Infection Control Today

JUN 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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10 ICT June 2019 By Nancy Chobin SPD dialogue RN, AAS, ACSP, CSPM, CFER Q Q: Our department is very small. The increase in neuro and total joint cases during the week has increased our inventory of sets which has surpassed the available space for them. This has led to over-stacking of trays, repetitive handling and last week, an increase in damaged packaging resulting in delays in the OR. A loaned-instrument representative told us that we can put his sets directly into the rigid containers we are using and sterilize them. I told him that I have not heard of a rigid container that you can just place a set of instruments from another company and sterilize them. He says that all his accounts do it. I know better and said, "I have to go by the IFUs." I have looked everywhere and nowhere do I see that it is OK to do this. Has something changed that I am not aware of that whereby we can take any loaned set (container and all) and its contents and just drop it in a rigid that it fi ts in and sterilize? A: The issue of damaged packaging, especially for loaned instruments, is one that will just not go away. The issue of damaged packaging seems to have begun when loaned instrument sets started to appear for neuro (spine) and total joint sets. Because of the sophistication of orthopedic and spinal procedures and the ever-changing instrumentation needed to perform them, it is necessary to borrow specialty instruments from orthopedic and spinal instrument companies. Many orthopedic and spinal procedures can require 10 to 30 sets of instruments, each of which could contain 25 to 100 instruments or implants. Therefore, effective management of loaned instruments is essential for patient safety and cost containment. Management of loaned instrumentation and implants for specialty operative procedures requires that the instruments be properly inventoried, cleaned, and sterilized. Sterile processing and operating room (OR) personnel must work together to see that this inventory is managed correctly to prevent a decline in the quality of service, costly delays in the OR, and unnecessary expenses because of damage or loss. Placing Loaned Sets Inside Rigid Containers: Fact or Fiction? The facility should have a policy and pro ce dure for the ord ering, re ceipt, processing, inspection, inventorying, post-use processing, post-use inventorying, and return to the vendor or manufacturer. The policy should specify who has the authority to order the loaned instruments and the notifi cation of the sterile processing department (SPD) of the arrival of the instruments (date of arrival and how the instruments will arrive [e.g., by courier, sales representative, delivery service]). SPD personnel should then track the instruments to ensure that they are processed in time for the scheduled case. If arrival information is not communicated to the SPD, case delays can occur. The polic y should also address the condition of the loaned containers (e.g., not broken, no sharp edges) and the condition of the instruments (not rusted, pitted, or damaged). Damaged containers can lead to compromise of the packaging integrity, which can lead to a delayed case. Any instruments that are pitted, rusted, or in otherwise poor condition should not be used. The vendor and the OR should be contacted regarding the problems so that they can be corrected before the scheduled case. Furthermore, the facility should require vendor compliance with the Association for the Advancement of Medical Instrumentation (AAMI) recommendation that the maximum weight of each instrument set, including the container, should not exceed 25 pounds. AAMI has published a Technical Information Report, Management of Loaned Critical and Semicritical Medical Devices That Require Sterilization or High-Level Disinfection (AAMI TIR63), which provides additional information on this topic. The major factors in damaged packaging include sets that exceed the AAMI standard, incorrect confi guration of the set (instruments not evenly divided on the set), Damaged containers and excessive and incorrect handling/storage of sets after sterilization. Damage to loaned set container ➤ ➤ ➤

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