“Clean and orderly instruments are totally necessary for keeping your costs down,” said Mr. Kovach. “Taking shortcuts causes damage to your instruments, and you will have to pay fines for not following procedure.”
Mr. Kovach related a particularly troublesome anecdote in which a contaminated orthopedic bone saw at a Huston hospital infected seven people over two weeks of operations.
This type of incident, he reported, is all too common. A 2007 study done at Walter Reed Medical Center found that 16 percent of loaner instruments tested positive for residual blood or tissue after they had been cleaned in accordance with their instructions.
Old re-processing standards, primarily visual, are not designed for modern instruments, which are often too complicated to be cleaned correctly even when technicians follow instructions for use, said Mr. Kovach. Instruments with crevices, serrations and small parts that otherwise seem clean often show residual tissue when examined by arthroscope.
In response to this problem, surgical equipment companies are beginning to re-design instruments to be either easily disassembled or disposable. While better design is a step towards cleaner instruments, ASCs can also take supplemental actions.
Mr. Kovach closed with a set of steps for administrators to ensure that orthopedic instruments stay clean.
1. Follow procedure exactly. Shortcuts do not save time; they may cause the instruments to be unsanitary or damaged. Procedures are designed a certain way for a reason.
2. Use teamwork. Be sure that the OR partners with the staff who clean the instruments. All instruments should available for cleaning before blood and protein have a chance to dry. Also, be sure to support certification of reprocessing staff so that proper reprocessing protocol is the rule, not the exception.
3. Have better equipment scheduling. Cleaning equipment properly requires time. Be mindful of this fact in the scheduling of the OR and in the turnaround time for loaner equipment. Scheduling the appropriate amount of time for cleaning
upfront will save time on unnecessarily difficult cleaning jobs later.
4. Be proactive with re-processing policies. Make sure reprocessing staff have access to the proper supplies to clean equipment, and double check trays after they are cleaned. Make good reprocessing easy.
5. Use data to communicate with staff. That way they will understand why you are making changes and be able to suggest improvements themselves. Keeping an open channel of communication is mutually beneficial.
More on Infection Control:
3 Steps to Use a Surgical Safety Checklist
