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Update your disinfection, sterilization in one month
Take time to study new CDC guidelines
After a six-year wait, the Centers for Disease Control and Prevention (CDC) has finally released the updated guidelines on disinfection and sterilization. So what's the next step for outpatient surgery managers?
Study and apply them now, says James T. Lee, MD, PhD, a member of the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) during assembly of guidelines. Lee is affiliate surgeon, Department of Veteran's Affairs Medical Center, and professor of surgery (retired), University of Minnesota, both in Minneapolis.
"The bacteria that may cause infections in our patients have no way of knowing whether we are in a surgery center or main OR," he says. As a result, "it's my belief: We have to do by the book," he says.
OR staff always are looking for ways to cut corners, he says. "They're not evil; they're trying to save money," Lee says.
It's estimated that 80% of hospitals don't follow sterilization guidelines, he says. Surgery centers have a reputation for turning over ORs very fast, he says. "That's OK, because a lot are clean cases, but they must mop them down and follow a regimented plan," Lee says.
To ensure your facility is following these new guidelines, have your nurses and central supply examine one of the four chapters every week for a month, he suggests. "Have them discuss them in great detail with management present," he says. Go through the chapters page by page, and highlight items and discuss areas that stand out, Lee advises. "The problem is that if they don't do something like this, if they plop it on the desk of the OR manager or central supply, it's just a large bunch of paper," he says. "It's not going to be assimilated and digested."
The new document took so long to be released because the co-authors reviewed 26 years of literature, Lee says. The end result is very comprehensive guidelines, he says.
"You can take it to the bank in terms of being dependable," he says. In fact, Lee says "it may be the best guidelines ever to come out of the CDC." Additionally, this is a "sensitive" document with cost implications, he says.
One of the most important new sections of the new disinfection and sterilization guidelines from the Centers for Disease Control and Prevention (CDC) points to the need for cleaning endoscopes, says James T. Lee, MD, PhD, a member of the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) during assembly of guidelines. Lee is affiliate surgeon, Department of Veteran's Affairs Medical Center, and professor of surgery (retired), University of Minnesota, both in Minneapolis.
Lee says he has found that even trained and experienced professionals sometimes do not appreciate the importance of aggressively cleaning used surgical instruments before the sterilization step. Channeled instruments, which have small diameter openings, are particularly an infection problem, Lee says. "Surgeons are fascinated with small instruments, and you have to make . . . sure they're all sterile," he says.
Also, outpatient surgery managers should understand which instruments require sterilization and which ones require high-level disinfection, he says. Read the section on p. 17 of the guidelines about laparoscopes and arthroscopes, he says. "Those are frequently used, and people tend to cheat," Lee says.
The revised CDC guidelines spell it out: ". . . laparoscopes, arthroscopes, and other scopes that enter normally sterile tissue should be sterilized before each use; if this is not feasible, they should receive at least high-level disinfection."
Lee says, "A lot of people have gotten away with doing it without sterilizing arthroscopes, but the standard should be a sterile arthroscope." (For updates on lists of disinfectants/sterilants and information on disinfecting surfaces, see story left and below. To access the full guidelines, go to www.cdc.gov/ncidod.)
Follow the Spaulding Classification System, which says anything that touches blood needs to be sterilized, suggests Kay Ball, RN, CNOR, FAAN, perioperative consultant/educator for K&D Medical in Lewis Center, OH. "Anything that touches intact mucous membranes needs to be high-level disinfected," she says. Any piece of equipment that touches intact skin needs to be cleaned, Balls adds. "Anything less than these recommendations is unacceptable."
What you need to know about disinfecting surfaces
In terms of cleaning surfaces in the OR, the Centers for Disease Control and Prevention (CDC), in its revised guidelines on disinfection, says, "The effective use of disinfectants is part of a multibarrier strategy to prevent health care-associated infections."
The CDC says if you use reusable cleaning cloths or mops, you should decontaminate them regularly to prevent surface contamination during cleaning, along with the subsequent transfer of organisms from these surfaces to patients or equipment by staff members' hands.
The CDC points out that some hospitals are using a new mopping technique that uses microfiber materials. The microfibers attract dust and are more absorbent than a conventional, cotton-loop mop, according to the CDC. Microfiber materials can be wet with disinfectants, such as quaternary ammonium compounds, it says. Microfiber systems prevent transferring microbes from room to room because a new microfiber pad is used in each room, it adds.
[Editor's note: A list of methods of sterilization and disinfection is enclosed with the online version of this issue at www.reliasmedia.com. If you need help logging in, e-mail email@example.com or call (800) 688-2421.]