IAHCSMM Viewpoint
For years, Central Service/Sterile Processing (CS/SP) professionals have been aware of the importance of proper point-of-use care and transport of contaminated reusable instrumentation. Still, ensuring those in the Operating Room (OR), Endoscopy Suite and other patient care areas consistently follow standards, guidelines, policies — and even federal regulations — isn’t always easy.
Failure to adopt proper point-of-use care and transport practices can lead to serious consequences. For starters, delicate and costly instruments can suffer damage that can lead to their malfunction and require more extensive and expensive repairs (or the need for outright replacement). Improperly transported contaminated devices may also jeopardize employee, patient and visitor safety — and bioburden that is allowed to dry and harden on devices following their use makes cleaning and reprocessing more difficult, which can increase the risk for a contaminated device being used on a subsequent patient.
Treating, sorting, transporting
Numerous regulations and evidence-based standards and guidelines align on the need to provide proper point-of-use care and transport of contaminated reusable items, and The Joint Commission (TJC) surveyors are using these regulations and guidelines to guide the survey process. Additionally, surveyors are looking to ensure that the facility’s policies and procedures not only reflect the latest evidence-based standards and guidelines, but are being followed consistently and in a standardized way throughout the healthcare organization, explained Rose Seavey, MBA, BS, RN, CNOR, CRCST, CSPDT, President and CEO of Seavey Healthcare Consulting, during her May 1, 2019, educational session at the IAHCSMM Annual Conference in Anaheim, CA.
She went on to state that instrument care and handling is a shared responsibility between user departments and CS/SP. Because biofilm, a mass of bioburden, can begin forming on instruments within minutes, it is essential to treat devices at the point-of-use — wiping off gross blood and bioburden, keeping the instruments covered with a water-moistened towel or wetted with an approved enzymatic product, and then ensuring the instruments are transported to the decontamination area safely and as soon as possible following completion of the procedure, and in accordance with regulations, standards and policy.
Instruments that can be disassembled and opened should be done so at the point-of-use, per standards set forth by the Association for the Advancement of Medical Instrumentation (AAMI), Association of periOperative Registered Nurses (AORN) and the Association of Surgical Technologists (AST). Per the standards, sharps should also be separated by personnel who understand the potential for injury, and those devices should be placed in a puncture-resistant container for transport.
“It’s important that the OR is separating those sharps,” reminded Seavey. She pointed out that TJC’s new scoring guidelines ensure that surveyors will be looking for that during inspections. Further, per Occupational Safety and Health Administration (OSHA) regulations, contaminated items should never be transported in the water in which they have been soaking, unless they are in a spill- and splash-proof container. Single-use devices and other disposable waste should be removed and disposed of in the OR.
Endoscopes should be pre-treated at the point of use. This includes suctioning and wiping down surfaces to facilitate the removal and break down of bioburden. Note: Seavey was careful to point out that point-of-use care and treatment does not mean point-of-use cleaning. “We don’t want them being cleaned outside dedicated decontamination areas.” Endoscopes should also be transported to the decontamination area and processed as soon as possible following their use. Some manufacturer instructions for use (IFU) clearly state that if reprocessing doesn’t begin within 60 minutes of use, extensive reprocessing will be required.
Regardless of the contaminated devices being transported for reprocessing, it’s essential that they are covered and marked as “biohazardous.” This is true regardless of how close in proximity the OR or procedure area is to the decontamination area in the CS/SP department.
Assessing and addressing risk
Ensuring contaminated reusable items are treated and transported in accordance with regulations, standards and policies requires a collaborative approach that includes not only CS/SP and OR professionals, but also infection preventionists and risk managers, according to Seavey. Risk assessments will help determine gaps in processes and areas in need of immediate improvement.
“We need to know what we know and close any gaps for the sake of our patients,” she said, adding that the writing of policies and procedures that address point-of-use treatment and transport should be done with interdisciplinary involvement to ensure all departments are on the same page. Finally, Seavey reminded attendees of the need to remain compliant with standards, regulations and facility policies to ensure employee and patient safety.
“If you think compliance is expensive — and it is — try seeing how expensive non-compliance is.”
