Sterile Processing

The reprocessing procedure for flexible endoscopes is an intricate multi-step process that requires a significant amount of time and diligence that can vary by endoscope type and manufacturer.

Q:  We reprocess vaginal specs for some local doctors' offices. I recently learned that once the office staff receives the instruments, they are then opening up the individual sterile peel pouches and then place the “unprotected” vaginal speculums into the exam table to be ready for use by the provider. Is there anything we can purchase to use for transportation purposes that will save us time and money and skip the sterilization process of these items?A:  This is an excellent question, especially with many sterile processing departments (SPDs) now processing devices for offsite clinics and doctors' offices.  Vaginal speculums fall under the semi-critical devices category (Spaulding).

ICT spoke with Karen Swanson LPN, CSPM, CFER, manager of the central sterile department at Connecticut Children's Medical Center and chairman of the board of directors of the Certification Board for Sterile Processing (CBSPD), regarding the challenges that face sterile processing professionals and the importance of building key skill sets.

In healthcare facilities, Clostridium difficile infections spread by transmission of bacterial spores. Appropriate sporicidal disinfectants are needed to prevent development of clusters and outbreaks. In this study by Kenters, et al. (2017), different cleaning/disinfecting wipes and sprays were tested for their efficacy against spores of distinctive C. difficile PCR ribotypes.

The sterile processing department (SPD) can be one of the more challenging environments in which to uphold infection prevention and control principles. As an example, the decontamination area of the SPD can pose a significant threat to its technicians "because of the numerous and unknown microorganisms that pass through," confirms Nancy Chobin, RN, AAS, ACSP, CSPM, a sterile processing educator and consultant. "In addition, there is the potential for a sharps injury due to sharps that are handled in this area as well such a towel clips, etc.," she says.

Q:  I have been using steam tape to place indicator on paper i.e., count sheets, and instrument bags inside of surgical trays before sterilization. I have been doing this for a number of years. My manager informs me that you cannot use steam tape to hold an indicator in place, be-cause "there is no way to validate that the tape is sterile after sterilization." Please clarify or give justification for this statement.

Several years following a widely publicized series of outbreaks related to contaminated and improperly reprocessed duodenoscopes, re-searchers are reporting that current techniques used to clean endoscopes for reuse are not consistently effective. However, some experts say that slow progress is underway.

Some central service (CS) professionals find comfort in knowing their chosen discipline provides them with a secure “job.” The fact is, though, that the dynamic, fast-paced and ever-evolving realm of CS/sterile processing delivers a challenging, yet rewarding career filled with rich opportunities for growth and advancement.

As an infection prevention consultant with 25-plus years of experience, I frequently audited healthcare facilities regarding proper reprocessing of their surgical, dental and/or endoscopic equipment. With each audit, I found healthcare professionals who had a strong desire to learn and adhere to best practices. This is important, as best practices should be adhered to in any profession because they reflect the values of that profession. In healthcare, adherence to sterilization and disinfection best practices ensures patient safety, as one of our greatest threats is healthcare-associated infections (HAIs). That said, I sometimes found it difficult to get everyone on board with compliance with national standards and guidelines, such as the Association for the Advancement of Medical Instrumentation (AAMI), the Association of periOperative Registered Nurses (AORN) and/or the Society of Gastroenterology Nurses and Associates (SGNA).  In recent years, my efforts were reinforced with help from two very important organizations, the Joint Commission and the Centers for Disease Control and Prevention (CDC).

Reprocessing endoscopes, particularly flexible endoscopes, requires numerous steps for proper cleaning and high-level disinfection. Studies have demonstrated that not all of these steps are followed by sterile processing personnel, leading to potential transmission of infectious organisms to patients during invasive procedures using contaminated scopes.