Outpatient Surgery Magazine

Helping Hand - July 2019 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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J U L Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 0 3 enced a staggering 22 such hiccups in a single month here at Children's Hospital in New Orleans, prompting a reboot of our instru- ment processing process. We began by getting input from all stake- holders — SPD staff, perioperative nurses and surgical technicians — and created a team with representatives from each group. We asked the team to take stock of our current process, identify strengths and weaknesses, and develop both a plan for change and an implementa- tion strategy. Here are 7 of those key changes: 1 Cleaning begins in the OR. The decontamination process should begin at the point of use. Arguably the most important step of decontamination is the removal of instrument debris in the OR during and at the conclusion of a case so that it does not dry. When soils dry on instruments, they become harder to remove, increasing the risk of biofilm formation and endotoxin accumulation. Sterilization requires direct contact between the sterilant and the surface of the instrument. So without decontamination, sterilization cannot be achieved. We asked our SPD staff to train OR nurses and surgical techs how to clean instruments in the OR. Most notably, SPD staff stressed the importance of and technique for removing gross debris from instru- ments with moist gauze and sterile water, and then spraying instru- ments with an enzymatic solution designed to facilitate breakdown of soils and finally wrapping instruments in a towel moistened with water for transport. The instruments must remain moist with a wet towel or enzymatic until proper decontamination begins. The instru- ments should be transferred in a closed system to the decontamina- tion area from the operating room. We also made it mandatory to wash all surgical instruments by hand, not just those with visible contamination. SPD staff also identi-

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