There are few more dangerous places to work in our nation's hospitals than the decontamination room of a Central Sterile department. The opportunity for bloodborne pathogen exposure is ever-present, and yet many CS/SPD technicians are daily put at risk of injury by unsafe post-operative instrument preparations. Let's take a look at the four most common dangers and how we can work together as a periOperative team to protect our people:
1) Blades
The Situation: Any surgical tray that includes a knife/scalpel handle (such as a #3, #4, #7, or microsurgical beaver handle) can immediately become a sharps risk when the knife blade is not removed from the instrument prior to returning the tray to your CS/SPD decontamination area. Although there are sharps removal protocols in most ORs, finding a blade at the bottom of a messy instrument tray is not an uncommon occurrence for some Sterile Processing departments. This danger multiplies as these blades are often difficult to see through typical plastic face shields worn by decontamination technicians and are even more difficult to safely remove while wearing slippery head-to-toe PPE.
The Solution: Post-op counts of blades must only happen after they are removed from knife handles. This will ensure the OR unintentional retention of foreign objections (URFOs) count is accurate, while also keeping your team members in SPD safe from stray blades.
2) Needles
The Situation: Though less common than blades, suture needles also pose a serious risk to your CS/SPD team when they make their way back to decontam after a surgical procedure. Typically, when these sharps are encountered by a decontamination technician, they are still locked in the jaws of a needleholder or floating near the bottom of a surgical tray (sometimes with suture still attached). Because of their minute size and ability to easily puncture a latex glove, suture needles must be handled with the utmost care – during both the removal from the needleholder and while untangling suture out of an instrument stringer. Still, seeing needles before they injure a decontamination technician is the most important part.
The Solution: Similar to the protocol referenced in #1 above (Blades), the best way to prevent needles from unintentionally endangering decontamination technicians is to require that these sharps be counted only after they are removed from the jaws of a needleholder. After this count, they should immediately be discarded into the sharps container in the operating suite.
3) Ring-handled Instruments
The Situation: Out of the four sharps dangers listed in this article, poor post-operative preparation of ring-handled instruments are by far the most common sharps risk that Sterile Processing professionals will encounter. The root causes for the likelihood of this decontamination hazard span the spectrum from overloaded instrument stringers to, well, a lack of adequate stringers in general -- and a host of reasons in between. Whatever the cause, it is an almost universal reality to find surgical trays returned to CS/SPD with the sharp distal tips of ring-handled instruments precariously pointed up, out, and even toward the handles of their transport baskets and containers. An instrument as benign as an Ochsner-Kocher clamp that is improperly restrung can puncture a technician's hand in an instant and expose them to any number of deadly bloodborne pathogens.
The Solution: While deceptively simple, the solution to this decontam danger has cultural and technological components. First, restringing of ring-handled surgical instruments must become the cultural norm in our operating rooms. While every second counts for the bottom-line of room turnover metrics, every second also counts for the safety of our CS/SPD teams who will receive these trays. Secondly, surgical trays - and in particular, surgical stringers - must catch up with the 21st century. The stringer technologies of our grandfathers may not be the best way to enable OR teams to safely return instruments to their decontamination counterparts. Solutions like Restore Medical's stringer technology are moving us in the right direction.
4) Loose Instruments
The Situation: Surprisingly enough, during my career as a Sterile Processing leader, I have seen more decontamination exposures due to loose instrument sharps than the other three dangers combined. Sharp towel clips, skin hooks, and even finely tipped forceps lead the field for the "Most Likely to Send a Technician to the Employee Health Office" award. While many of these items are sent to the OR in disposable sterilization bags or fitted with tip-protectors, the instruments are often returned to CS/SPD loose in the bottom of the surgical tray. Because of the manner in which instruments can jostle about during transport, these loose instruments can sometimes become dangerously positioned to cause harm to any technician who ventures to lift the tray out of a transport cart.
The Solution: As with the stringer technology mentioned in #3, the answer to the loose instrument danger starts with CS/SPD leaders being proactive in how they containerize and outfit their instrument trays to ensure the OR safely returns these items in a manner that protects decontamination staff. Internal rubber mats and small cages/containers specifically identified to hold skin hooks and other sharp instruments are a must for overcoming this perennial sharps risk. For OR personnel, in lieu of better alternatives, it is almost always a safe bet to place these items flat, on the bottom of the tray, with tips pointing toward the inside of the transport basket.
While these four sharps dangers are by no means the only way a decontamination technician can be injured in your facility, together they tell an important story about the need for teamwork and accountability across surgical services to ensure a safe workplace. With all the (necessary) emphasis placed on patient safety in our hospitals, we should never forget our team members whom we serve and have the tremendous responsibility to protect. If you are a CS/SPD or OR leader, make it a point to raise the red flag over these issues in your department and labor to implement creative, sustainable solutions to dull the dangerous risks of decontamination sharps.
What say you?
Hank Balch
Beyond Clean © 2019