SURGICAL SITE INFECTIONS A HIDDEN HOSPITAL

Leslie Teachout MT(ASCP), CICInfection Prevention Riverton and

Lander Hospitals

Objectives Discuss the five steps in Sterilization

Process Learn what processes in the OR the

Infection Prevention should review and/or understand.

Learn the five steps to monitor sterilization

OR Suite is hidden in the Hospital

Behind closed doors Special clothing-only scrubs Red lines to cross Very busy Sterile! Patient privacy very important A very specialized team

Sterile Processing Department (SPD) deep in the bowels of

the hidden hospital Sterilize instruments

Remove bio-burden!!! Proper type of sterilization

Proper instruments in each tray/wrap Monitor autoclaves/sterilization

equipment Maintain autoclaves/sterilization

equipment Immediate use sterilization

ANSI/AAMI ST79Association for the Advancement of Medical Instruments Standards

AORN STANDARDSAssociation of Operating Room

Nurses

Five steps in Sterilization Process

1. Clean/Disinfect 2. Prep/pack 3. Sterilize 4. Store 5. Issue/use

Clean/DisinfectInstruments

Open hinged instruments to remove bio-burden

Must clean before sterilization! Rust and/or pitting are the enemy! Instruments design and material Don’t reprocess single use instruments FOLLOW MANUFACTURE

RECOMMENDATIONS!!

Prep Enzymatic cleaner immediately Washer sterilizer can be used Monitor process with indicator Load size? Maintenance

Pack or Wrapping Hospital specific trays or sets All surfaces of the instruments must be

contacted by sterilant Wet packs mean water can contaminate

instruments Weight limits of trays

Autoclaves/sterilization Best way to sterilize

steam (see below for types) ETO Sterrad (plasma)

Types of steam cycles Gravity Pre-vacuum SFPP (Steam Flash Pressure Pulse)

Regular Cleaning Lint trap Maintenance

Five Steps to Monitor Sterilization

1. Equipment Control2. Load Control3. Pack Control4. Exposure Control5. Record keeping

Equipment ControlHow to determine if your sterilizer is doing it’s job.When using dynamic-air removal (i.e. vacuum-assisted steam cycles or pre-vac)

Begin each day with a Bowie-Dick test to detect air leaks.Air leaks, poor steam quality, inadequate vacuum and air pockets can lead to poor steam penetration.

Monitor the rest of the day by watching physical monitors

Load Control Foundation of successful

sterilization process monitoring: Biological Indicator or BI Only way to detect actual killing of microbial

spores Most reliable test Rapid read outs reduces risk of recalls and is

less expensive Required with implantable devices

Pack Control Use of chemical indicators (CI) for internal

monitoring of packs Verifies the sterilant has penetrated the

pack/peel pouch Chemical indicators are designed to react to two

or more of the critical variables required for steam sterilization: Time Temperature Presence of steam

CI have classes (not hierarchical!) Staff aware and understand importance!!

CI Classes

Exposure Control To know at a glance if

the packs have been exposed to the sterilization process.

These are CI class 1 process indicators

So packs don’t have to be opened

Record keeping Provides documentation that items have

been processed along with evidence of their monitoring results.

Extremely important in a recall investigation

Required for accrediation

Store How long is the wrap good for/shelf life? Inventory control Look for wet packs

SPD Immediate use (IU) Are “flashed packs” being used-

preferred Instruments cleaned prior to IU? Types of cycles Monitor for frequency of IU as this

may indicate an instrument need Is all the OR staff educated and

aware of the whole process?

How to combat “colon cancer” of SPD in the bowels of the hidden Hospital

Gown up or bunny suit up and go to the OR!

Ask questions! Ask questions! Watch processes! Get educated by staff as well as know the

standards! Who cleans the OR rooms/how often Check for cleanliness-white glove test

How to combat “colon cancer” of SPD (continued)

Review logs for monitoring and maintenance!

Watch processes in the OR! (i.e. medication administration)

Open doors! Check carts be NOSEY! Look at storage areas especially sterile

storage Look for storage in “hidden sterile storage

areas”(i.e. ED, PT and OB)

How to combat “colon cancer” of SPD (continued)

Remember and remind we are all on the same team!

Find out who does and owns the processes

Open doors on cupboards! Check drawer in carts for open skin

preps or medication! We all have the patients’ safety in

mind!

How to combat “colon cancer” of SPD (continued)

Monitor Surgical Site Infections for trends: OR staff OR Room Surgeon Was the immediate use autoclave used for instruments Customize for your hospital

Share findings with OR Staff! Share findings with Surgeons Share findings with Anesthesia Keeping patients’ is everyone's

responsibility

Check list Who process the instruments at your hospital? Are the individuals employed by your

organization! Check packages – have a process just like

checking outdates Initials Date Condition of package Indicator on peal pack

Is SPD cleaning instruments well before sterilization? Watch process

Are any instruments being used in your facility coming form outside (vendors, dentists, etc.)

Check List (cont.) Is washer used? Then how is it monitored? Are all autoclave cycles and autoclaves

monitored? Know what class of monitors are being used Frequency and documentation of Biological

Indicators (BI) Assure all implants are being monitored with a

BI What is your recall process when there is a

failure? (make sure your on the list)

Check List (cont.) How are autoclaves cleaned (how and

frequency)? Monitor room cleaning

All patient rooms (ATP or Diazo) White glove the tops of high surfaces/high

dusting and vents? Frequency of terminal cleaning and difference

between daily cleaning Who does the cleaning?

Immediate use Check list Cleaned prior? Walk through process; same a SPD Cycles used for what and when Are logs complete? Who owns this process? Is OR staff knowledgeable and

handles instruments appropriately?

Objectives Discuss the five steps in Sterilization

Process Learn what processes in the OR the

Infection Prevention should review and/or understand.

Learn the five steps to monitor sterilization

Questions? Be aware of the hidden hospital in your

hospital Stop the spread of the undiagnosed

cancer! Bring the process into the light!