Meeting Disinfection and Sterilization Standards Starts with Proper Instrument Point of Use Processes

by John Stehle, PhD, CIC | Director of Client Value at Infinite Leap

The process of proper cleaning and disinfection is a critical part in reducing the risk of exposure to COVID-19. However the importance of this process in the healthcare setting is not a new issue. The complexity around keeping patients safe is continually highlighted in data released by The Joint Commission. For example in 2017, the agency reported that 72 percent of surveyed hospitals and critical access hospitals were found to be noncompliant with The Joint Commission’s high-level disinfection and sterilization standard IC.02.02.01.

A common situation is when a proper instrument point of use process breaks down and fails to meet the AAMI and/or AORN guidelines. These instrument point of use guidelines are meant to reduce the risk of biofilm formation when instruments sit after a procedure, which can impact the efficacy of the sterilization. In brief, these guidelines recommend the following actions:

  1. Remove as much bioburden as possible from the instruments at the point of care, immediately following a procedure.

  2. Keep soiled instruments moist until terminal cleaning can begin.

  3. Transport the soiled instruments to the Sterile Processing Department (SPD) as quickly as possible for cleaning.

These 3 steps seem simple but have logistical complexity you must work through in order to maintain compliance and ensure patient safety. This is especially true when it comes to implementing these steps outside the surgical/procedural areas as highlighted in the ambulatory clinic and inpatient unit settings.

The first step involves educating clinical staff on the importance of removing gross soil at the point of use, with a disposable gauze pad or a cloth moistened with water. This point of use cleaning should be performed when the procedure ends. Ultimately, this step involves the monitoring of staff as well to ensure compliance with the process. 

The second step, keeping the instruments moist, can be accomplished in a number of ways including through the use of the many enzymatic/protolytic sprays. However, a simpler and less costly way is to place a moistened towel or pad over the instruments, then place them in a sealed, rigid container. As long as the towels stay moist and the container stays closed and sealed, the humidity should be maintained at 60-80% RH, which will keep the instruments from drying out. 

The third step in this process involves the efficient pickup of the instruments for timely delivery to SPD. This can be accomplished with regular courier pickup from ambulatory clinics and through appropriate rounding on inpatient units to check soiled utility rooms. These processes may or may not involve the clinical staff notifying SPD staff of the presence of soiled instruments via phone calls, emails, and/or texts. However, these represent labor and resource intensive options and still have a high risk of breakdown in the process.   

The use of a Real-Time Location System (RTLS) can greatly optimize these workflows by saving staff time while simultaneously monitoring and ensuring compliance. Infinite Leap has worked with clients to utilize RTLS technology to improve the communication between clinical and SPD staff. One such example is by leveraging RTLS to notify the SPD team when soiled instruments have been placed in a container, along with the location of the container. An example of the process is shown in the illustration below.

The clinical staff place soiled instruments in the secured containers, ensure moistened towels are present, then press a button on the location tag attached to the bin. In this example clinical staff press the yellow button, which triggers a notification (email and/or text) to be sent to the SPD team with the exact location of the bin. In addition, a display board located in the SPD department shows the exact location of all bins that need to be picked up, so the SPD team can optimize their pickup route. Once the instruments are picked up the SPD staff pushes the green button to clear the alert and add a timestamp that the instruments have been picked up and will soon be undergoing terminal cleaning in the SPD area.

The use of an RTLS system also adds the benefit of providing data for compliance purposes, immediately providing the ability to know the amount of time instruments sit within a unit or clinic, which can be used for compliance documentation and for process improvement. Additionally, a temperature/humidity tag can be placed inside a sealed container to monitor humidity levels. The automated readings can serve as further compliance records, indicating that high humidity was maintained and the instruments were prevented from drying.  

From my experience, including managing the Infection Prevention Department of a large, multi-hospital academic healthcare system, using RTLS combined with this simple three-step process greatly improves staff productivity while monitoring and ensuring compliance. The end result is optimal use of staff time and costly instruments, while at the same time achieving the main objective of ensuring patient safety. If you would like to brainstorm how to improve patient and staff safety, please reach out to me. I will be glad to help.