With technology continually evolving and new manufacturer’s instructions for use (IFU) to follow, ASC staff might need a refresher course on best practices in cleaning and sterilizing loaned instrument trays.
Sometimes, ASCs have to clean, sterilize, and turn around these loaned trays quickly, says Delores O’Connell, LPN, CRCST, CIS, clinical education specialist at STERIS Corporation in Mentor, OH. O’Connell speaks about operating room cleaning and sterilization processes at national surgery center conferences.
There is more time to prepare instrument trays when an ASC owns the instruments, but organizations have less control over when a vendor will deliver a loaned instrument tray. It might arrive soon before the surgery for which it is needed. Still, the tray will need to be cleaned and sterilized before use, even if the last user already performed the same process. “Sometimes, there are multiple instrument trays for one patient,” O’Connell notes.
There are a few best practices when it comes to processing loaned instrument trays:
• Check manufacturer’s IFUs. Read outlines on how the instruments should be cleaned and sterilized and check for any packaging considerations. As loaned instrument trays are sent from one facility to the next and subjected to various risks during transportation, an ASC must clean and sterilize these trays after they arrive, O’Connell says.
“You don’t know where it’s been and what it’s been subjected to during transportation. You don’t know what the previous place’s processes were,” she says. “For instance, I’ve seen loaned instrument trays arrive via an open pickup truck.”
• Match manufacturer’s IFU with mechanical washing. “Make sure you have the proper chemistries and proper cycle,” O’Connell says. “You go from the instructions for use for the machine and match them.”
Most instructions for use are generic, but some include specific details — watch for those. For instance, some instrument sets contain plates, screws, and wires, and the IFUs indicate that no lubricant is to be used during the wash cycle.
• If the ASC uses chemical integrators, insert these during assembly process. Some surgery centers use integrators that monitor sterile trays to ensure they meet all the critical parameters, including time, temperature, and steam quality. These tools are small sticks that use the words “pass” or “fail.” If there is a problem with one of the parameters, the tool will say “fail” when the packaging is opened. Operating room staff will need to reprocess the tray.
O’Connell says the integrators should be placed on opposite corners on each pan. “On the first level, I would place it on the upper left and lower right corners; on the second level, I’d place it on the upper right and lower left, and then move it back and forth on each level. At the top, you can have at least one in the middle so the team can see it as soon as they open it.”
Even the integrators will include their own manufacturer’s instructions for use. ASCs should follow those instructions when available.
• Match manufacturer’s IFU to packaging. After the mechanical or manual instrument washing, the next steps are inspection and packaging in rigid sterilization containers or sterilization wraps. ASCs need to check manufacturer’s instructions to ensure these steps match. Inspection ensures there is no hidden debris before the instruments are packaged in a sterile barrier that prevents recontamination before the tools are ready for use, O’Connell explains.
• Clean and inspect after using instrument tray. After the tray is used, staff wash and inspect the tools. There is no point in sterile packaging as the vendor receiving the returned items will re-inspect and verify that all critical components are returned, O’Connell says.
Some surgery centers have begun to take an additional step: using technology that photographs the instrument tray when it arrives from the vendor, places a barcode on it, and tracks it. This electronic instrument management system helps surgery centers keep track of the loaned instruments and devices, creating an electronic inventory that can be compared to what is assembled after use and before the instrument tray is returned to the vendor. ASCs can ensure that they have returned the tray in the same condition as when they received it, O’Connell says. “This is something that’s been needed a long time,” she adds. “It closes the loopholes of what was in the tray and what it looked like.”
ASCs should provide instrument cleaning and reprocessing training based on federal regulatory standards and monitor staff practices and habits to continually update and refine training. “You will have new employees entering the field, newly certified, or, depending on the state, it can be on-the-job training for sterile processing,” O’Connell says. “We have to make sure everyone is following best practices and guidelines.”