As ASCs become a more convenient, less costly alternative to hospital-based surgeries, it's important that sterile processing procedures are implemented properly and consistently to ensure safe and high-quality patient care.
During a September webinar hosted by Becker's ASC Review and sponsored by Healthmark Industries, Malinda Elammari, clinical education specialist at Healthmark, discussed special challenges faced by ASCs, the importance of point-of-use treatment of medical instruments, the proper decontamination and sterilization process and suggestions for how to maintain high-quality procedures in the long run.
Four takeaways:
1. ASCs face unique challenges related to sterile processing. "Many ASCs must perform procedures with limited inventory levels and high case turnaround time," Mrs. Elammari said. "Procedures tend to be quick and that may lead to breaks in standards and high immediate use steam sterilization. I'm not saying that every facility breaks standards and it’s processes due to lack of resources, but it tends to happen more often than not and that's usually caused by lack of knowledge."
2. Correct point-of-use treatment of medical instruments is not only critical to patient care but will also protect instruments from damage. Blood, bodily fluids and saline are highly corrosive and can begin breaking down passivation layers of instruments within 20 minutes, which is why it's important to keep instruments from drying before the decontamination process begins.
Both The Joint Commission and industry associations such as the Association for the Advancement of Medical Instrumentation, the Association of Surgical Technologists and the Association of periOperative Registered Nurses stress the importance of point-of-use cleaning. "We know point-of-use is important for patient care," Mrs. Elammari said. "The ramifications of not doing point-of-use include damaging your instruments, extended turnover time and and most importantly patient risk."
3. Posters, charts and training can help remind ASC staff of correct protocols throughout the sterilization process. Examples of steps that can be taken by ASCs include using a staff member as a model to illustrate the correct procedure for putting on and taking off personal protective equipment. It can also be helpful to post reminders about the correct temperature and dilution levels of enzymatic detergents. "In decontamination, there must be strict rules about your workflow going from dirty to clean," Mrs. Elammari said.
Besides PPEs and enzymatic detergents, the decontamination process includes proper use of ultrasonic cleaning equipment, accurate placement of instruments in the washer and correct procedure for cleaning instruments. Additionally, following standards around packaging and wrapping procedures are critical steps in assuring patient safety. This is followed by the sterilization process, which includes correct cart loading and the use of physical monitors, indicators and tests. Finally, it's important to release trays properly, avoiding human touch and allowing them to cool to room temperature to ensure proper seal and eliminate contamination.
4. ASCs should use a combination of testing, audits, and team huddles to ensure high-quality sterilization on an ongoing basis. Both borescopes and magnifiers can help ASCs perform better visual inspection of instruments. "Creating audit forms and doing a Joint Commission awareness audit with your staff is really helpful," Mrs. Elammari said. "It allows them to see things that they might usually not and trains their eyes on what to look for. It's also good to have standard policies and procedures so that staff understand expectations, and everyone is held accountable to the same level." Finally, tools such as huddles or kamishibai boards can help improve communication throughout the ASC.
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