Author: Deb Haley, RN, CNOR, CSPDT, MBA | Director of Clinical Services

My name is Deb Haley and I am the Director of Clinical Services for Censis.  My career in health spans over three decades and my how times have changed!

When I first started in the Operating Room (OR) in 1973, there was no Sterile Processing Department.

I worked as a scrub nurse in the OR, straight out of nursing school. Since I had 3 months of clinical training, I was able to take ‘call’ within 6 weeks of starting. I learned so much at my first job. Not only did I scrub for surgeries and act as part of the IV team for the hospital; our OR staff was the SPD staff. After surgeries, we decontaminated our instrumentation, assembled the instrument trays by memory (no count sheets), wrapped and sterilized our instruments, and then folded our linens for drapes (no disposables!). We had a gravity steam sterilizer, no Sterrad or EtO. We did have Glutaraldehyde for soaking special items (scopes).

Moving on from my first hospital, you can imagine my delight when I went to a hospital that had a “real” Sterile Processing Department (SPD). Knowing first-hand what SPD was responsible for, I always valued the professionals in the department and how they contributed to patient care. And later, as I moved up the management ladder to Perioperative Director, I continued to stress a healthy working relationship with the OR staff and SPD staff.

The one overriding principle I started nursing with and continue to believe today is: You never know who is going to be on the OR table. It could be your mother, father, brother, relative or friend. I stressed this to everyone in the OR/SPD so they would offer the best and safest care for every patient.

Over the years, I’ve witnessed the technological transformation within healthcare and have been lucky to be part of some amazingly innovative teams who have truly changed how we process instrumentation for better patient outcomes.

But there’s always work to be done.

Take for instance point of use processing for endoscopes.  Endoscopes have been receiving attention in the news recently, due to poor design and hard to clean areas, causing poor patient outcomes. Robust and effective methodologies for cleaning and disinfecting endoscopes must be in place to decrease the risk of Hospital Acquired Infections (HAI). This publicity led many facilities to review their policy and procedures for the processing of endoscopes, to ensure safety to patient care. Many hospitals found their policies and procedures were not accurate, detailed, or based on the latest standards.

If we go back to the basics, we must first consider the cleaning of the endoscope. Precleaning of the endoscope at the point of use is essential to avoid buildup of bioburden and drying of bodily fluids. Proper sterilization or disinfection is not possible if debris or biofilms are present.

While wearing appropriate PPE, the endoscope is wiped of visible debris and biofilm with cleaning solution. The cleaning solution is flushed through the interior lumens of the endoscope while the distal end of the scope is placed in the cleaning solution until liquid runs clear.

Using proper technique, the endoscope is transported to an area for high-level disinfection or sterilization.

These simple but necessary steps can prevent a negative patient outcome. (Plus the additional steps to follow: leak testing, manual cleaning, and rinsing, inspecting, high-level disinfection, hang time, storage, and record keeping.) And, as always the manufacturer’s IFU’s should be reviewed for specifics endoscope cleaning instructions.  

From guidelines to recommendations professional and regulatory organizations suggest, I’m grateful for the growth and expansion our industry has seen just in the past decade. When we come together and work side-by-side to ensure a safe, positive outcome for patients we all win.

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