In my last post, I talked about the importance of communication between the Operating Room (OR) and the Sterile Processing Department (SPD). Specifically highlighting that there are several different professional organizations that dictate our practice, though we may not always be familiar with every organization. Our lack of familiarity with the different organizations and their guidelines often hinders our communication between our departments - and our understanding of our roles and responsibilities.
SPD references AAMI Standards.
When the OR hears AAMI referenced, they might think, "Who's that?" or, "Why are they important?" Or, when the OR comes to SPD referencing the AORN Guidelines or AST Standards, the SPD staff might not know how the guidelines line up with AAMI standards. But oftentimes, it's simply because we view our own guidelines as "the most important" since those are the ones that we're familiar with, instead of recognizing that all of the different organizations provide valuable guidance for our practice.
A great example of this is in the instrument pretreatment, or point of use cleaning, guidelines. All three organizations provide guidance on how and when anyone using instruments during a procedure should be cleaning those instruments.
Let's take a look...
6.3.1 Handling of instruments during surgical procedure
"Throughout the surgical or invasive procedure:
instruments should be wiped, as needed, with sterile moistened surgical sponges to remove gross soil; and
cannulated instruments or instruments with lumens should be irrigated with sterile water, as needed, without creating aerosols.
6.3.2 Removal of gross soil
Gross soil should be removed as soon as possible to:
reduce the number of microorganisms on the item;
reduce the nutrient material that supports microbial growth;
prevent it from drying on;
reduce the potential for environmental contamination by aerosolization or spillage;
remove all disposables including disposable sharps; and
minimize corrosion risk and damage to devices from such substances as blood, saline, iodine, and radiological dyes or from the subsequent vigorous cleaning processes needed to remove encrusted material."
AORN Guideline for Care and Cleaning of Surgical Instruments
6.1 "Moistening and removing gross soil at the point of use can help prevent organic material and debris from drying on instruments
6.1.1 – During the procedure, remove gross soil from instrument surfaces with a sterile radiopaque sponge moistened with sterile water. Do not use saline.
6.1.2 – Use sterile water to irrigate instruments with lumens at frequent intervals during the procedure
6.4 – Keep instruments moist until they are cleaned by using either saturation with an enzymatic pretreatment product or a towel moistened with water placed over the instruments. Do not use saline."
AST Standards of Practice for the Decontamination of Surgical Instruments
Standard of Practice I
"The cleaning of instruments should begin during the surgical procedure to prevent drying of blood, soil and debris on the surface and within lumens.
The CST in the first scrub role should keep the instruments free of debris and blood during the surgical procedure.
The instruments should be wiped clean using a sterile, water-moistened sponge. Care must be taken that the sponge is not used on the tissues of the patient.
Instruments with lumens should be flushed with a sterile, water-filled syringe to remove blood and debris and prevent drying of the gross soil.
Instruments that may not be used for the remainder of procedure, eg, acetabular reamers used during a total hip arthroplasty, may be placed into a basin containing sterile water to soak.
Saline must not be used, since the chloride ions can cause pitting and deterioration of the finish on the surface of the instruments."
OK, that was A LOT of information about point of use cleaning...
Yes, it's a lot to take in! I listed the key points from the different guidelines to highlight something very important:
No matter which guideline you reference, AAMI, AORN, and AST all state that point of use cleaning is the responsibility of the person using the instrument at the point of use.
Sometimes, though, SPD comes to the OR to discuss instrument pretreatment, and the OR's response is, "That's not our job." As if the OR has no responsibility when it comes to the care and handling of instruments. This couldn't be further from the truth!
This response only shows that the staff don't know what the guidelines say. It doesn't matter which guideline gets referenced - all of them outline the responsibility of the person using the instruments.
Which means, the OR plays a CRITICAL role in the pretreatment process. We are the ones using the instruments during invasive procedures. We are the ones there when gross soil and debris need to be wiped off or when lumens need to be flushed. Our partners in SPD aren't in the OR during the procedures - we are.
This makes us the first step in the instrument reprocessing cycle. And makes us part of the reprocessing team, working hand-in-hand with our sterile processing counterparts to ensure that our instruments are well-cared for and safe for patient use.
Improving education around the different guidelines and standards can help all of our departments better understand the interconnectedness of our roles and responsibilities. While instrument pretreatment is the example that I used today, there are plenty of other areas of overlap between the OR and SPD. We improve communication and teamwork between our departments when everyone recognizes and respects the guidelines and standards that are being referenced. And together, we not only ensure that our instruments are properly cared for, but we also make surgery a safer experience for each of our patients.
Until next time,
For more information from the guidelines, reference AAMI ST79, section 6.3; the AORN Guideline for Care and Cleaning of Surgical Instruments, section 6; the AST Standards of Practice for the Decontamination of Surgical Instruments. Standards 1 & 2.