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Getting Over Decontam Oversights: How to Help Your CS/SPD Team Never Miss a Microbe

One unseen Fogarty insert that makes its way back to the OR can cost your facility upwards of $10K if it is discovered on the sterile field, not to mention the unthinkable possibility of the instrument being reused on an unknowing patient. I need not even mention the danger lurking in poorly processed Ortho shavers, Andrews suctions, or Kerrison rongeurs...

So how do we ensure that our first line of defense against these processing breakdowns -- our department decontamination areas -- will actually stop these dangers in their tracks? What must CS/SPD leaders and frontline technicians do to break the chain of infection during this critical stage of processing? Here are a few ideas for how to make missing microbes a thing of the past...

1) Stock the Armory: It's Tool Time!

One of the most frustrating positions to be in as a frontline decontamination technician is to be asked to do a job, but not given the tools you need to do the job well. Flush every cannula: but how? Brush every suction: with what? When your team walks into the decontamination area to start the day, it should be fully stocked with every processing tool needed to complete the task laid before them: mass microbial destruction. At the very least, you should have the following items: Brushes of proper style, diameter, and length (including pass-through brushes), adequate flushing technologies (a low tech hose or high-tech flushing system), sinks of adequate height, width, and depth, the proper chemicals, appropriate PPE, sharps container, pre-processing equipment (such as stand alone ultrasonic washers), and any other supplies needed to safely restring and sort stainless steel instruments. Going back to the brushes for a moment, make sure these are organized and easily identifiable. Many an internal scope channel has been damaged by incorrect or compromised brush usage. Make it easy for your team to do the right thing -- and more often than not, they will. 

2) Ensure OR Ownership: First Things Must Be First

As important as the proper tools are in the hands of a competent, well-functioning decontamination team, the SPD department is actually the second set of eyes to guard against possible microbial mistakes. The first opportunity to tackle potential processing pitfalls actually happens immediately post-op, before the instruments ever leave the OR room.

As a CS/SPD leader, it's your responsibility to work closely with OR leadership to ensure nurses and techs in the room are aware of the necessity of post-op prep of their instrument trays, such as removal of any inserts (Fogarty clamps, Brainlab tracking balls, etc.), disposal of (*ahem*) disposables (such as plastic/rubber attachments, suture, single-use towel clips, etc.), removal of gross bioburden (blood, fat, tissue, bone), restringing of ring-handled instruments (on a low-tech stringer or high-tech restringing technology), flushing of any suction devices (such as Frazier, Andrew, or Abdominal suctions), and finally, pre-treating the instruments (with a low-tech damp towel or high-tech pretreatment solution). To win this war on decontamination oversights, we need our partners in the OR to begin the process as soon as possible. Every minute counts.

3) Traffic Control and a One-Way Flow

Anyone who's ever worked in a busy decontamination room knows how easy it is to look up from your sink after 10-15 minutes, only to realize the room looks like an instrument bomb went off, scattering trays, carts, and container accessories to the four corners of the earth. Something about 2pm in the afternoon just seems to wreak havoc on an organized decontamination workspace.

And that is why it's imperative for CS/SPD leaders to implement clear "traffic control" policies for how, when, what, and where contaminated items enter/flow through the decontamination space. Some facilities struggle with inadequate staging areas, so they cram 20 carts into a decontamination room, which leads to poorly routed instrument trays coming through the work-flow. Not only does a crowded/muddled workflow take a lot of precious time to navigate in and out of, it often leads to missed steps and processing oversights because there's not one right place for a prepped/soaked/rinsed tray to go. Technicians struggling to keep up with the volume and feed the washers/cart washers, can inadvertently short-circuit a processing lifecycle without even knowing it. Well-marked staging areas (even if you need to physically delineate each space with colored tape on the floor) can go a long way in keeping each tray in its proper processing stage. Traffic control the one-way flow.