Surgical Site InfectionsSterile Processing

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical CentersJody Church/Martha Young

Centralization optimum, recommended by AAMI. Important for patient safety.

Supporting resources: AAMI Guideline 2010 with 2012 Amendments, AORN 2013.

If you need help convincing your administration, use real life examples of breaches in patient safety.

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers

Causes of possible safety risks:No consistent level of staff to do the processing, e.g.,

MAs, LVNs, techsNo well planned space, equipment, timeInadequate pre-cleaningNo knowledgeable oversight, no “expert”Not following professional organizations practice

recommendations

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers

Causes of possible safety risks:Not following manufacturer’s written recommendations, current

IFU (instructions for use).

Relying on verbal instructions from sales reps. Use manufacturer’s corporate website for IFU.

Resource for IFU: www.onesourcedocs.com. Pay a yearly fee.

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers

AAMI recommendation that SPD staff be certified within 2 years of employment. Joint Commission has been asking this question.

TJC is now trained by AAMI in HLD /sterilization and citations have gone from 10%to 40%.

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers Set up of area :

Should be unidirectional from dirty to cleanTransport from exam room in covered bin, moistened with

wet towel or foamFull PPE (fluid resistant gown) and eyewash station

available. Need heavy duty, long, cuffed, water proof gloves

Need soiled receiving area, sink for washing, sink for rinsingClean area for milking, drying and wrapping, sterilizationMay need plexi-glass barrier to separate clean from dirty

 

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers

Set up of area:Sinks large enough and deep enough (8-10 inches deep)

for trays of instruments to be submergedFinal rinse in “special water” e.g., RO, DI, or distilled waterRange of temp and humidity 68-73 degrees and 30-60 %

humidityBrushes are single use or if reusable, decontaminate and

HLD/sterilize after each use

 

Lessons from the Hybrid RoomHeather Hohenberger“Hybrid room” or space can be either an OR room,

Diagnostic Imaging room (Interventional Radiology), Cath lab.

Flexibility maximized if in OR.Area where both diagnosis AND treatment/procedure

take place in same room. “All in one” room for minimally invasive procedures. No wait for OR space after diagnosis made. Especially important for critically ill patients.

Lessons from the Hybrid Room

No standard definition, location, design, type of patient, staffing matrix, procedure type.

Most often for cardiac, ortho, or neuro cases

Different from the OR because it has diagnostic capabilities (fluoroscopy, CT, MRI or fixed angiography), a control room, special fixed bed with no metal attachments, monitors in physician’s line of site.

Lessons from the Hybrid Room

Different staffing mix: Only consistent staffing is MD and anesthesia. Often has no scrub nurse, may be a variety of techs.Often product reps in room.

Staff may need orientation to sterile OR procedures:Surgical attire, skin prep, draping, traffic patterns, sterile

field and surgical conscience

Lessons from the Hybrid Room

Possible procedures

Cardiac-percutaneous valve replacements, VSD closures, cardiac rhythm device, valve repairs, lead implantation, congenital cardiac repairs

Neuro/Ortho-tumor resections, aneurysm coiling, traumatic fracture of spine and pelvis

Lessons from the Hybrid Room

If the hybrid room is in the OR, must use OR standards/policies.

Must be adequate air exchanges to convert to open procedures if necessary.

If in IR, may need additional/new policies and must use OR standards when the procedure begins.

Oral AbstractsCommunity Medical Center’s Approach to Reducing Joint

Replacement SSI- Alison EssenmacherIn 2008-2009, experienced a spike THR and TKR SSIs

One OR room, 2 surgeons , and multiple environmental organisms identified

Multidisciplinary team formed

Rate to 0% during study period

Oral AbstractCommunity Medical Center’s Approach to Reducing Joint

Replacement SSIFocused on back to the basics:

Drains, faucets and aerators removed and cleanedMandatory surgical attireStandardizing CHG prepTraffic control100% Certification in SPDMaintaining positive air flow in all roomsCleaning vents (bat and rat hair found)Terminal cleaning of rooms dailyLab coat covers when out of dept

Oral Abstract

Reduction in C Section SSIs Through Surgical Instrument Repair- Elizabeth Stutler

Original investigation focused on skin prep, antibiotic dosing, patterns of organisms.

Eventually found problems with instruments, with pitting, staining and chipping. New work flow in dept had caused prolonged soaking of instruments before they went to SPD.

Immediately signed a contract for repair and maintenance of instruments and outbreak stopped.

Oral AbstractReduction in C Section SSIs Through Surgical Instrument

Repair- Elizabeth Stutler

Never assume you know the problem- go out and look. Validate!The answer won’t be found in a chart.