ment reprocessing routine, rarely pretreating instruments in the OR,
and we'd never had problems with SSIs. So they thought, if it's not
broke, why fix it? Well, you need to fix it because you're playing with
fire with both auditors and patients. After all, there's a first time for
everything — including SSIs.
The idea, of course, is that by pretreating instruments at point of use,
you not only reduce the risk of SSIs, but perhaps more importantly,
bioburden won't harden and make the jobs of your reprocessing techs
more difficult and time-consuming. You know how hard it is to clean a
bowl caked with mac-and-cheese residue you left in the sink overnight?
Now you know how your sterile processing staff might feel. Getting the
guck off right after your meal works wonders when you actually wash
the dishes later on. Same goes for surgical instruments.
The Joint Commission now "expects" surgical instruments to at
least be kept moist until terminal cleaning if the instructions for use
(IFUs) of specific instruments call for it, which increases the urgency.
Now that this is the standard of care, surgical facilities need to adapt
and implement. We found that successfully changing the clinical
process required us to also change the culture around it.
In the endless battle to balance on-time starts and turnover time, OR
staff prioritize many duties, which leads to compromises. When you
ask them to complete another task in the same time frame, you might
receive a response like, "How are we supposed to make this happen
and still remain efficient?" Well, in our case, we made it happen. Here's
how.
Audit. Take a close look at how you're currently doing things.
We audited the decontamination area to determine how well our
OR staff was complying with pretreatment protocols, collecting data
on how many instruments enter CSP in substandard condition. We
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