The door to decontamination opens.
In walk three strangers with bunny suits and clipboards in hand, followed closely by an anxious looking Perioperative Director, with eyes darting back and forth across the empty case carts and stacks of contaminated surgical trays.
And there YOU stand...
Maybe you're the frontline Sterile Processing technician who just so happened to be working in decontam on the one week this year that Joint Commission decided to drop by for a visit. Or perhaps you're the CS department manager, who now has your moment in the spotlight to see if all those months of hard work are going to stand up under accreditation scrutiny. Whoever you are, the time for fixing and improving has run out -- either you're compliant today, or you're not. (*Obviously eternal compliance is the goal, but you get what I mean.)
So, how are you going to prove that you can and do meet the standards for best practice and IFU compliance in your decontamination area in regards to time? Here are five tips to make sure you can win the race against the reprocessing clock:
1) You Can't Find the Time if You Can't Find the Clock
So, first things first. While there is such a thing as a biological clock, you're going to need a little more than that in your decontamination area if you don't want to get dinged on your next survey. How can your technicians confirm they are following any time-related IFUs if they don't have line-of-sight to a clock or timer at their processing sinks? As we'll discuss in a moment, nearly every single processing stage of your instrument tray has some sort of timing function to it. The classic "low-hanging fruit" in this scenario is making sure you have accessible and visible timers at every station. Although I've been using "clock" and "timer" interchangeably here, really what I mean is a "timer," like the one pictured above. If you're like most departments, you'll have multiple items going through different decontamination stages at the same time, so it would be nearly impossible to keep track simply by glancing at a clock and committing it to memory. It's time to make friends with some 'new-Timers'.
2) From Done to Dunk: Combatting Biofilm When Every Second Counts
How long has that case cart been sitting there? How long was it from the time the case ended until the tray was placed in a processing sink? How would you know? While foam/gel pretreatment sprays (or even just a damp towel) are helping extend the time between point of use and decontamination, the dangers of biofilm formation are always lurking in your SPD. Whether you utilize a timing function on your automated instrument tracking system, or hit the "Start" button on a timer, being aware of the elapsed time of 'contaminated but not processed instrumentation' is a critical part of stopping these dangerous microbial fire-breathers in their tracks. If your technicians are unable to process immediately, additional pretreatment may need to be reapplied per the time requirements in the manufacturer's IFUs.
3) Becoming a Super-Compliant Super-Soaker
Much like our sterilizers have multiple particular parameters that must be met for the cycle to be effective, soaking in enzymatic detergents is no different. Besides proper dilution ratios and optimal temperature ranges, soak time is the operative function to whether those perfectly temperature'd chemicals are actually going to be able to touch your instruments long enough to breakdown the existing bioburden. But there's two important things to keep in mind here: the chemical manufacturer's IFUs and the medical device manufacturer's IFUs, both of which will have particular times required for the soaking stage. Your technicians need to be familiar with both -- especially when the device requires a longer soak time than the effective time posted on the chemical being used. Again, none of this is possible to do without the ability to time each tray as it begins it's soaking step.
4) Brushing, Flushing, and Rinsing Until It's Clean... For at Least "X" Seconds
Once your tray is out of the soaking stage, you're not out of the timing woods yet. If you take a look at your instrument IFUs, you may very well see MORE time instructions for brushing, flushing, and rinsing of your equipment. Robotics are a great example of this:
While there are some great options for PSI-compliant, Time-enabled flushing devices such as the FlexiPump from Pure Processing, the brushing and rinsing stages for these instruments still require a good old fashioned 60 seconds of technician activity. Important to note here is the common refrain now in many IFUs to visually inspect the instrument after the initial time/activity has elapsed, and then repeat the process, if necessary, until all visible soil is removed. Brushing, flushing, and rinsing times are to be understood as minimum requirements, and always verified by further inspection or testing.
5) The Minute Details of the Ultrasonic Minute
If you haven't caught the dual themes of this article yet, I'm going to spell it out for you now: compliance is impossible without time. And one of the other glaring time-monsters in your decontamination is your ultrasonic cleaner. Just like with everything else we've mentioned, these too have device specific time requirements linked to FDA approved cleaning validations for particular instrument trays. While you shouldn't need a separate timer for this equipment, you do need to ensure the proper cycle lengths are #1) Known to your technicians for each instrument tray and #2) Properly selected when running a cycle. Ultrasonics shouldn't be seen as a magic box that will "work" regardless of the length of cycle or type of instrument placed inside. Your team should be able to speak to surveyor questions related to IFU requirements for sonication cycle times and their ability to choose those times on your ultrasonic unit.
While the days of pocket watches may be behind us, and wrist watches are a no-no for infection control reasons, the decontamination area of your SPD should still be replete with plenty of ticks and tocks. Besides knowing how to clean (which is challenging all by itself), frontline reprocessing technicians must also be given the tools to know how long to clean. This is the only way to ensure the time spent during your next accreditation survey is a pleasant and compliant one.
Moral of this story? It's (all) about time.