Prioritize Point-of-Use Instrument Care

Bedside treatments prevent bioburden, making it easier for SPD technicians to thoroughly clean tools before sterilization.

There’s plenty of compelling big-picture data out there to support the need for meticulous and consistent point-of-use instrument care. A 2020 study in BMJ Quality & Safety is a great example. According to the study, healthcare-associated infections (HAI) affect 5%-10% of hospitalized patients, with 1.7 million HAIs per year resulting in 99,000 deaths and costing $20 billion per year in the U.S. Surgical site infections account for 20% of these HAIs, a number of which can be traced directly back to deficiencies in sterile processing — including a lack of or ineffective precleaning.

Onboard the USNS COMFORT (T-AH 20), a 1,000-bed Navy hospital ship that houses 12 operating suites, our protocols are designed to avoid any potential deficiencies in sterile processing. No easy task considering our services include general surgery, OB-GYN, orthopedics, ophthalmology, urology, plastics, oral and maxillofacial and otorhinolaryngology. On any given day, our surgical team can go through more than 100 sets, filled with a variety of surgical instruments. Even though the Sterile Processing Department (SPD) is equipped with state-of-the-art washer-disinfectors, ultrasonic machines, and steam and low-temperature sterilizers, surgical techs must ensure soiled instruments are properly treated before transport for reprocessing. Here’s how we manage point-of-use cleaning — and how it helps maintain the lifespan of our instruments while improving workflow and patient care.

Extending the lifecycle of surgical instruments

The cleaning of medical equipment ranks among the top 10 most common compliance issues. Even though a designated team member is responsible for decontaminating all surgical equipment and instruments, it’s imperative for all members of the surgical team to promote awareness and demonstrate timely decontamination methods. Proper and consistent point-of-use instrument care is a crucial step in fostering a responsible culture and safe environment. It may feel like an unnecessary step to add to a lengthy sterilization process, but it sets the SPD team up for success. Essentially, precleaning consists of using an enzymatic spray and a moist towel to wipe away any excess debris or bioburden, or sterile water, which is used for soaking and cleaning of surgical instruments in this stage of the process. 

After an instrument is used in a procedure, it’s important to decontaminate instruments as soon as possible on the back table to promote the removal and breakdown of bioburden. During surgery, I always soak my instruments in sterile water to prevent any blood or any bodily fluids from drying and hardening. Before the instruments travel to sterile processing, I’ll spray them down with a ready-to-use dual-enzyme pretreatment foam that’s designed for point-of-use care. It’s one small step in the precleaning process that can make a difference in the overall sterilization process. 

Surgical instruments are an investment and should be handled with care. If soiled surgical instruments are transported to the decontamination area without being treated, the SPD team is required to use a little more “elbow grease” during manual decontamination, especially with power tools, which can potentially cause budget issues for our facility. That’s because failing to pre-treat instruments not only makes the SPD’s job harder, but it also increases the possibility that the instruments will be improperly reprocessed.

Like all departments, staffing levels play a pivotal role in overall efficiency. If your SPD is short-staffed, it will likely take them a little longer to get to every tray in a timely fashion. This means that some dirty instruments may sit around for longer than the recommended 15 minutes to an hour. If bioburden hasn’t been pre-treated and is caked on a surgical power tool for an extended period of time, you may end up needing to replace it — a big hit to any facility’s bottom line. This is magnified by our unique situation. During a mission, which can last between two and six months, point-of-use instrument care, a step that goes a long way toward increasing an instrument’s lifespan, is absolutely vital. Replacement instruments are extremely limited, and we don’t have the luxury of ordering them while we’re deployed on a mission.

Creating workflow and building relationships

TEAM BUILDING The USNS COMFORT (T-AH 20) is a 1,000-bed Navy hospital ship that houses 12 operating suites and can go through more than 100 sets, filled with a variety of surgical instruments, during the course of a single day.

Creating a courteous professional relationship with staff members allows for effective communication and compliance. This allows everyone to work together toward the same goal in maintaining the point-of-use instrument care and helps to sustain a good relationship with the crew by maintaining a smooth workflow that ensures patient safety. Ineffective point-of-use instrument care by the surgical team impedes cleaning, increases sharps risks and increases the likelihood of missing, wrong and damaged instruments. This process can be simple, providing that consideration and keen attention are geared towards pre-treating the instruments before transport to the decontamination area. Proven results have shown that this process makes an enormous impact not only for the lifespan of the instruments, but it also helps in cultivating an efficient and respectful relationship between the Main Operating Room (MOR) and SPD staff.

Following through with point-of-use instrument care does two things: 

• It helps make everyone’s job much easier, and
• It keeps surgery running on time. 

Failing to practice point-of-use instrument care is a disservice to your staff and your facility, and most importantly, can do undue harm to your patients.

Providing safe patient care

The best way that we can successfully support the facility is to take diligent care of our instruments in accordance with the manufacturer’s instruction for use. Maintaining the safety of our patients is always our number one goal, and precleaning plays a pivotal role in achieving this end result. In short, properly caring for surgical instruments at point-of-use has a profound impact on the delivery of safe, timely and efficient surgical care. 

Point-of-use instrument care is a joint responsibility between SPD and the entire surgical team. Engaging in proper precleaning practices throughout and immediately after each procedure will ultimately impact outcomes and promote the type of efficient, top-quality care your patients deserve. OSM