Sterilization and Cleaning (Instruments, Reusable Goods)

Guidelines:

• Perioperative personnel perform surgical instrument cleaning and sterilization to reduce the risk of surgical site infections (SSIs)
  • Cleaning = removes microorganisms
  • Decontamination = renders microorganisms noninfectious
  • Sterilization = kills microorganisms and spores
• Cleaning, disinfection, and sterilization processes build upon each other and should be performed sequentially for maximum efficacy

Considerations:

• Use saturated steam under pressure to sterilize heat and moisture-stable items unless otherwise indicated by the device manufacturer
  • Sterilize under controlled conditions after complete cleaning, inspection, and assembly by qualified personnel
  • Enclose in a rigid sterilization container intended and validated for IUSS (this is terminal sterilization)
  • Allow to cool to room temperature before use to prevent patient burns
  • Investigate wet loads or wet packs in a terminal sterilization cycle and take corrective measures
  • Bowie-Dick Tests are used to quality sterilizer performance and are used each day the sterilizer is in operation. They are also used when the sterilizer is first installed, anytime it is moved, and following a major repair.
    • Performance: steam quality, air removal

Nurse’s role:

• Perioperative RNs
  • Be familiar with terminology related to cleaning, decontamination, and the different types of sterilization
  • Supervise point-of-use cleaning by scrub tech or LPN in the scrub role
    • Removes gross soil and debris from instruments to prevent it from drying on the instrument
    • Sterile water-moistened radiopaque surgical sponge (saline can cause corrosion)
    • Instruments with lumens should be irrigated with sterile water frequently during the procedure to prevent biofilm from forming
    • Keep instruments moist until the cleaning and decontamination process begins to prevent formation of dry biofilm. Saturate with enzymatic pretreatment or place a towel moistened with water over instruments
    • Transportation in leak-proof, puncture-resistant container
    • Transport contaminated instruments to the decontamination area as soon as possible after completion of the
      procedure
  • Use chemical, physical, and biological indicators in accordance with the manufacturer’s IFU

Pitfalls:

• Successful instrument sterilization requires thorough instrument cleaning and disinfection
  • Includes removal of organic and inorganic material and microbial contaminants that can inactivate the sterilant or prevent it from contacting all surfaces of the instruments
  • Refer to the manufacturer’s instructions for use (IFU) for information on cleaning, decontamination, and sterilizing instruments and using any associated equipment
• Immediate-use steam sterilization
  • A sterilization method that involves the shortest possible time between a sterilized item’s removal from the sterilizer and its aseptic transfer to the sterile field
  • A sterilized item intended for immediate use is not stored for future use not held from one surgical procedure to another
• Reusable semi critical items
  • Some items cannot be sterilized or mechanically processed
  • May be processed using manual methods when that is the only processing method recommended by the manufacturer
  • If manufacturer validated for sterilization, then sterilize
  • Follow the manufacturer’s IFU

Examples:

• The Spaulding Classification:
  • Strategies the risk of infection transmission based on the patient tissue the device will contact during use. The device classification determines the level of disinfection/sterilization required.
• Critical: Device contacts sterile tissue or the bloodstream. Requires sterilization. Example, surgical instruments
• Semi-Critical: Device contacts mucous membranes or non-intact skin. Requires high level disinfection. Example, flexible endoscopes, vaginal specula, anesthetic equipment
• Non-critical: Device only contacts intact skin. Requires intermediate or low level disinfection. Example: non-critical ultrasound probes, BP cuffs, environmental surfaces.

Linchpins (Key Points):

• Surgical instrument cleaning, decontamination, and sterilization is done to reduce the risk of SSIs
• Cleaning, decontamination, and sterilization should be performed sequentially
• Cleaning and decontamination begins at the point of use
• Follow the manufacturer’s IFU