Infection Control Today

APR 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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31 April 2019 ICT When healthcare facilities have instituted clear policy and procedure guidelines for personnel, the fear of handling biohazards is lessened through training. Infection prevention and control during pandemics rests heavily in the hands of the operating room, materials management and sterile processing. The highly trained operating room personnel are always at the frontline of exposure to pathogens. The daily use of aseptic technique during operative procedures helps their personnel to avoid contamination and exposure. The sterile goods in the materials department are critical during disaster level events. The operating room and all other departments survive by the level of inventory in the storeroom. Platforms have come about during these fscally sound times that may limit availability during a pandemic event. There are many multi-hospital systems that maintain separate warehouses in anticipation of large-scale disasters. The sterile processing department sits at the hub of the hospital reprocessing wheel. As the emergency rooms fll up, there will be a massive need for reprocessed sterile goods, and the sterile processing department must meet the needs of the sick. The department leadership, having established policy and procedures for each specifc pathogen, will maintain the reprocessing cycle. The staff should have access to all documentation on these processes in computerized or printed format. The ability to retain or recall the needed staff is important by updating phone and address listings annually. The sterile processing technicians are trained for these events as they practice universal precautions daily. The tendency to be reactive during disasters and pandemics will leave us scrambling to provide service in critical situations. The proactive thought process establishes a planning matrix to account for all known possibilities. The plan then notes the desired resources needed to affect the best outcome. There will always be outliers that crop up. Departments will be infnitely more prepared for the appearance of these outliers by being proactive. The proactive approach can mitigate problems that arise with the use of a disaster plan. Health care facilities have done an excellent job in cooperation with regulatory agencies to develop internal and external disaster plans. We no longer fnd ourselves as stand-alone hospitals but as major health care systems servicing large segments of a populace. How do you service the public in a time of mass crisis? How do we make sterile goods available? When governmental agencies and operational resources become overburdened, the sterile processing department must be there to fll the needs. The nursing and surgical staff will be critical partners in all processes developed. The feld of sterile processing sits at another point of continual development where it has the opportunity to combat pathogens such as Ebola. The sterile processing discipline often goes unrec- ognized as the hub of the hospital. Through achieving a proactive pre-disaster plan, we are able to provide proper infection control during pandemics. Sterile Processing Sample Pandemic Response Checklist 1. Linen All linen used should be segregated using the appropriate linen disposal methods. One facility may choose to incinerate the soiled linens, while another will re-launder the goods. The guidelines established should be closely followed. 2. Presoaking Instruments W hatever ins trument ation is used during the surgical procedure it is vital that they are pre-rinsed. The pre-rinsing agent should be low-foaming with good adherence to instruments. All used items and rigid containers should then be placed in heavy-duty, sealed maintenance bags. An open enclosed case cart should be staged outside of the operating room. This will aid in preventing cross contamination during transport. Place a disposable cart cover on the cart during the trip to the sterile processing department. 3. Decontamination Room The decontamination room is the most important portion of the reprocessing cycle. We cannot clean an item if there is bioburden present. I would suggest removing all non-essential stock and carts from the decontamination area prior to arrival of the contaminated cart. Personnel should b e at tired in the appropriate personal protective equipment (PPE) prior to entering the area. The PPE may consist of fresh scrubs, shoe coverings, double gowning, double gloving, full face shield, goggles, bunny suit and head covering. The individual facility may employ the use of portable air purifying respirators (PAPR) for the decontamination personnel. Once the technician is fully attired disas- sembly of the trays can begin in earnest. There must be a clear delineation between clean and dirty as work progresses. The normal cleaning processes take place, as there may be an intentional doubling of exposure times during cleaning. The instruments may be soaked and placed in the ultrasonic cleaner for an extended cycle. Rigid containers and carts should also go through a double cycle. Having a steam, ethylene oxide or hydrogen peroxide sterilizer in the decontamination area will help to facilitate a higher level of immediate disinfection. 4. Terminal Disinfection Metal instrumentation should be placed on a double length cycle in the washer-dis- infector. The door on the clean side must be reclosed at the end of the cycle to restart the unit. The impingement action of the jet arms will render instruments safe for handling in assembly. 5. Electrical Equipment Sterile processing may receive items from the operating room of an electrical nature. Anesthesia carts and items used in that particular room may be sent for cleaning. Use established department guidelines that will render the devices safe for handling. Thoroughly wipe all surfaces of item with a low foaming broad spectrum detergent. Always check with department leadership before moving forward. Cleanup All surfaces in the decontamination area should be wiped down with a low-foaming detergent. Tables, sinks or ultrasonic units should be cleaned per the established policies. Environmental services should be employed at this point to provide a higher level of cleaning to the area. William C. Henry, Sr., has spent more than 35 years in the felds of sterile processing, surgical services, and materials management, as well as served as a central sterile consultant. References: CDC. Hansen's Disease. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Division of High-Consequence Pathogens and Pathology (DHCPP). CDC. Plague. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Division of Vector-Borne Diseases (DVBD). CDC. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Division of High- Consequence Pathogens and Pathology (DHCPP) Viral Special Pathogens Branch (VSPB). Ò Health care facilities have done an excellent job in cooperation with regulatory agencies to develop internal and external disaster plans.

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