We are observing increasing incidence of organizations struggling to follow their point of use sterile instrument reprocessing procedures. This is a major infection control risk and patient safety concern. Surveyors will also have this on their list of items to observe. This image was taken in a soiled utility room. Staff had indicated that they rarely use sterile instruments as they are exclusively using disposable instruments and didn’t think there were any instruments in the container. However, when the consultant checked their contaminated instrument container, he found that a well-intentioned team member had placed the entire instrument tray including instruments, surgical towels, cotton swabs, and other disposables into the container after use. Obviously, linens and disposable supplies would need to be removed and processed or discarded as policy dictates. It was also difficult to determine if the team member rinsed the instruments to remove visible bioburden and sprayed the instruments with enzymatic spray and the instruments sat undetected long enough to completely dry or never rinsed and applied the enzymatic spray. Inspection showed there was dried bioburden present, which increases the risk of infection if the bioburden is not removed during the manual cleaning component of sterilization process. There was no guidance posted for staff to refer to on the procedures for instrument preparation for reprocessing at the point of use. Make sure your team is trained and has references available to guide their practice, especially if you have gone to mostly disposable instruments. Lower volume of these tasks can put staff out of practice and job aids, such as a task list or poster, can help keep them on point with your expectations. Ensure that your practitioners are trained in your procedures or have staff perform the initial decontamination process for them. Remember, enzymatic spray is to be applied at the point of use. Infection control leaders and managers should be checking periodically for alignment with policy and don’t forget to check those contaminated instrument containers for any “surprises”!
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