SELF-STUDY SERIES
and their ability to properly perform all tasks should be verified. Using compe- tency checklists and spot audits confirms technician performance and captures process changes, both intended and unin- tended, before they become problems. echnicians also need easy access to the
tools they need to do the ob. or eample, lighted magnification at the sink allows technicians to see residual soil that may otherwise be missed. aving the correct brushes, syringes and attachment acces- sories to scrub and ow uids through robotic channels helps assure thorough cleaning and avoid internal damage. In addition, ultrasonic cleaners must
meet the validated parameters described in each robotic devices instructions for reprocessing. ince robotic instrument channels are too small to be brushed, its critical that cleaning solution be ushed through them during ultrasonication to remove bioburden. echnicians should be trained on the use of the ultrasonic clean- ers and the correct attachments to ensure effective ow. hermal disinfection is the last step
before the instruments are sent to assem- bly. hen an ultrasonic cleaner is not capable of thermal disinfection, depart- ments use automated washer disinfectors for thermal disinfection. Unfortunately, most of these systems are not designed for use with robotic instruments. lthough placing robotic devices loosely in a basket during the automated washer disinfector cycle may seem like a good idea, it can pose serious risks. leaning chemistry can become trapped in the channels during the cleaning cycle. ithout a ow mechanism, there is no guarantee that the channel is ushed free of chemistry. he instrument may be thermally treated, but it could harbor residual cleaning chemistries that may harm patients or interfere with ster- ilization. nly washer disinfectors with racks designed and validated for thermal disinfection of robotic instruments should be used for these devices. Its important to note that even washer disinfectors that have been designed for robotic instruments may not fully replace reuired manual cleaning and ultrasonication steps. thorough read- ing of the washers instructions for use will help determine which, if any, of the manual cleaning and ultrasonication steps described in the robotic instruments reprocessing instructions can be replaced by the washer disinfectors cycle. In addi- tion, the correct cleaning chemistry must be used.
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Assuring quality control uality control is an important function that helps to assure that robotic instrument sets are delivered to the on time and ready for use. onsistent cleanliness is one of the deliverables needed for every robotic set to be made ready, and uality checks can help capture failures to meet this deliver- able before the set gets to the . roper training and tools contribute
to better cleaning uality. or eample, both the decontamination technicians performing the cleaning and the assembly technicians preparing sets for steriliza- tion must be aware of the difficult spots to clean and must watch for evidence of physical part failure fracture lines, cracks, plastic chips, etc.. oth teams should have lighted magnification to perform these intricate obs. urthermore, all staff members, including operating room and sterile processing staff, must be trained for their robotics-handling functions and demonstrate competency. eevaluation of competency should be set per the facility policies and account for any deficiencies found during audits or inspections. arious types of cleaning tests also help departments manage uality. or eam- ple, protein detection tests help detect residual soil on cleaned instruments. leaning indicator tests for automated euipment should be conducted daily to assure cycle effectiveness. nd all tests should be documented to provide a trace- able record of the data. or robotic tools, accurate sterilization counts are essential for controlling costs and preventing overprocessing. olicies and procedures should identify who is responsible for tracking the instrument sterilization counts and when this will occur. acilities can also consider using an instrument tracking software to automate the tracking process. If they do, a policy should be in place to resolve discrepancies between the robotic use counter and the tracking systems sterilization counter. ven if sterilization counts are accurate, premature disposal can still occur. ny time a set is opened to retrieve just one instrument, the remaining instruments must be processed again before the set can be used. ight-sizing the robotic sets can reduce the chances of breaking up a set and wasting a sterilization cycle. ollaborating with surgeons and personnel can help determine the mini- mum reuirements for each set. It can also help to use peel pouches for instruments or staplers that may be needed as proce- dure replacements or for specific cases.
50 November 2020 • HEALTHCARE PURCHASING NEWS •
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his will not only optimize sterilization processes but will offer versatility when picking case carts.
The future is here obot-assisted surgeries are here to stay. hey will continue to evolve and advance therapeutic techniues to help improve patient outcomes. ith proper planning, training, and uality control measures in place, sterile processing departments will be better able to reduce risk and support the uniue processing needs of robotic instruments, staplers, and all the new accessories to come. HPN
References
1. Anthony R. Lanfranco, BAS, Andres E. Castellanos, MD, Jaydev P. Desai, PhD,*† and William C. Meyers, MD (2004) Robotic Surgery A Current Perspective. Annals of Surgery 239:1, January 2004
2. William E. Kelley Jr, MD SLS President 2008 The Evolution of Laparoscopy and the Revolution in Surgery in the Decade of the 1990s 2008 Presidential Address Journal of the Society of Laparoscopic & Robotic Surgeons (JSLS) (2008) 12:351-357
Chasity Seymour, BSHM, CST, CRCST, AGTS, is a clinical educa- tion specialist at STERIS Corporation. She began her healthcare career as a surgi- cal technologist and later gained extensive experience as a sterile processing tech- nician, a unit educator and
a regional manager for sterile processing. Chasity has presented lectures, in-services, and webinars at local, regional, and national conferences and has authored and delivered numerous lesson plans. Chasity is a member of AAMI, AORN, AST, IAHCSMM, and SGNA. She currently serves as vice president of the Central Texas IAHCSMM Chapter. She is completing her Bachelor of Science in Healthcare Management from Texas Tech University Health Science Center, Austin, Texas.
Tamara Behm MSN, RN, CIC, FAPIC, CER, CRCST, is a clinical education spe- cialist for STERIS Corpo- ration, with 14 years of clinical nursing leadership and healthcare experience. She has held various roles as
a director of ICU, ICU nurse, infection preven- tion director, infection prevention consultant, mentor, adjunct professor, presenter, author, and mock surveyor. She is an expert in infec- tion prevention, CMS and other regulatory requirements, and in process improvement. She is a member of APIC, SHEA, AORN, IAHCSMM, SGNA, ASQ, and AAMI.
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