• Point-of-use cleaning. The longer biofilm sits on instruments, the
stronger it becomes and the harder it is to remove. Begin the cleaning
process as soon as possible after instruments have been used. After
you wipe and rinse away all gross, heavy organic debris and flush can-
nulas with sterile water, keep instruments moist. You can spray them
with an enzymatic solution or foam, cover them with a moist towel, or
place them in a plastic bag or pouch. Don't let moist instruments sit
for too long. The conditions for biofilm to form are perfect when bac-
teria remain in a wet environment for a long time. Then it becomes
even more difficult to get your instrument microbe-free.
• Transport to central sterile. After point-of-use cleaning is com-
plete, promptly transport instruments to central processing in a cov-
ered container. New AORN guidelines state that OR staff should docu-
ment when the procedure ended so techs know how much time has
elapsed between the end of the procedure and the start of cleaning.
• Cleaning. This step depends on the instrument and the manufac-
turer's instructions for use (IFU). Follow these instructions exactly to
ensure thorough cleaning. Depending on the type of instrument, this
might include manual cleaning, ultrasonic washing or using an auto-
mated washer. If allowed by the IFU, mechanical cleaning is preferred
over manual scrubbing because it's more thorough and less variable,
according to some endoscope reprocessing guidelines
(osmag.net/oVrP6X).
When you manually clean, lumen-flushing devices, pull-through brush-
es and other endoscopic cleaning aids may boost the tech's effective-
ness during scrubbing. Detergents have a difficult time penetrating
biofilm colonies, so typically you'll need to scrub any observed biofilm
with a brush and detergent several times. No studies show that one par-
ticular detergent is better than another at removing biofilm.
• Sterilization and/or high-level disinfection. Following the IFUs,
7 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 6
