POPE 4023 THE PERIOPERATIVE ENVIRONMENT DECONTAMINATION AND DISINFECTION; CENTRAL PROCESSING DEPARTMENT AND CENTRAL SERVICE PERSONNEL SITI ZAIRINI AHMAD ILKKM KUBANG KERIAN
LEARNING OUTCOMES At the end of this learning session, the students will be able to 1. Explain the work flow in central processing department 2. Explain the role of central service personnel
CENTRAL PROCESSING DEPARTMENT • The surgical services central processing department (CPD or SPD) is located in close proximity to the main surgical suite to minimize the potential for cross-contamination between soiled and clean instruments and supplies. • The CPD is composed of the decontamination area, set assembly room, sterile processing, sterile storage, and case cart packing room.
WORKFLOW IN THE PROCESSING AREAS Received soiled instrument Checking and counting Cleaning and decontamination Organizing the instruments into standardized trays Packaging and labelling Sterilizing Storing Distributing
ROLE OF CENTRAL SERVICE PERSONNEL • Credentialing of Central Service Personnel • Coordination of Central Service Staff and Operating Room Staff • Cleaning and Decontamination of Instrument • Repairing or Restoring versus Replacing Instrument
CREDENTIALING OF CENTRAL SERVICE PERSONNEL Association for the Advancement of Medical Instrumentation (AAMI) stated that - CS are required to become certified - New hires will have 18 months from the date of hire to attain the credentialing - Training programs take between 6 and 12 months to complete.
CREDENTIALING OF CENTRAL SERVICE PERSONNEL International Association of Healthcare Central Service Materiel Management (IAHCSMM) stated that - Require mandatory standardization of education and certification of all CS personnel - Offer Certified Registration Central Service Technician (CRCST) by IAHCSMM • Offers short-term 1-year certification at three levels: (1) technician, (2) instrument processing, and (3) leadership.
CREDENTIALING OF CENTRAL SERVICE PERSONNEL Certification Board of Sterile Processing and Distribution (CBSPD) - Must have completed 12 months of employment or has passing grade of 70% or higher in the role of a formal central processing course - Successful candidates earn the CSPDT (Certified Sterile Processing and Distribution Technician) credential. - Certification is valid for 5 years - - Can be renewed through reexamination or by attaining 100 points through education or experience during the certification period.
CREDENTIALING OF CENTRAL SERVICE PERSONNEL - Is an international sterile processing certification examination program accredited by the National Commission for Certifying Agencies (NCCA) - Offer 4 times per year - Examination in English - 5 levels of certification: (1) technician, (2) supervisor, (3) manager, (4) surgical instrument processor, and (5) ambulatory surgery.
COORDINATION OF CENTRAL SERVICE STAFF AND OPERATING ROOM STAFF • The relationship between CS staff and OR staff is complex and synergistic. • The OR staff relies on the CS staff to provide complete instrumentation processed to the appropriate degree of safety for patient use. • The CS staff relies on the OR staff to return used sets in a safe-to-process condition without concealed blades or other sharps that pose a risk for injury during preparation for processing.
COORDINATION OF CENTRAL SERVICE STAFF AND OPERATING ROOM STAFF • Each person has a stake in the intricate coordination of preparing for a surgical procedure. • Mutual respect and cooperation between the two specialty areas is in the best interest of safe and efficient patient care.
INSTRUMENT CLEANING AND DECONTAMINATION • Point of use cleaning referred to the scrub person can facilitate the instrument decontamination process by wiping instruments as they are used on the sterile field and then opening the instruments completely before placing in a tray for return to the processing area • Enzymatic cleaner such as a foam or solution can applied to the instruments to prevent debris from drying during transport to the central service area
INSTRUMENT CLEANING AND DECONTAMINATION • Decontamination = mechanical or manual cleaning + physical or chemical microbicidal process • Thorough Cleaning or Return-to-use Cleaning referred to prerinsing, washing, rinsing, and disinfecting/sterilizing is done in the processing department
INSTRUMENT CLEANING AND DECONTAMINATION • Prerinsing / Presoaking • Manual Cleaning • Washer-sterilizer / Washer-Decontaminator • Ultrasonic Cleaning • Lubrication • Inspecting and Testing • Instrument Marking for Identification
REPAIRING AND RESTORING VERSUS REPLACING INSTRUMENT • Instruments in poor working condition inhibit the surgeon and create a serious hazard for the patient. • Instruments should be repaired at the first sign of damage or malfunction. If an instrument breaks during a procedure, all pieces should be accounted for in their entirety. • A lighted magnifying lens is a useful central service tool for examining instrumentation.
REPAIRING AND RESTORING VERSUS REPLACING INSTRUMENT – REPAIR • Normal usage the blades of scissors and the edges of other cutting instruments become dull over time • Steam sterilization causes the softening of the metal that in turn dulls the edge. • Cutting instruments must be sharp. For this reason, scalpel blades are disposed of after a single patient use. • Osteotomes, chisels, gouges, and meniscotomes can be sharpened by specialty companies that use handheld hones or a honing machine designed for this purpose.
REPAIRING AND RESTORING VERSUS REPLACING INSTRUMENT – REPAIR • Some specialty instrument repair companies will come to the facility in a mobile van fully equipped with all the machines and tools needed to recondition and repair surgical instruments. • Scissors, curettes, rongeurs, and reamers should be frequently rotated for sharpening. • OR and CS personnel are not qualified to sharpen or repair surgical instruments
REPAIRING AND RESTORING VERSUS REPLACING INSTRUMENT – REPAIR • Drill bits and saw blades should be single-use items. Reuse and processing cause the cutting edges to rip tissue instead of cutting. • Stiff joints or frozen box locks are the result of inadequate cleaning or corrosion caused by trapped moisture or a corrosive substance. The instrument should be repaired before the box lock cracks and the instrument must be replaced. • After repeated use, instruments eventually wear, misalign, and stiffen. Parts such as inserts, screws, or springs may need to be replaced. • The life of many instruments can be extended by preventive maintenance or prompt repair.
REPAIRING AND RESTORING VERSUS REPLACING INSTRUMENT – RESTORATION AND RESURFACING • Light or dark water spots (from mineral content in tap water or condensate in sterilizer; caused by inadequate drying) • Rust-colored film (from iron content or softening agents in steam pipes) • Bluish-gray stain (from some chemical sterilizing or disinfecting solutions) • Brownish stain (from polyphosphate cleaning compounds that are incompatible with local water supply, leaving a chromic oxide film on instruments)
REPAIRING AND RESTORING VERSUS REPLACING INSTRUMENT – RESTORATION AND RESURFACING • Purplish-black stain (from detergents that contain ammonia or from amines in steam lines) • Rust deposits (from inadequate cleaning or drying, agents not thoroughly rinsed, electrolytic deposits from exposed metal under chipped chrome plating onto stainless steel, or residues in textile wrappers; avoid the use of plated instruments in surgery; these are not surgical grade instruments).
REPAIRING AND RESTORING VERSUS REPLACING INSTRUMENT – REPLACEMENT • Broken instruments must be replaced if they are beyond repair or restoration. • With normal use, good-quality surgical instruments have an expected life of at least 10 years. • Misuse and abuse are the most common causes of instrument breakage. • Use of a lightweight instrument on heavy tissue causes the jaws to bend or “spring.”
REPAIRING AND RESTORING VERSUS REPLACING INSTRUMENT – REPLACEMENT • Using a needle holder to load and disarm knife blades can damage the jaws. • Replacing instruments that have been needlessly damaged is an unnecessary expense for the OR. • Repairing the laundry equipment can be an additional expense. • Personnel could be injured by instruments that protrude through trash bags and puncture the skin.