ECRI Institute: If it’s not clean, it’s not sterile: reprocessing contaminated instruments (November 2017)

Summary

The American based ECRI Institute Patient Safety Organization (PSO), identified 234 events in its database pertaining to dirty surgical instruments. This report contains several recommendations based on the findings.

Content

The top five factors for the contamination were:

• inadequate cleaning before sterilisation (34%)
• immediate-use steam sterilisation (also known as flash sterilisation) issues (12%)
• holes in wrappers (11%)
• instruments not sterilised in time for case (10%)
• vendor instrument issue (9%).

Of the events in which inadequate cleaning before sterilisation was identified as a factor, the instruments were identified as the following (percentages do not add up to 100% because of rounding):

• Complex instrument (39%)
• Cannulated or lumened instrument (35%)
• Simple noncomplex instrument (9%)
• Other or unidentified (16%).

ECRI Institute PSO recommends the following:

• Emphasise to all personnel involved in reprocessing (cleaning and disinfection or sterilisation) reusable medical devices—including clinical and central sterile department staff—that omitting any of the cleaning steps in the reprocessing protocol can lead to deadly infections.
• Assess the organisation's reprocessing program to identify and rectify factors that could contribute to poor instrument cleaning.
• Review reprocessing procedures to ensure that they are comprehensive and easily accessible to all personnel involved in the cleaning process.
• Review procedures periodically to confirm that they are aligned with current manufacturer recommendations for cleaning.
• Review compliance with reprocessing procedures to ensure that they are being following appropriately and that fail-safes are in place to prevent contaminated instruments from reaching the field or patient.
• Assess competency on an ongoing basis, and provide refresher training at regular intervals to help staff sustain competency. The U.S. Centres for Disease Control and Prevention (CDC) recommends that training be provided at least once a year (CDC 2015).
• Prevent productivity pressures from forcing staff to deviate from the cleaning instructions for the instruments at hand.
• Seek input from reprocessing staff when assessing new instruments for purchase.
• Foster regular communication between reprocessing staff and the clinical departments they support.