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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Constant instrument care Treating instruments in the OR immediately after they're used ensures the cleaning process in the ster- ile processing department is as easy and efficient as possible. A member of the surgical team should use a four-by-four-inch gauze pad to wipe soiled instru- ments with sterile water each time they're handed back by the surgeon. In addition to this being sound instrument care, it also helps the procedure run smoothly as surgeons appreciate being handed back a pair of non-bloody scissors the second they're needed. A point of emphasis: Saline should never be used to wipe down instruments. It degrades stain- less steel over time and, like blood, can eat through the top passivation layer to cause pitting. In a larger OR setting, set up a draped Mayo stand with a basin of water and gauze pads. When handed an instrument, simply turn to the table, wipe the instrument clean and return it to where it's kept until it's needed again. If you work in a smaller OR with limited space to move, draw a square on the back table with a marker and label it "water for cleaning." Place a silver or plastic basin and gauze pads in the area. Either setup ensures you're not mixing soiled instruments with tools that have not yet been used. At the end of the procedure, the surgical assis- tant, surgical tech or nurse who wiped down the instruments dur- ing the case simply wipes them down again using the same water and the same gauze, and places them in a discard pan, back on the surgical tray or in a biohazard box — whatever container is used to transport instruments to the sterile processing department. There aren't a lot of requirements for the type of containers to use. They should be big enough and high enough to completely con- tain the instruments they hold. They should also be puncture resistant and affixed with a bio- hazard label if they're transported through a common hallway. Soiled instruments should be sprayed with a pre- treatment gel or spray before transport to sterile processing. Although transport gel is preferred, using a damp towel to cover the instruments is accepted practice. This step is particularly impor- tant in surgery centers with smaller sterile process- ing departments where delays between a set's arrival and when the decontamination process begins are relatively common. Keeping tools moist makes stuck-on blood and other bodily fluids easier to remove when manual cleaning ultimately begins. There is some concern about aerosolizing bio- hazardous bodily fluids in the OR. For this rea- son, some hospitals insist that instruments are taken to a dirty instant room for treatment before transport to sterile processing. I don't recom- mend this practice, however. Instead, purchase a non-aerosolizing moisturizer and, after the patient has left the room, spray the instruments as they're spread out in the OR. This is a better option for a couple of reasons. One, application of the moisturizer takes place soon after the case ends, and the sooner it's applied the better. Two, it's more likely that the surfaces of all the instruments will be treated. After an instrument set has been put into a closed cart and taken to a dirty room, whoev- er is doing the spraying will likely just open the 4 6 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 2 0 WORKING AHEAD Instruments that are treated in the OR are easier to clean when they arrive in central sterile. Penn State Milton S. Hershey Medical Center