following exposure to a chemical disinfectant, the chemical agent must be rinsed from the instrument.
• If the instrument is urgently needed, you can clean it manu- ally according to the manufacturer’s IFU.
• The wipe-off game is a RISKY GAME. Be sure to read the instructions very carefully and follow them precisely.
I am the sterile processing quality assurance coordinator for a large healthcare system, which includes a clinical research center. The research center utilizes many unique medical devices, including many prototypes, which require reprocessing and sterilization. A new instrument set that includes several small canulated devices and specialty needles was recently introduced at the research center. I am concerned about cleaning these items effectively; they are visibly inspected and appear to be clean, and when the channels are fl ushed the water appears to be clear. However, I am concerned about the possibility of invisible soils that may remain in the channels, presenting a barrier to effective sterilization and posing a risk to patient infection. Can you suggest any additional methods that I could incorporate into our processes to ensure that the items are thoroughly clean and free of any organic soils?
Q Photo courtesy: Healthmark Industries Figure 1
Ray Taurasi is Principal, Healthcare CS Solutions. His healthcare career spans over fi ve decades as an Administrator, Educator, Tech- nologist and Consultant. He is a member of AORN, AHA, SGNA, AAMI and a past president of IAHCSMM. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration, nursing and health sciences.
hpnonline.com • HEALTHCARE PURCHASING NEWS • November 2020 47
We have reached the point of a good, old-fashioned standoff amongst members of our CSSD team when it
As you noted, effective cleaning must include the removal of visible as well as invisible soil. Channeled and can- nulated medical devices are amongst the most challenging to clean; residual soils remaining in the lumen of these devices can inhibit the sterilization process and indeed result in the transmission of infectious agents from one patient to another. With the widely publicized reports in the media of breaches in cleaning procedures, which have placed thousands of patients at risk, coupled with professional standards and recommenda- tions, cleaning verifi cation has become the standard of practice. There are various quality assurance tests now commercially available for testing medical devices for cleaning effi cacy. There are swab and some fl ush type tests that can detect either adenosine triphosphate (ATP), protein, or blood. Since you spe- cifi cally expressed your concern with cannulated and channeled devices, many with very small lumens, I would recommend a fl ush method test known as ChannelCheckTM. This test can detect residual organic soils, including carbohydrates, protein, and hemoglobin. Post cleaning, sterile water is fl ushed through the channel and collected in a plastic bag. A test strip consist- ing of three pads, which are sensitive to either carbohydrates, hemoglobin, or protein, is dipped in the test sample. If any pad shows deviation in color, the test is positive for the presence of that soil and must be recleaned. (See Figure 1) HPN
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