Point of Use Care for Surgical Instruments: A Hot Button for Surveyors

Care and handling of surgical instruments is a shared responsibility between the Operating Room (OR) and Sterile Processing (SP) personnel. Research has proven that preparation for decontamination must begin at the point of use (POU). However, many facilities are not following the guidelines. Surveyors from accreditation organizations such as The Joint Commission are citing facilities for not following POU care and handling of surgical instruments, which can put patients at risk. In addition, facilities have been fined from OSHA for Blood Borne Pathogen Standard violation relating to skipping POU care and handling that puts employees at risk.1

 

The following are excerpts from current guidelines/standards relating to POU care of surgical instruments from the Association of periOperative Registered Nurses (AORN), the Association for the Advancement of Medical Instrumentation (AAMI) and the Association of Surgical Technologists (AST).

 

  Begins at POU

 

During procedure

 

Post-procedure

 

AORN III.a. Preparation for decontamination of instruments should begin at the point of use (POU).

-help prevent organic material and debris from drying on instruments

– can improve the efficacy and effectiveness of cleaning

III.b.1…scrub person should remove gross soil by wiping the surfaces with a sterile sponge moistened with sterile water

III.b.2. Periodically during the procedure, the scrub person should use sterile water to irrigate instruments with lumens

III.d. In preparation for transport, sharp instruments must be:

– segregated from other instruments

– confined in a puncture-resistant container

– minimizes risk of injury to personnel handling instruments during cleaning and decontamination

 

AAMI 6.3 Gross soil should be removed at the POU

–  reduce number of microorganisms, nutrient material that supports growth

6.3.1 Throughout the procedure…

– wipe instruments as needed with sterile sponge moistened with water.

– irrigate cannulated lumens

6.2 Reusable items should be separated from waste at the POU

– separation is best done at the POU by persons aware of the potential for injury from sharps, and the potential infection hazards of the contaminated items

 

AST I. The cleaning of instruments should begin during the surgical procedure to prevent drying of blood, soil, and debris on the surface and within lumens.

 

I. The CST in the first scrub role should keep the instruments free of debris and blood during the surgical procedure.

– use sterile water-moistened sponge

– lumens flushed with a sterile, water-filled syringe

– Instruments not being used for the remainder of procedure, eg, acetabular reamers should be placed in a basin of sterile water to soak.

II. The cleaning of instruments should continue at the point of use post-procedure, including:

– sorting and disassembly of instruments,

– containment, and

– transportation to the decontamination room

 

Appropriate POU care of surgical instruments can help decrease risks to patients, employees, and the instruments.  Healthcare facilities should ensure their policies and procedures for care and handling of surgical instruments includes detailed information on POU care following current published guidelines and standards.

REFERENCES:

  • United States Department of Labor. Occupational Health and Safety Administration. Inspection 974812.015 – Hallmark Health – Melrose Wakefield Hospital. https://www.osha.gov/pls/imis/establishment.inspection_detail?id=974812.015.
  • Guideline for cleaning and care of surgical instruments. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2018.
  • ANSI/AAMI ST79:2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation; 2017.
  • Standards of Practice for the Decontamination of Surgical Instruments Standard of Practice I – The cleaning of instruments should begin during the surgical procedure to prevent drying of blood, soil and debris on the surface and within lumens. Available at: http://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/Standard_Decontamination_%20Surgical_Instruments_.pdf Accessed 4/17/2018

 

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