23 Aug Popular Do’s and Don’ts for Sterile Processing in ASCs
Ambulatory surgery centers (ASCs) have made convenient surgery possible in the United States. These centers are popular, with ASC healthcare staff members treating numerous patients per day. Efficiency is the name of the game in ASCs so that providers can better maximize case volume and reduce costs. Equally as important as efficiency and cost is instrument cleaning and sterilization.
Productively turning over surgical instruments in preparation for the next case helps keep costs down, aids time management and contributes to patient safety. However, if corners are cut to save time or mistakes made during instrument cleaning, preparation and sterilization, patients can develop surgical-site infections. Taking shortcuts is never a safe decision when it comes to cleaning patient care equipment and surgical instruments.
Don’t let improperly cleaned equipment delay your cases or cause harm. Ensure your ASC follows all recommended sterile processing guidelines, and continue reading to learn about important do’s and don’ts for sterile processing in ASCs.
Sterile Processing Do’s
There are many helpful practices to implement when sterilizing surgical devices. Additionally, medical personnel must always adhere to standard precautions in the surgical setting, which includes wearing:
- Gloves
- Masks
- Gowns
- Eye protection
Along with surgical attire do’s and don’ts, there are practices to implement and avoid regarding instrument processing. Keep the following “do’s” in mind for proper sterile processing in your ASC:
1. Protect Sterile Items During Transport
When transporting items to and from a centrally located sterile processing department, contamination can occur. Even after successful sterilization, exposure to certain elements can increase the risk of contamination and degradation, including:
- Moisture
- Dust
- Extreme temperatures
- Direct sunlight
Be sure to take extra care when transporting sterile items around your ASC, and avoid exposing the instruments to harmful elements. Before you send devices off for sterile processing, clean off any debris and gross soil. This step accomplishes two things: 1) decreases the time needed when the instruments are cleaned before sterilization and 2) contributes to decreased instrument turnover time. The bottom line is that this simple step helps to assure instruments are available when needed for surgery.
Since the sterilant (e.g., steam) must reach all instrument surfaces, debris from the previous procedure will interfere with this process. If debris isn’t removed before sterilization, it can prevent the surface from being exposed to the sterilant.
2. Process Reusable Medical Devices Based on Their Intended Use
Different surgical devices have distinct sterilization requirements based on their intended uses. Various sterilization methods are based on specific details about the instruments, including:
- The device’s material
- How the instrument is designed
- Compatibility with the sterilant
- Packaging
- Environmental concerns
- Load limitations
- Safety requirements
Additionally, there are three main categories of medical devices: critical, semicritical, and noncritical items.
Critical Items
All instruments that come in contact with a sterile body cavity are considered critical items, so they should always be thoroughly sterilized before and after use. Common examples include:
- Surgical instruments
- Surgical implants
- Needles
- Syringes
Semicritical Items
Semicritical items come in contact with mucous membranes and non-intact skin but not sterile body cavities. These items should be sterilized whenever possible or undergo high-level disinfection (HLD) when items are heat sensitive. Common examples include:
- Endoscopes
- Some rigid cystoscopes
- Some anesthesia equipment
Noncritical Items
Finally, noncritical items require a minimum of a low-level (surface) disinfection process as they only interact with intact skin, not sterile body sites or mucous membranes. Noncritical items include:
- Stethoscopes
- Blood pressure cuffs
- Blood glucose meters
3. Provide Education
It is essential to prioritize providing adequate training for all medical personnel who perform instrument cleaning and sterilization activities. Improper device cleaning can lead to surgical site infections or notification of many patients to potential exposure to harmful microorganisms (e.g., HIV, hepatitis B), so all providers should be educated and observed to assure competency to avoid causing patient harm.
Prioritize hiring a qualified infection control consultant at your ASC. Even if your ASC has a limited staffing budget, an infection preventionist should not be overlooked. Effective instrument cleaning and sterilization practices are developed by people with a diverse knowledge of microbiology, infectious diseases, sterilization and disinfection, vaccines, antibiotics, and more. As you can tell, infection prevention should not be handed off to just anybody.
In addition to surgeons and surgical technicians, all ASC nurses should be educated on sterile processing practices. All providers in your ASC should undergo an orientation phase that covers sterile processing, high-level disinfection (as applicable), and immediate use steam sterilization (IUSS).
4. Document IUSS
Immediate use steam sterilization is an accelerated sterilization process that can be used when specific instruments are needed for an emergency procedure. However, this method is not intended for routine device sterilization. It is good practice to require all ASC staff to document every time they sterilize an unwrapped instrument.
Record keeping is crucial, and ASC staff should keep a consistent log of IUSS that indicates the following details:
- The date and time of the cycle
- Name of person who sterilized the item
- Item that was sterilized
- Temperature of the cycle
- Type of cycle used
- Results of the chemical integrator
- Any process indicator used
- Patient name and medical record number
- Reason for IUSS
Keeping this data will help your staff know how many times something has been sterilized and if certain instruments have been undergone more than others. This information will allow the ASC to address instrument shortage issues, instrument turnover issues, or potential scheduling issues. Keep in mind that specific devices should never be placed in an IUSS cycle, such as:
- Implants
- Instruments used on patients with Creutzfeldt-Jakob disease or similar conditions
- Devices that are sold sterile and intended for single-use
- Any devices that have not been validated with the immediate-use sterilization cycle
Instrument Processing Don’ts
Just like how there are instrument processing practices to implement in ASCs, there are also instances you should avoid. For proper sterilization, follow these don’ts:
1. Don’t Get Casual With Instructions For Use (IFU)
Manufacturers include instructions for use (IFU) for a reason. Even though it may be tempting to cut corners during the cleaning and sterilization process, don’t give in to the temptation. Always follow the IFU on every medical device that needs sterilization.
Avoid getting casual with where you perform instrument processing as well. Instrument cleaning and sterilization should always be performed in a clean area that is designed and intended for this purpose.
2. Avoid Relying on IUSS
Above, we covered how important it is to always document IUSS. Although IUSS is permissible in certain instances, don’t rely on it for every process. It may seem ideal to bypass steps and reduce sterilization cycle time, but immediate-use sterilization should never be used as a general sterilization method.
In most cases, flash sterilization should only be used in emergencies or other urgent settings, and it should never take the place of sterile processing.
3. Never Reprocess Single-Use Devices
Single-use items were given their name for a reason. Any reprocessing of single-use devices should be prohibited in all ASCs. Reprocessing single-use devices can lead to patient harm and potential liability.
The packaging will clue you in if a device is reusable or not. Reusable instruments include reprocessing instructions from the original manufacturer. If the item lacks instructions for cleaning and sterilization, regardless of how it is packaged, it can’t be reused.
Prioritize Infection Control Through Sterile Processing
ASCs have made surgery safe, convenient, and accessible to people from all walks of life. Hold onto your patients’ trust by prioritizing proper instrument cleaning and sterilization processes to reduce the risk of infection. Remember, the best way to responsibly minimize infection risk is to provide infection control training and education.
If you need guidance or resources from an infection control specialist, reach out to Infection Control Results today to learn more about how you can keep your patients protected from healthcare-associated infections.