OR Manager June 2023 - 28

Sterilization & Infection Prevention
A gap analysis would involve the IP to
assess in real-time the current practices
and processes, then compare them to
best practice recommendations and
requirements provided by AORN and
ANSI/AAMI standards. She also advises
IPs to start with what they already know
and feel comfortable assessing.
To make rounding in the SPD more
interactive, Holdsworth instructs IPs to
engage with SPD staff rather than just
using a clipboard to check for errors.
This approach has resulted in reciprocal
feedback from SPD staff, she says.
To address this issue, Advantage
Support Services has developed an IP
checklist and education program to improve
the oversight of IPs during the tray
assembly stage. The program is based
on quality steps outlined in AAMI ST
79, AORN guidelines, and certification
courses, emphasizing the importance of
following standard tasks to ensure the
tray is clean, complete, and sterile. This
education has enhanced IPs' knowledge
and understanding of assembling trays
and allows them to evaluate compliance
with quality standards more effectively.
In addition, it has provided them with
checklists to conduct a department assessment
of their current practices.
As the solutions are determined and
implemented, the SPD can be periodically
evaluated to ensure best practices
are being consistently performed, rather
than conducting a full assessment of
sterilization practices. The IP/SPD partnership
should aim to unlearn old habits
and develop new ones, allowing for a
learning curve for those performing sterilization
tasks. The ultimate goal of this
partnership is to make best practices
second nature to SPD technicians.
Assessment of tray assembling
SPD technicians have long-established
practices for preparation and packaging
to ensure instrument quality. One
of these is that each assembly station
should be disinfected and that a barrier
be placed on the assembly table to help
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OR Manager | June 2023
deter cross-contamination and prevent
damage to instruments. The technician
should also ensure that all instrument
functionality and cleanliness testing
tools are available at the assembly stations,
including plastic dowels, kid skin,
gauze, cotton balls, distilled water, syringes,
non-linting single-use brushes,
and a borescope.
Upon receiving a tray, the technician's
initial step of inspection is to ensure
there are no sharps or visible debris
on the instruments or in the mesh
basket. If necessary, the technician
also removes any chemical internal or
external indicators and other debris that
may have been missed during the decontamination
stage. Debris may consist
of blood, bone, or tissue. Each assembly
station should also provide magnification
lighting to assist technicians
during the inspection, especially for delicate
instruments or small crevices.
When assembling a tray, the technician
must conduct a function test for
each instrument. This involves making
sure it is suitable for use, which can
include, for example, using kid skin to
check the tips of scissors for sharpness.
Delicate scissors can be tested using
yellow kid skin less than 4.5 inches,
while larger scissors require red kid skin
larger than 4.5 inches. Distilled or sterile
water and syringes can be used to
ensure that lumens are bioburden-free.
Testing also involves ensuring that
screws are secure in scissors; plastic
dowels are present on the assembly
table to test for sharpness of rongeurs,
osteotomes; a visual inspection of forceps
and clamp teeth, jaws, and tips to
confirm they align properly; and a check
to make sure carbide inserts are not
chipped in the jaws of box-locked items.
The technician also needs to inspect
stainless-steel instruments' external or
passivation layer. Discoloration or pitting
of the surface may indicate issues
with the manufacturing process. Following
the final stage of forging, a passivation
layer is applied to the instrument
to safeguard it from corrosion and rust.
Discoloration of the stainless-steel surface
may also result from inadequate
water quality, incorrect detergent or enzymatic
concentration, insufficient rinsing,
or exposure to conditions beyond
the scope of the manufacturer's instructions
for use. It is crucial to check for
signs of corrosion because the presence
of any potential pathogenic microorganisms
may lead to cross-contamination,
particularly in crevices that were
not cleaned thoroughly.
After closing the tray, another quality
assurance measure is to inspect that
the container system or wrap used to
package the tray is intact. These steps
provide a level of assurance for the
quality of the instrument tray assembly,
ultimately contributing to the safety of
patients and healthcare providers.
Communicating results
Effective communication of assessment
findings is crucial in developing an improved
practice between IPs and SPDs.
The ANSI/AAMI ST 79:2017 Risk Communication
section provides guidance
that SPD personnel should engage in
an interactive dialogue within the department
and with IP personnel. While
performing initial department assessments,
Holdsworth interacted with IPs
nationwide. She found that many made
notes but left without sharing their findings
with the SPD leaders or staff. To
address this issue, she instructs IPs to
debrief the SPD leaders and staff about
the findings that could be improved at
the end of the assessment process.
According to an article titled Multidisciplinary
collaboration with sterile processing
published in the AORN Journal,
Brenda Nack, MSN, RN, CNOR, CSSM,
CRCST, emphasizes that " communication
and information sharing are vital
components of collaborative leadership
in building relationships with multidisciplinary
teams. This approach can lead
to shared goals and informed decisions
about cleaning, disinfecting, and sterilwww.ormanager.com
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OR Manager June 2023

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