Advanced Instrument Processing Solutions

Archive for the ‘AAMI’ Category

International Healthcare Central Service/ Sterile Processing Week Oct. 12-19 2014

I want to take this opportunity to wish all my colleagues throughout the World a Happy CSSD/SPD Week!! You are all truly the unsung and forgotten HEROS of Healthcare, without whom a facility cannot function, yet few people know who you are and how important your job is. I know from personal experience that if someone asks me what I do for a living and I tell them I’m a Certified Sterile Processing Technician their eyes glaze over they look around quizzically and then ask “what the heck does that mean?” I think it is high time we make ourselves known. Everybody knows what a Doctors job entails, what a Nurse does and even what X-ray and Respiratory techs do, but how many people know what you do for a living? When I explain to people that a Sterile Processing Tech decontaminates assembles and disinfects, high level disinfects, or sterilizes equipment and instruments according to the modalities needed to make them safe to reuse I am usually told “I thought the nurses and doctors did that” (sigh…yes and pigs can fly). All of us who have ever worked in CSSD/SPD know the answer to that.

Isn’t it time you got the recognition you deserve for the job you do? Be proud of what you do, you are patient safety advocates, let people know that! Tell people what you do and how your adherence to recommended best practice and standards keeps patients safe from HAI’s and SSI’s even though you have no direct patient contact. Celebrate your week with your Team too…Yes You are TEAM…I know the tensions that go on in CSSD/SPD, I have worked all three shifts, unless your department works as a “well oiled machine” one shift helping out the other, you will never garnish the respect your department deserves.

 Above all I urge you all to keep yourselves educated and educate others on what you do and why. Always follow recommended best practices, this is what your facility will be audited on by TJC, AAHC, CMS, etc. If you process items “off label” to get things done quicker for a case, it is not the doctor that will be in question in court if there is litigation due to an SSI, it is you. If someone asks you why things are taking so long, tell them you are following the IFU of the manufacturer on reprocessing. Let those who question you see the IFU of what you are reprocessing, unless they have the capability of changing the laws of physics, you are doing things right. Keep yourself abreast of all the newest technologies in Sterile Processing and what is going on in medicine. We live in an ever changing world. The Sterile Processing Department of today is not what it was 30 years ago, instruments have become exceedingly complex and the pathogens we are fighting have become more drug resistant.  Keep the IFU’s for all the equipment you reprocess current and learn about the pathogens you are fighting (here is a link to the CDC’s 2013 antibiotic resistant threats to get you started, yes it’s pre Ebola and EV-D68 but those both are Viruses which antibiotics have no effect on. )


Above all I want to personally Thank You All for working diligently in the most Important Department in Healthcare!

We have a lot of problems cleaning the soil off of the Bi-polar and Mono-polar surgical instruments at our facility, do you have any suggestions?

The problem of cleaning  eschar off of electrosurgical instruments has been an issue since these instruments first started being used.  As you know these instruments are used to cauterize tissue to minimize the amount of bleeding at the surgical site. This is done by passing an electrical current through the instrument either through opposing tips with different electrical charges or through a mono-polar tip that passes the current through the patient to a grounding pad. In the case of mono-polar cauterization the tip of the instrument touching the tissue does the brunt of the work, while the weakened electrical charge passes through the patient to the grounding pad. (I hope that everyone is checking the insulation on their electrosurgical laparoscopic instruments after each use, since a break in the insulation can cause a “misfire” during a surgical procedure. Electrical current can pass through breaks in the insulation, and if this break is close to any other organ the current will take the closest route out of the instrument, damaging tissue that was not meant to be cauterized).  When these tips cauterize,  tissue, blood and body fluid are basically cooked onto the instrument. This burned on tissue or Eschar (your new $50.00 word) should be removed AT POINT OF USE. Many surgical “kits” come with a little scouring pad that the surgical tech should use to remove the eschar AT POINT OF USE. Each time the instrument is used the eschar should be removed, but we’ve all seen those bipolar forceps with layer upon layer of burned on blood and tissue come into decontamination.  I have capitalized and underlined “at point of use” twice now for a reason, The Association of Surgical Technicians, AORN, and AAMI all state in their recommended best practices that “The cleaning of instruments should begin during the surgical procedure to prevent drying of blood, soil and debris on the surface and within lumens.”(AST RSOP for the Decontamination of Surgical Instruments, Standard of Practice I). If you are constantly receiving electrical surgical instruments with layers of eschar on them, then someone in the OR is not doing their job correctly. Here I would suggest you get together with your manager arm yourself with photographs  of the instruments as evidence and written recommended best practices, the A.S.T. version is readily available on line and set up a meeting with the Director of the OR.

Now as far as the removal of eschar from electrosurgical instruments, my first recommendation would be the use of a stiff plastic brush, soak your instruments as recommended in their IFU preferably in a high quality multi-enzymatic detergent (see our deconex® Power Zyme Brush them under the soak water surface to remove the eschar. If staining from the burned on tissue is still a problem, and the material you are cleaning is stainless steel, I would suggest you use a surgical stain remover (deconex® 34GR is great for the removal of both organic and inorganic stains on surgical instruments and Washer/Disinfectors again refer to the IFU of the product you are using.

One more suggestion I would like to make is that if you are in a larger institution and have more than one washer, you dedicate one of your washers for instruments that are difficult to clean. Use a two component cleaning chemistry system in your washer (deconex® Twin pH10/Twin Zyme Two component cleaning chemistries like the “Twin system” employee both an enzymatic detergent and a mildly alkaline detergent  that when combined in the washer/disinfector  form an extremely effective cleaning system and have demonstrated efficacy in cleaning  hard to clean instruments like the DaVinci Endowrist instruments.


Our ASC is trying to figure out the correct standards for how often to change the water for cleaning instruments before reprocessing?

The water in the manual soak sink and ultrasonic cleaner should be changed when it becomes visibly soiled and at least once each shift. The soak sink and ultrasonic cleaner should be rinsed clean before refilling and at the end of the day or between shifts should be disinfected with a lint free cloth soaked in 70% alcohol.

If you are cleaning intraocular instruments, The American Society of Cataract and Refractive Surgery, The American Society of Ophthalmic Registered Nurses and AAMI ST79, Annex N all recommend that the water be discarded after EACH set cleaned. Also for intraocular instrument after cleaning and a tap water rinse all instruments should be rinsed in sterile, distilled or deionized water. This sterile water rinse should provide flow of water over and through the instruments, should not be done in a basin with agitation and should not be reused.

Always follow the cleaning chemistry manufacturers IFU for dosing/dilution ratios. Have your soak sink marked so that when you fill it to that mark you know the amount of water in the sink (e.g. 5 gallons) and dose your cleaning chemistry appropriately. The AAMI ST79 also recommends that you monitor and document the temperature of your soaking solution to make sure it stays in the correct temperature parameters suggested by the detergent manufacturer.

I noticed you did not mention Level 1 Gowns in your recommendations for PPE. What are Level 1 gowns and where are they appropriate?

Level 1 Gowns are not at all appropriate for decontamination, they are the “isolation gowns”you see on the nursing units when contact isolation is indicated. They allow less than 4.5g of liquid penetration under normal atmospheric pressure (based on AATC, 42test for a fabrics resistance to rain penetration), which ANSI/AAMI consider too high a level for use in the decontamination area. They are fine to wear in a “dry” environment, like a patient room, where the possibility of being in contact with a large volume of fluid is slim, but for use in “decontam”, even if you were to wear a plastic apron over a level 1 gown, it would not afford you with the proper protection, because your arms would still be exposed to liquid penetration.

Reflections on the recent AAMI/FDA Medical Device Reprocessing Summit

Following my attendance at last week’s AAMI/FDA Summit on Medical Device Reprocessing, I feel impelled to get up on my “soap box” and repeat the sentiments I heard over and over at the summit:
Elevate Reprocessing to the Level Where We Need It to Be
Mandate Certification

Yes, I was shocked and amazed too, but there really are people who understand the problems encountered by the Sterile Processing community on a daily basis. They spoke up, and I cannot agree more!

I have witnessed many changes in Sterile Processing since the 1980s, and the processes for cleaning and sterilization have become more and more complicated; yet, the monetary compensation for those who perform this job has remained less than adequate.

Let me ask you:
• How many children do you know say “I want to be a Sterile Processing Technician when I grow up”?
• How many people do you know are even remotely aware of a job or department in the hospital called Sterile Processing?

It is high time that we elevate ourselves as Sterile Processing Techs and get the recognition we deserve.

First and foremost, GET CERTIFIED! It doesn’t matter if certification is mandatory or not in your state. It makes no difference to me with whom you are certified (CBSPD or IAHCSMM). Just get it!

Here’s why I feel so strongly about certification: I am fortunate enough to have worked with people in the past who foresaw the day when certification would become mandatory in my home state of New Jersey. So I took their advice and received my first certification in 1991. This put a few more pennies (yes pennies, not dollars) in my paycheck; however, when the state mandate was passed, I, and many others like myself, was ready for it. Here’s another way to think of it: when a physician becomes Board Certified, it reflects his/her exceptional expertise in a particular specialty. So I ask, if you were searching for a plastic surgeon, would you be satisfied with just any surgeon, or would you select one who was board certified? Certification demonstrates your understanding of the subtle nuances of your job. Furthermore, certification not only proves that you can perform day in and day out, but it also shows you can apply that understanding on paper. So go out and show your exceptional job expertise by getting certified!

Getting certified is only the start. Once you are certified, it is crucial to STAY certified! Go attend as many educational seminars as you can and obtain the CEUs you need (get a few extra for your own good) to keep your certification current. The field of Sterile Processing is constantly evolving: techniques from 25 years ago are outdated, and the instruments and equipment we work with are becoming more and more complex, so stay current with your certification and education. Remember, this is not only for yourself, but also for the people you do your job for–the patients.

Lastly, join your local Central Supply/Sterile Processing organization. Membership has its advantages, such as discounted admission to their CEU seminars. They often can act as advocates for you and your peers when it comes to legislation in your area. Remember, there is power in numbers and solidarity: the more members in your local organization, the more likely they will be to work for its members. Also, once you are a member, remember not to lose your voice. Speak up and let them know your concerns.

I truly believe that we Sterile Processing Technicians are the First Line of Defense Against Infection and the Unsung Heroes of the hospital; however, we will only be taken seriously and receive the recognition we deserve, both verbally and monetarily, if we all:
• elevate ourselves
• get certified
• stay educated
• enlist our legislators to mandate our certification

Above all, the sense of pride and accomplishment that you feel in becoming certified and staying educated will become a driving force in your life, because you will know that you are doing the best job you can for the patients who are ultimately under your care.

Enough Said!

A Belated, Happy Central Sterile Processing Week to All,