Sterile Processing Case Study
Decontamination Principles
The apparent issue in the case presented is the entry of dirty instruments into the operations. Operation rooms are critical locations with strict environmental conditions for invasive procedures. In this respect, ORs should be free from all sources of pollution and any other micro-environmental alterations that may compromise the integrity of ORs (Kirnon, 2024). All items used in the OR must be sterile. The entry of a dirty or sterile item into the operation room is a demonstration of a significant compromise of the safety standards and OR protocols for infection control. This was the case in the case presented.
Several factors can result in the entry of dirty instruments into the operation room. Improper cleaning of instruments before sterilization can result in the entry of dirty instruments into the OR. This may be the case when particulate matter clogs tiny channels within surgical instruments. In this case, the cleaning process may not remove all the dirt (Cutler et al., 2020). Infrequent cleaning of surgical instruments may also allow the entry of dirty surgical items into the OR. This may be the case if instruments sit around for hours or days before being cleaned. In this case, blood and tissue on the surface of the surgical instrument may dry and harden, making them hard to remove during cleaning. Human factors, such as fatigue, may also contribute to work inefficiencies when cleaning surgical instruments. This may result in improper cleaning and consequent release of dirty instruments into the operation room. Technicians’ inexperience in complex cleaning procedures may also result in dirty instruments entering the OR. Advancements in medical instrumentation have seen the entry of sophisticated surgical instruments that are difficult to clean (Cutler et al., 2020). Lack of knowledge of the cleaning protocols for these items may result in the entry of dirty items into the OR.
The sterile processing technician should take into consideration the cleaning protocol for various surgical equipment. In this respect, all surgical instruments should be cleaned per the protocol before sterilization. Additionally, surgical instruments should be kept wet before cleaning to prevent blood and other tissue components on the surface of these instruments from drying up. The cleaning surfaces should also be clean. This can help prevent decontamination of cleaned items.
The sterile processing department can take several steps to resolve the issue. To begin with, all sterile processing technicians should be educated on the significance of sterilizing surgical equipment and the cleaning protocols for various surgical instruments. This may help bridge apparent gaps in knowledge of cleaning complex instruments and enhance their accountability. Staffing considerations should also be met to reduce the work burden on available staff. This may help address human factors such as fatigue that may interplay in the entry of dirty instruments into the operating rooms.
The decontamination process is multi-step and begins with pre-sterilization cleaning. In this step, particulate matter and substances clogged on the surfaces are removed. This step is followed by the inspection process. It involves checking all cleaned instruments for cleanliness and damage. The step is followed by sterilization. The sterilized instruments are then stored. The pre-sterilization cleaning, inspection, and sterilization processes occur in the SPD. While some surgical instruments are stored in the OR, some are kept in the SPD.
Cleaning is sometimes considered the cornerstone of instrument processing. This is because it ensures the physical removal of contaminants. It also provides a better guarantee of sterilization, as an instrument that is not clean can never be sterile (Cutler et al., 2020).
Sterilization Methods
The case is of a technician at the sterile processing department reporting that at least two of the four sterilized loads are moist. The primary concerns in the case presented included the presence of a wet load and its potential impacts on patient safety in the surgical department.
A wet pack is a term used to describe the presence of identifiable traces of moisture on an item upon exposure to a steam sterilization process. This can be in the form of dampness, puddled water, or droplets within the pack. They are usually indicative of a defective step during the sterilization process. Wet packs are a potential source of contamination and should thus be addressed.
A wet load is a term used to describe the presence of identifiable moisture in more than one pack from a single autoclaved load. It is usually indicative of a more severe defect in the steam sterilization process. Likewise, wet loads are a potential source of contamination and should thus be addressed. Consistently, there are several causes of wet loads during steam sterilization. The first cause of a wet load is an operator’s error. Operators’ errors are usually due to a lack of training of the operators on autoclave use within the laboratory setting or operators’ inexperience in using the autoclave. It can also be a result of intrapersonal factors, such as fatigue and emotional instability, hindering the operational efficiency of the operator. Operator errors can be in the form of overloading of the autoclave machine, wrong selection of the sterilization cycle, or improper handling of the load (Barbosa Rodrigues et al., 2022). Regardless of the form and cause, the error may result in identifiable moisture on the sterilized item, surmounting a wet load.
Component failure can also cause a wet load. This can be due to defects in specific components such as valves, vacuum systems, steam traps, or chamber drain strainers. Wet loads can also be a result of a defective steam supply. The presence of clogging in the steam trap of the main steam line can cause the load to be waterlogged due to excessive condensation.
There are several measures Kristine can take to ensure freedom from wet loads. To prevent operator-related wet loads, Kristine should ensure the autoclave is not overpacked and that there is plenty of space left for the steam to travel around the load. She should also ensure that she selects the correct cycle for every sterilizing cycle to allow the proper dry time. To prevent component failure-related wet loads, Kristine should ensure the vacuum system is functional, and the chamber drain strainer is clean before beginning the sterilization process. To prevent steam supply-related issues, Kristine should ensure that the autoclave is fed with saturated steam with acceptable particulate and dryness levels. These measures may minimize the potential for steam loads.
The presence of wet packs and wet loads is suggestive of operational inefficiencies during the sterilization process. In the operating room, wet loads can cause delays in surgical procedures, causing frustration to the team members and the patients. To the sterile processing department, wet loads can result in time wastage as they may warrant process duplication, increase the workload on the staff, as they may have to reprocess the items, and eventually increase the cost for sterilization processes, as the process may have to be repeated. To ensure quality control, Kristine should completely reprocess the wet loads while taking precautions to prevent wet packs.
References
Barbosa Rodrigues, S., Queiroz de Souza, R., Uchikawa Graziano, K., & Sidnei Erzinger, G. (2022). Specialists’ opinion regarding factors related to wet loads after steam sterilization. Journal of Hospital Infection, 120, 117–122. https://doi.org/10.1016/j.jhin.2021.12.003
Cutler, H. S., Romero, J. A., Minor, D., & Huo, M. H. (2020). Sources of contamination in the operating room: A fluorescent particle powder study. American Journal of Infection Control, 48(8), 948–950. https://doi.org/10.1016/j.ajic.2019.12.027
Kirnon, S. (2024). The role of decontamination in reducing healthcare-associated infections. Nursing Standard, 39(5), 45–50. https://doi.org/10.7748/
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Question 
Objective
The purpose of the case study is to allow you to analyze information retained throughout the sterile processing program and apply that knowledge obtained to provide specific solutions to common issues that may occur within the sterile processing department.
Sterile Processing Case Study
Instructions
Choose two of the four topics listed below:
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•⚫ Decontamination Principles
• Sterilization Methods
• Preparation of Medical Equipment and Supplies
• Inventory Control and Distribution Systems