Surgical Site Infections a hidden Hospital
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Transcript of Surgical Site Infections a hidden Hospital
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!