ASC Spotlight - Q2 2019 - 29

HEADER

AAMI provides reasonable guidance on
transportation and the issue of bottom or
side leaks on crash carts in section 6.5.3
Transportation Equipment, if you've
purchased the manual. In a nutshell, carts
need to be appropriate for transport of the
items being moved. If the instruments are in
containers with solid sides and bottom and
are covered, an open cart may be appropriate.
If the items are placed in open bins and then
on an open cart, the organization should use a
cover for the cart. Items in closed case carts do
not need to be covered.
The cart should be designed to prevent items
from falling off. Surveyors may ask infection
control/operating room and central sterile
processing management if they have evaluated
that risk and if items have ever fallen off.
Ensuring the Sterilant Reaches All Surfaces
All surfaces of the instruments undergoing
sterilization must be accessible for the sterilant
to reach them. Manufacturer instructions
provide information on how to prepare items
for sterilization. In addition, AAMI and
AORN state that items should be sterilized
in the open (unratcheted) position and
disassembled in accordance with manufacturer
instructions.
We recognize that some instruments, such as
scissors, are likely to close after sterilization
when they are being transported or stored.
Therefore, surveyors will review the process
for ensuring the item is prepared in a manner
that will ensure exposure to the sterilant.
Surveyors will observe the instruments coming
19MS4306

INSTRUMENT REPROCESSING

through the cleaning process to ensure that
they have been disassembled and are packaged
in accordance with manufacturer instructions.
They will also review peel packs to see if items
that are awaiting sterilization or have just been
sterilized are in the unratcheted position.
In order to ensure accurate scoring, surveyors
may ask for manufacturer instructions for use
to confirm whether an item should be taken
apart.
Surveyors may ask staff to prepare a tray
from those waiting to ensure instruments
are opened and inspected during assembly.
They will be watching how staff checks for
cleanliness of instruments that are being
processed. In some cases, staff may be asked
to open a rigid or wrapped tray awaiting
sterilization to confirm that items are being
opened or disassembled in accordance with
manufacturer instructions.
Careful Instrument Release after
Sterilization
Instrument release should be a thoughtful and
deliberate process to ensure only sterilized
items are released.
Internal and external, if the internal indicator
is not visible through packaging, chemical
indicators must be used for every item
undergoing sterilization. Physical monitoring
of cycle (e.g., time, temperature, and pressure)
and a check of the external (or internal if
visible through the packaging) chemical
indicators must occur before each non-implant
load is released. Implant loads may be released

after all of the following actions:
* Verification that the physical parameters
of the sterilization cycle have been met
* A biologic indicator has been done
and is negative
* A type 5 integrating indicator
(aka integrator) confirms the process.
Unless there's a facility policy allowing
emergent release of implant loads before the
biologic indicators are read, surveyors will
score as not compliant with the standard if the
result of the biologic is not recorded prior to
use. If a facility policy does allow individuals
to proceed without reading the biological
indicators in emergent situations, the policy
must be followed.
Storage of Items that Have Undergone
High-Level Disinfection, Including
Endoscopes and Endocavity Probe
Items must be stored in a way that's consistent
with their intended use. This means that
items that require a minimum of high-level
disinfection may be stored in a way that
protects from contamination even if they were
sterilized.
Again, manufacturers' instructions for use
must be followed for storage. If instructions
for use do not provide direction on storage
requirements, items should be stored in a way
that prevents contamination. Surveyors will
score based on compliance with facility policy
or risk assessment unless the manufacturer's
instructions for storage were not followed, or
the containers/locations of storage are visibly
soiled, or if staff are observed contaminating
other high-level-disinfected products.
Log on to www.henryschein.com/medical

29
http://www.henryschein.com/medical
ASC Spotlight - Q2 2019

Table of Contents for the Digital Edition of ASC Spotlight - Q2 2019
