OR Manager March 2022 - 27

AMBULATORY
SURGERY CENTERS
BY ERICA SMITH
Vital role of the central sterile department in ASCs
A
ccording to the Centers for Disease
Control and Prevention,
about one in 31 hospital patients
has at least one healthcare-associated
infection (HAI) on any given day.
To help mitigate HAIs, implementing infection
control procedures and policies,
frequently performing hand hygiene by
all staff and patients, and keeping the
healthcare environment and equipment
clean are key. One clinical space that
continues to help ensure that infection
prevention methods for both patients
and staff are met is Ambulatory Surgery
Centers (ASCs). ASCs implement
a variety of strict infection prevention
protocols at their facilities and often
establish a central sterile department or
location.
The chain of infection is a prime example
of why central sterile is important
for ASCs. The chain of infection
is a series of links that must be connected
for an infectious agent to have
the ability to transmit from one host
to another. These links include infectious
agents, reservoirs, portals of exit,
mode of transmission, a portal of entry,
AMBULATORY
SURGERY
ADVISORY BOARD
* Claire Everson, RN, CNOR, CCAP, Clinical Educator
and Consultant, Bloomfield Hills, MI
* Diane Fecteau, MSA, RN, CASC, NE-BC, Executive
Director, Maine Medical Center Scarborough Surgery
Center, Scarborough, ME
* Cynthia Hess, MSN, RN, FNP-C, RT(R)(CT)(ARRT), Director
of Nursing, Northeast Missouri Ambulatory Surgery
Center, Hannibal, MO
* Tracy Hoeft-Hoffman, MBA, MSN, RN, CASC,
Administrator, Heartland Surgery Center, Kearney, NE
* Beverly Kirchner, BSN, RN, CNOR, CASC, Chief Compliance
Officer, SurgeryDirect, Highland Village, TX
and a susceptible host. It is the job of
a healthcare professional to break at
least one, if not all, of the links to prevent
transmission.
Infectious agents can be eliminated
through cleaning, disinfecting, and sterilizing,
as well as by wearing the proper
personal protective equipment (PPE)
and appropriately changing and discarding
PPE. Additionally, air purifiers and
disinfectors can be used to remove any
modes of transmission in the air. Practitioners
can also enhance the safety of
immunocompromised patients by placing
them in different rooms. Performing
these steps correctly helps mitigate the
risks of HAIs or surgical site infections
for patients.
The following steps in the central
sterile process help keep ASC facilities
safe from infections.
Immediately transport
contaminated instruments
After a procedure is complete, used
instruments should be transported back
to the decontamination room as soon
as possible to prevent any soil from
drying on them. According to a comparison
study on the efficacy of cleaning
methods for ophthalmic microscopic
instruments, " the dried microbial biofilm
exhibits bacterial resistance to antibiotics,
disinfectants, and sterilization
agents. " Dried soil makes the cleaning
process more difficult; if instruments
cannot be properly cleaned, they cannot
be sterilized, which in turn increases the
chances of surgical site infections and
other harms from dried soil.
When transporting used instruments
to the decontamination area, the instruments
should be moved in a closed
container or a leak-proof cart. According
to AORN and Occupational Safety
and Health Administration (OSHA) guidelines,
when transporting sharps, the
container must be puncture-resistant,
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large enough to contain all contents,
and labeled with a fluorescent orange
or orange-red biohazard label. Proper
transportation prevents damage, potential
injuries to personnel, or exposure to
bloodborne pathogens.
Unsterile instruments not only pose
a safety risk for the ASC, but they also
have a financial impact. The cost of
throwing away instruments varies depending
on the size of the ASC and
the number of procedures it performs.
In addition, not properly sterilizing,
handling, and transporting instruments
could result in OSHA penalties. Depending
on the willfullness of the violation,
the corrective actions, the presence of
exposed sharps, and the risk of bloodborne
pathogens exposure, ASCs could
be fined as much as $70,000. Penalties
for repeat violations may incur higher
fines.
Once used instruments are properly
transported to the decontamination
area, they must be cleaned and
decontaminated. When cleaning the instruments,
follow the manufacturer's
instructions for use (IFU) on how to disassemble
and clean (manual or mechanical).
The IFUs will also detail if the
instrument should be submerged, and
which type of cleaning solution works
best. This will help promote proper
cleaning for the soil to be removed from
the instruments. It will also help the
instruments last longer since they are
cleaned using the manufacturer's IFU.
If manually cleaning instruments,
make sure instruments are submerged
under water to help minimize any aerosolization.
Also, keep the water and
detergent at a lukewarm level where
the temperature should range between
27˚C to 44˚C. The lukewarm water level
helps keep soil from staying on instruments
and makes an easier manual
cleaning process. When soaking the
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