Sterile Processing Case Studies Project

Sterilization Methods

One of the aims of sterilization is to prevent the recontamination of instruments and devices and to keep them isolated from the external environment. After being removed from a sterilizer, packages should be dry for them to remain sterile for a long. However, there are cases where instruments are moist after being removed from a sterilizer. The presence of moisture can lead to recontamination of the instruments since moisture can be a pathway for microbes. This paper focuses on the causes of the presence of moisture on surgical instruments and supplies, the effects of this moisture, and the solutions to the issue.

The presence of moisture on or in a pack on removal from an autoclave after a complete sterilization cycle is referred to as a wet pack (van Doornmalen et al., 2019). Moisture may be evident as puddled water, droplets, or visible dampness on or within a pack. The load is regarded as a wet load if more than one pack is wet. Wet packs can lead to the recontamination of surgical instruments by allowing the entry of microorganisms. They can also lead to the corrosion of instruments. Therefore, they should be identified and reprocessed completely.

Wet packs can occur due to various reasons. Operator errors have been associated with wet packs. Some of the common operator errors that result in wet packs include cycle errors, load errors, and sterilization packaging errors. Sterilization packaging errors include the use of incorrect packaging during sterilization and placing a wrap that is too loose or too tight. Operators are also prone to double-pouching or double-wrapping packs using pouches or packages not used for this purpose. Therefore, the quality of the materials used in packaging instruments is important. The packaging materials should allow air and steam entry into the package. Reusable linen is used in some countries for sterilization in an autoclave. Moisture can be retained during sterilization, leading to wet packs.

Operators can also make cycle errors that would result in wet packs. For instance, the selection of the wrong autoclave cycle would make the instruments moist. Condensation can also occur on the packages when the packs are removed from the autoclave before the end of the recommended cool-down period. Placing the packs on cool surfaces even after the cool-down period is complete could also cause condensation to take place on the packs. Also, operators may fail to choose the drying time recommended by manufacturers, or they may interrupt the drying cycle.

The common load errors made by operators include packages that are too dense, incorrect loading or overloading the autoclave, and packages that are inappropriately stacked. Wet packs can occur when packs are placed in the autoclave in such a way that air cannot be easily eliminated from the autoclave. Difficulty in eliminating air from the autoclave prevents effective drying of the packs since air circulation is necessary for proper drying (Keitel, 2019). The instruments are not supposed to be placed in a way that impedes moisture drainage. Instruments with concave surfaces and those with lumens-like handpieces trap moisture or prevent the drainage of moisture, making it difficult to dry them. Instruments from the autoclave are also likely to be moist when the chamber drain is obstructed. A package that has a heavy metal mass, with an unequal metal mass distribution, or one that is too dense can also lead to wet packs. However, this is a common occurrence for instruments used in dentistry due to their heavy metal mass.

Autoclave performance issues would also lead to wet packs. Such issues include a damaged gasket, malfunctioning vacuum systems, poorly calibrated pressure cages, clogged strainers and screens, and the malfunctioning of a drain check valve and a steam line trap. Most of these issues arise from poor maintenance of the sterilizer. The load should be reprocessed if the indicators show that the drying cycle was aborted or sterilization parameters were not met. It is important to note that dynamic air removal autoclaves are more effective in drying instruments than gravity displacement autoclaves. Therefore, identifying the best sterilizer to use and the issues associated with the performance of autoclaves can help in preventing wet packs.

The quality of steam used in drying the instruments is also important. Steam with a moisture content of 3% is considered saturated steam. Excessive pressure drops may cause steam from a boiler to be very wet. This can end up causing wet packs. Wet packs can also result from non-condensable gases such as nitrogen, oxygen, and carbon IV oxide (Rodrigues et al., 2021). This occurs due to a faulty vacuum pump or a long duration between cycles, leading to the formation of air pockets in the sterilizer. Besides, the non-condensable gases traveling inside the steam pipeline cannot be entrapped by poor steam traps. This can result in wet packs.

Kristine can apply several solutions to prevent wet packs. She can start by checking if there are steam supply issues. She should check if there is a point where steam is trapped. A steam trap could lead to incomplete drying of the instruments. Therefore, she should check for any steam trap starting from the boiler to the autoclave. In addition, she should make sure that the steam being fed into the autoclave is of acceptable dryness. Too much moisture in the steam could make the instruments moist even after the completion of the sterilization cycle.

Other than checking for possible steam supply issues, Kristine should ensure that she is not making any errors. She should confirm that she is selecting the right sterilization cycle. Also, she should ensure that she is packing the instruments properly. Loading the autoclave with too many instruments could be the cause of the wet packs. This is because air does not freely circulate in an autoclave that is heavily loaded with materials. Therefore, she should ensure that she is packing the autoclave with the right quantity of instruments, and there should be enough space for steam to travel around the load.

The wet packs could have various effects on the operating room and the sterile processing department. In the operating room, the wet packs could be a potential source of infections, thus affecting patient care and safety. The presence of moisture on instruments creates a route for microbes to travel into the package from the outside (Basu, 2017). A wet package contaminates a sterile field when placed there. An entire sterile field has to be set up again when a wet pack is opened in surgery. Therefore, there is a delay in a surgical case whenever a wet pack is discovered in the OR.

The sterile processing department is also affected by the presence of wet packs, as they lead to an increased workload. The technicians in the sterile processing department would be forced to reprocess the wet packs. In addition, they would have to check for the presence of wet packs among instruments that have already been sterilized. This might cause recontamination of the instruments. The sterile processing department would also consider retraining its personnel. The technicians would have to be trained on how to handle such issues in case they occur in the future. This would also involve informing them of the possible causes of wet packs. As a result, the sterile processing department would use a lot of training for its personnel.

Overall, the wet load is a common issue that should be avoided. Determining the causes of wet packs can play a significant role in finding solutions to the problem. Wet packs could occur due to operator errors or issues associated with the performance of the autoclave. Operator errors such as load errors, cycle errors, and sterilization packaging errors are common causes of wet packs. The malfunctioning of the autoclave, such as a steam line trap, could also cause wet packs. Therefore, technicians have to check for all possible causes of the wet packs to get solutions to the issue. If not resolved, wet packs could cause problems for the OR and sterile processing department since they enhance the recontamination of instruments.

References

Basu, D. (2017). Reason behind wet pack after steam sterilization and its consequences: An overview from Central Sterile Supply Department of a cancer center in eastern India. Journal of Infection and Public Health, 10(2), 235–239. https://doi.org/10.1016/j.jiph.2016.06.009

Keitel, S. (2019). Wet packs: is extending drying time increasing water (scarce natural resource) consumption? Pharma Times, 42(2), 21.

Rodrigues, S. B., de Souza, R. Q., Graziano, K. U., Erzinger, G. S., & Souza, O. (2021). Performance evaluation of chemical, biological and physical indicators in the process of sterilization under the effect of non-condensable gases. Journal of Hospital Infection, 108, 1–6. https://doi.org/10.1016/j.jhin.2020.11.005

van Doornmalen, J. P. C. M., Tessarolo, F., Lapanaitis, N., Henrotin, K., Inglese, A., Oussoren, H. W., & Queiroz de Souza, R. (2019). A survey to quantify wet loads after steam sterilization processes in healthcare facilities. Journal of Hospital Infection, 103(1), e105–e109. https://doi.org/10.1016/j.jhin.2019.05.008

Decontamination Principles

More than 45 million surgical procedures are done every year in the United States. All surgical procedures involve contact between a patient’s mucous membranes or sterile tissue with a surgical instrument or medical device. This implies that precautions have to be put in place to ensure that all the surgical instruments in operating rooms are decontaminated. Failure to properly sterile or disinfect surgical instruments has been associated with mild to severe infections. Sterile processing professionals have been handling issues revolving around reprocessing of surgical instruments and reusable medical devices. This paper focuses on an analysis of decontamination principles that should be put into consideration in a surgical suite based on a case study.

In the case study, the main issue was that dirty neurological instruments were found in the operating room the previous week. This is not the first time the incident has occurred since the instruments have made it into the OR on multiple occasions over the past few months. This could be occurring because the instruments are not properly cleaned and sterilized before being taken to the OR. The personnel responsible for cleaning and sterilizing the instruments could not follow the protocols. It is also possible that the manufacturers of the instruments did not come up with clear instructions regarding the cleaning and sterilization of the instruments. The presence of dirty neurosurgical instruments in the OR could also be occurring because the instruments are usually not taken for decontamination. The personnel in charge of sterilizing the instruments could forget to take some of the instruments when taking them for sterilization. However, there is also the possibility of the instruments being handled poorly after being cleaned and sterilized (Holmes, 2019). For instance, the instruments are stored in dirty environments even after being cleaned and sterilized.

Other than preventing dirty neurological instruments from getting into the OR, there are several other precautions the sterile processing technician should take with neurological instruments. The technician needs to wear personal protective equipment when handling the instruments. This would help in preventing exposure to infectious microorganisms such as bacteria. There have been reports of sterile processing technicians acquiring infections from neurosurgical instruments. Wearing protective equipment such as full-body suits, safety glasses, and gloves can help reduce the risk of exposure to infections. In addition, the technician should ensure he does not contaminate other instruments after handling dirty instruments. This can be done by cleaning hands with soap and water before handling any other instrument.

There are several things the sterile processing department has to do to prevent dirty neurological instruments from getting into the OR. First, it would be necessary to train all the personnel involved in the cleaning and sterilization of neurological instruments. They should be trained on the cleaning and sterilization protocols that should be followed for different instruments. The training can be done through the use of seminars. However, it would also be necessary to evaluate the qualifications of different personnel in the department. Those who did not acquire proper training before being employed should be trained further to improve their skills. Besides, the department should consider hiring personnel who underwent proper training to avoid the expense of retraining its personnel. This would ensure that the department is staffed with personnel who are highly skilled in handling neurological instruments.

The sterile processing department should also come up with policies regarding the reprocessing of neurosurgical instruments. For instance, it should have the standards of procedures that personnel need to adhere to when cleaning and sterilizing neurosurgical instruments. There should be guidelines on how the instruments are taken from the OR to the room where they are cleaned and sterilized. Single-use instruments should be separated from multiple-use instruments and disposed of properly. Moreover, the department should have a policy on the frequency at which reprocessing procedures are reviewed. Reviewing the reprocessing procedures would help the department identify the factors that lead to dirty neurological instruments getting into the OR. This would also help the department determine compliance with the protocols by personnel. Also, the department should have a policy on the people involved in purchasing new neurological instruments. Reprocessing personnel can play a significant role in the assessment of new neurological instruments. They can help determine the instruments that are easier to clean and sterilize.

The process of decontaminating surgical instruments is a complex process involving multiple steps. The decontamination process begins during surgical procedures when instruments are cleaned to prevent the drying of blood and debris on the surface and within lumens. A sterile, water-moistened sponge is used to wipe the instruments clean. For the instruments with a lumen, a syringe filled with water is used to flush the lumens to remove blood. However, saline should not be used since it has chloride ions, which can lead to pitting.

After the instruments have been decontaminated at the point of use, they are taken to the reprocessing area. In the reprocessing area, they are cleaned and rinsed thoroughly. Several microorganisms and inorganic matter are removed during this process. It has been shown that there is a 99.99% decrease in microbial load when instruments undergo thorough manual cleaning (Rutala et al., 2020). A mechanical washer-disinfector is more effective in decreasing the microbial load on instruments. Residual detergent and loose debris are removed when they are thoroughly rinsed. Since cleaning and rinsing the instruments does not remove or kill all the microorganisms, the instruments need to undergo further processes for complete decontamination. However, the instruments should be dry before being taken for subsequent decontamination.

After being cleaned and dried, it is necessary to sterilize instruments to kill more microbes. Sterilization can kill 99.9999% of microbes(Lopes et al., 2019). Different methods of sterilization can be used to sterilize instruments. The most commonly used methods are physical methods, chemical methods, and physical-chemical methods. Physical methods involve the use of moist heat and dry heat. Chemical methods involve the use of liquids such as glutaraldehyde and ortho-phthalaldehyde. The effectiveness of sterilization depends on several factors, including location and number of organisms, types of organisms, and contact time (Chobin, 2019). Therefore, all these factors have to be put into consideration when choosing a method of sterilization.

Ensuring that clean instruments are delivered to the surgical suite is a collective effort of every person working in the sterile processing department. Every personnel should ensure that all the necessary procedures are followed when cleaning and sterilizing instruments. In case challenges arise from the methods used in decontaminating the instruments, it should be the responsibility of every person to report such issues. In addition, the instruments should be handled properly during decontamination. The instruments should be kept in a clean environment, and the personnel handling them should be clean and wearing personal protective equipment.

All in all, several issues are likely to arise regarding the decontamination of neurosurgical instruments. Dirty instruments can easily be found in a surgical suite if the necessary procedures are not followed when cleaning and sterilizing the instruments. It is the role of the sterile processing department to ensure that these instruments are not found in any OR. The sterile processing department should come up with policies regarding the cleaning and sterilization of instruments.

References

Chobin, N. (2019). Surgical Instrument Decontamination: A Multistep Process. AORN Journal, 110(3), 253–262. https://doi.org/10.1002/aorn.12784

Holmes, S. (2019). An overview of current surgical instrument and other medical device decontamination practices. In Decontamination in Hospitals and Healthcare (Second Edition, Vol. 2017). Elsevier Ltd. https://doi.org/10.1016/B978-0-08-102565-9.00020-0

Lopes, L. K. O., Costa, D. M., Tipple, A. F. V., Watanabe, E., Castillo, R. B., Hu, H., Deva, A. K., & Vickery, K. (2019). Complex design of surgical instruments as barrier for cleaning effectiveness, favouring biofilm formation. Journal of Hospital Infection, 103(1), e53–e60. https://doi.org/10.1016/j.jhin.2018.11.001

Rutala, W. A., Gergen, M. F., Sickbert-Bennett, E. E., & Weber, D. J. (2020). Comparative evaluation of the microbicidal activity of low-temperature sterilization technologies to steam sterilization. Infection Control and Hospital Epidemiology, 41(4), 391–395. https://doi.org/10.1017/ice.2020.2

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Sterile Processing Case Studies Project

Assignment Instructions

Sterile Processing Case Studies Project

OBJECTIVE: The purpose of the case study is to allow the student to analyze information retained over the duration of the sterile processing program and apply that knowledge obtained to provide specific solutions to common issues that may occur within the sterile processing department.

CASE STUDY INSTRUCTIONS

Choose two of the four topics as listed below: Decontamination Principles, Sterilization Methods, Preparation of

Medical Equipment and Supplies, and Inventory Control and Distribution Systems. Once the two case studies are chosen, answer the questions using your own vocabulary and address the conflicts or issues with solutions specific to your topics of choice. To fulfill the requirements of this case studies project, you must employ research techniques. You can utilize your text or other credible sources from the internet to build a thorough paper that contains at least six main ideas with supporting details regarding the topic chosen and a minimum of three credible references. The paper must be written in APA format with an extensive introduction, body, and concluding statement per case study. Minimum of four pages, double-spaced excluding title and reference pages per case study. Please refer to the rubric regarding specific grading criteria.

Now that you understand the basic goals of this project, let’s get started.

1. Decontamination Principles: Sarmiento is a well-known neurosurgeon at Baptist Medical Center. He is known for working on complex cases that involve the spine and other neurological tissues. This past week, his private scrub tech has discovered that dirty neurological instruments have made it into the OR. The technician consults with the patient care manager of surgical services because the incident has been reoccurring over the past few months. With this knowledge, respond to the following questions:

• What issue(s) have occurred, and what may be the cause of these errors?
• What other special precautions may the sterile processing tech need to take with instruments exposed to neurological tissues?
  

  Sterile Processing Case Studies Project

• What might the sterile processing department have to do to resolve this issue?
• Thoroughly explain the decontamination process. What extra efforts should be made to ensure that clean instruments are delivered to the surgical suite?

1. Sterilization Methods: Kristine, a technician in the sterile processing department, has noticed that after the sterilization of surgical equipment and supplies that at least two out of every four loads sterilized for the day have been moist. She has consulted with her supervisor on effective ways in which she could troubleshoot the concerns with wet loads, because it has now affected the department’s work efficiency and quality control.

• Define a wet pack.
• Define a wet load.
• Why might the loads be wet?
• What solutions can Kristine apply to ensure that the processed instrument sets aren’t moist?
• Discuss how this issue can affect both the operating room and the sterile processing department. How should Kristine handle the wet packages to ensure quality control?

Sterile Processing Case Studies Project

Your work will be evaluated on the following criteria:

Specific Criteria for Grading	Case Study 1: Decontamination Principles	Case Study 2: Sterilization Methods	Case Study 3: Preparation of Medical Equipment and Supplies	Case Study 4: Inventory Control and Distribution
Student demonstrated a thorough comprehension of selected topic discussed	5/	5/	5/	5/
Topic discussed was pertinent to subject selected	5/	5/	5/	5/
Content is supported with at least three references from textbook or valid Web content	5/	5/	5/	5/
Content offered solutions to issues that could potentially develop within that specific case study selected	5/	5/	5/	5/
Student was able to provide at least eight main ideas with supporting details about the topic discussed	5/	5/	5/	5/
Student writing was well-organized	5/	5/	5/	5/
Student used appropriate grammar and punctuation	5/	5/	5/	5/
Student case study was written in the appropriate APA or MLA format; references are cited using APA or MLA format	5/	5/	5/	5/
Student reflection provided details on how the student could contribute to central processing in an effective manner for quality control and patient safety utilizing specific examples relevant to the text or other credible sources	5/	5/	5/	5/
Student answered all the questions as elaborated in case study	5/	5/	5/	5/
Total Points Possible	50/	50/	50/	50/

 

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