CENTRAL SERVICE (CS) IS A VITAL DEPARTMENT IN ANY HOSPITAL

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2 CRCST Self-Study Lesson Plan Lesson No. CRCST 158 (Technical Continuing Education - TCE) by Jon Wood, BAAS, IAHCSMM Clinical Educator Sponsored by: Understanding and Preventing Cross Contamination LEARNING OBJECTIVES 1. Discuss the importance of preventing cross contamination 2. Discuss the transmission of infection 3. Identify vulnerable areas for cross contamination in Central Service 4. Review processes that can help reduce cross contamination CENTRAL SERVICE (CS) IS A VITAL DEPARTMENT IN ANY HOSPITAL or ambulatory surgery center. Although CS is more commonly known for the care and handling of surgical instrumentation for the Operating Room (OR), in many facilities, the CS department is also responsible for the transportation, pick up and delivery of instrumentation to ancillary departments, including Labor & Delivery, the Emergency Department (ED), outpatient clinical areas and more. Because of CS s expansive service reach, CS professionals must take every precaution to prevent cross contamination. Cross contamination is the result of transferring bacteria or microorganisms from one person, object or work location to another. CS professionals should know the importance of preventing cross contamination, understand mode of transmission and how to reduce cross contamination incidents, and have knowledge of areas most susceptible to cross contamination. OBJECTIVE 1: DISCUSS THE IMPORTANCE OF PREVENTING CROSS CONTAMINATION Understanding cross contamination is critical because such incidents can lead to healthcare-associated infections (HAIs). HAIs are acquired through the transferring of bacteria or microorganisms from one person, object or work location to another within the facility. This means that patients being medically treated for one issue then contract a separate or secondary This series of self-study lessons on CS topics was developed by the International Association of Healthcare Central Service Materiel Management (IAHCSMM). Purdue University s Extended Campus and IAHCSMM both offer grading opportunities. Earn Continuing Education Credits: Online: Visit for online grading at a nominal fee. By mail: For written grading of individual lessons, send completed quiz and $15 to: PEC Business Office, Purdue University, Stewart Center Room 110, 128 Memorial Mall, West Lafayette, IN Scoring: Each quiz graded online at or through Purdue University, with a passing score of 70% or higher, is worth two points (2 contact hours) toward CRCST re-certification (12 points). Subscription Series: From January 1 to June 30 each year, Purdue Extended Campus offers an annual mail-in or online self-study lesson subscription for $75 (six specific lessons worth 2 points each toward CRCST re-certification of 12 CE). Call for details. For More Information: IAHCSMM provides online grading service for any of the Lesson Plan varieties. Purdue University provides grading services solely for CRCST and CIS lessons. Direct any questions about online grading to IAHCSMM at Questions about written grading are answered by Purdue University at

3 CRCST Self-Study Lesson Plan preventable infection from a source within the facility. HAIs can adversely affect patients through longer hospital stays, increased pain, additional surgical procedures, prolonged wound healing, morbidity and even mortality. HAIs developed through cross contamination are entirely preventable. HAIs also have a significant financial impact on the hospital. The hospital must report patients who develop HAIs during their hospital stay to governmental agencies such as the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention s (CDC s) National Healthcare Safety Network. CMS uses the reported information to determine the amount of reimbursement facilities will receive. If reported HAIs are above the national benchmark, CMS could reduce reimbursement. OBJECTIVE 2: DISCUSS THE TRANSMISSION OF INFECTION To better understand cross contamination, it is important to become familiar with the chain of infection and the role that the mode of transmission plays within the chain. According to the CDC Guidelines for Isolation Precautions, six elements are involved in disease transmission that comprise the chain of infection. These include: Causative agent The microorganism that causes an infection; Reservoir The place where an infectious agent (microorganism) can survive; Portal of exit The path by which an infectious agent leaves the reservoir; Mode of transmission The method of transfer of an infectious agent from the reservoir to a susceptible host; Portal of entry The path used by an infectious agent to enter a susceptible host; Susceptible host A person that lacks the ability to resist infection by an infectious agent. To prevent cross contamination, the focus should be on the mode of transmission within the chain of infection. During the mode of transmission, the CS professional has the opportunity to interrupt the chain of infection by breaking the transmission link. There are three important transmissions routes that must be understood in order to break the transmission link and stop cross contamination: direct contact, indirect contact and airborne transmissions. Direct contact is when an infectious person transfers an infectious organism directly to another person. Hands are the most common form of direct transmission. Direct transmission usually involves blood, bodily fluids or a breakdown in skin integrity. Not using gloves to protect hands when examining patients can cause a direct contact transmission. Indirect contact occurs when an object is involved in the transmission of an infectious organism. In the CS department, pathogens can be transmitted through instrumentation that is not properly cleaned or sterilized. Medical equipment that is not adequately cleaned between patients can also transmit the microorganisms. An improperly-cleaned surgical instrument used on one patient can harbor the infectious organism and be transferred to another patient the next time that instrument is used. Airborne transmission occurs when tiny particles in the form of droplets are spread or scattered in the air and then find their way to a susceptible host. Airborne transmission can use air currents to travel greater distances, transmitting microorganisms such as Mycobacterium tuberculosis (TB) and Instruments that can only be manually washed according to their instructions for use (IFU) can be challenging and pose several opportunities for cross contamination. Once instrumentation has undergone the manual cleaning and rinsing process, the CS professional must ensure there is a dedicated clean area provided for the instrumentation that is separated from other dirty instrumentation.

4 CRCST SELF-STUDY LESSON PLAN Instrumentation and equipment that are not properly contained during transportation can create the potential for cross contamination and transmission of microorganisms through contact and airborne transmission routes. Transporting instrumentation and equipment, whether from the OR or ancillary departments in the hospital, should be done in a closed system that prevents spillage and aerosolization. varicella-zoster virus (chickenpox). This can occur when patients with active TB are not in an airborne isolation room. OBJECTIVE 3: IDENTIFY VULNERABLE AREAS FOR CROSS CONTAMINATION IN CENTRAL SERVICE The next step in breaking the transmission link in the chain of infection and preventing cross contamination is to identify areas of vulnerability in the CS department. Although this is not an inclusive list of all areas of vulnerability, the following examples will help guide CS professionals by linking the modes of transmission to areas in decontamination and the assembly area, and through instrument and equipment transportation. DECONTAMINATION Instruments that can only be manually washed according to their instructions for use (IFU) can be challenging and pose several opportunities for cross contamination. Once instrumentation has undergone the manual cleaning and rinsing process, the CS professional must ensure there is a dedicated clean area provided for the instrumentation that is separated from other dirty instrumentation. In the absence of a dedicated clean area, there is the potential to recontaminate the instrumentation. Another area of concern revolves around the use of a pass-through window designed to transfer clean instrumentation from the decontamination area to the clean CS area. Passing clean instrumentation through a pass-through window without changing to clean gloves can recontaminate instrumentation. Once items are cleaned and ready to be sent to the clean area of the department, the CS professional should remove the dirty gloves, perform hand hygiene and don (put on) clean gloves. Cross contamination in the decontamination area can also occur with the use of reusable cleaning tools and brushes. Reusable items must be decontaminated on a schedule or at least daily. Reusable cleaning tools can harbor microorganisms such as blood and tissue, and those microorganisms can be passed from one device to another. In the decontamination area, room air pressure needs to be monitored regularly in accordance with hospital policy. Positive air pressure in a decontamination room has the potential to carry contaminates or microorganisms via airborne transmission to other work locations, thereby, placing patients and co-workers at risk. ASSEMBLY AREA Dirty instrumentation in the assembly area can pose a risk for cross contamination and transmission of infectious microorganisms. It is important to visually verify that instrumentation is clean prior to sterilization. If a dirty instrument is found during assembly inspection, the instrument must be returned to the decontamination room to be recleaned. Any instrumentation that was in contact with the contaminated instrument must also be reprocessed. If the instrument was sitting on an assembly rack above other instrumentation, those instruments must be evaluated for possible contamination as well. Once the instrument is returned to the decontamination area, hand hygiene must be performed to ensure there is no transmission of microorganisms to other instruments, workstations or individuals. If necessary, the workstation may also need to be cleaned. TRANSPORTATION OF INSTRUMENTATION Instrumentation and equipment that are not properly contained during transportation can create the potential for cross contamination and transmission of microorganisms through contact and airborne transmission routes. Transporting instrumentation and equipment, whether from the OR or ancillary departments in the hospital, should be done in a closed system that prevents spillage and aerosolization. Transporting uncovered instrumentation through the surgical suite from an OR to the decontamination area may lead to airborne transmission of microorganisms. Aerosolized microorganisms can

5 CRCST Self-Study Lesson Plan potentially enter the OR and increase the likelihood of an HAI. When the CS technician is rounding ancillary departments such as Labor & Delivery and the ED to pick up used equipment and instrumentation, the technician must wear gloves and perform proper hand hygiene practices to prevent any cross contamination that could occur during the process. OBJECTIVE 4: REVIEW PROCESS THAT CAN HELP REDUCE CROSS CONTAMINATION Cross contamination and the transmission of infectious organism can be reduced and nearly eliminated with good hand hygiene practices and the use of personal protective equipment (PPE). Hand hygiene is the most effective method for reducing cross contamination and transmission of microorganisms. To effectively reduce cross contamination, the CS professional should perform hand hygiene before starting and after ending the working shift; before and after lunches and breaks; when entering and leaving the department; after restroom breaks; and any time hands become visibly soiled or contaminated. Jewelry and artificial fingernails can harbor harmful microorganisms and should not be worn in the department. Changing gloves, along with proper hand hygiene, is effective in reducing cross contamination. Hand hygiene should be performed before and after donning (putting on) and doffing (removing) gloves. PPE, including gloves, eye protection, fluid-resistant protective gowns, masks and boot covers, protect the CS professional from potential contamination from chemicals, blood and bodily fluids. When transporting instrumentation, personnel should ensure the instrumentation is contained and can prevent spillage of fluids. A closed case cart system can fulfill both of those goals. Wearing gloves when handling dirty equipment and instrumentation (when performed in conjunction with good hand hygiene practices) will prevent cross contamination in CS. CONCLUSION HAIs can be devastating to patients and are a result of poor infection prevention practices in the healthcare facility. Understanding cross contamination and transmission of microorganisms is the first step to breaking the link in the chain of infection and stopping the spread of infectious microorganisms. Identifying areas of vulnerability and creating processes to prevent cross contamination are the keys to reducing HAIs and providing better outcome for patients in the healthcare facility. RESOURCES Association for Advancement of Medical Instrumentation. ANSI/AAMI ST79: 2017 Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Association of perioperative Registered Nurses. AORN Guidelines for Hand Hygiene International Association of Healthcare Central Service Materiel Management. Central Service Technical Manual, Eighth Edition, Chapter 6, Infection Prevention, pp Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. IAHCSMM ACKNOWLEDGES THE FOLLOWING CS PROFESSIONALS FOR THEIR ASSISTANCE IN THE CIS LESSON PLAN SERIES Linda Breadmont, CRCST, ACE Deborah Bunn, BS, MS, CRCST, CIS, CHL, ACE Gwendolyn Byrd, CRCST, CHL CIS, CFER, GTS Michelle Clark, CRCST, CSPDT Ava Griffin, BSN, RN, CNOR Susan Klacik, BS, CRCST, ACE, CIS, FCS Susan Ober, MSN, MBA, RN, CNOR, CRCST Christina Poston, CRCST, CIS, CHL, BA ED Donna Serra, CRCST, CHL Kelly Swails, MA, CHL, CRCST, CST Cindy Turney Smith CRCST, CBSPT WANT TO BE AN AUTHOR? IAHCSMM is seeking volunteers to write or contribute information for our CRCST Self-Study Lessons. Doing so is a great way to contribute to your own professional development, to your Association, and to your Central Service department peers. IAHCSMM will provide guidelines and help you with the lesson to ensure it will be an enjoyable process. For more information, please contact Natalie Lind (natalie@iahcsmm.org).

6 CRCST Self-Study Lesson Plan Quiz - Understanding and Preventing Cross Contamination Lesson No. CRCST 158 (Technical Continuing Education - TCE) Lesson expires January 2021 Sponsored by: 1. Transferring bacteria or microorganisms from one person, object or work location to another is the result of what? a. Decontamination b. Cross contamination c. Reservoir d. Mode of transmission 2. What is the term used for patients who acquire an infection while being medically treated at a hospital? a. Healthcare-associated infection b. Healthcare-acquired organism c. Facility-associated infection d. Facility-acquired organism 3. Healthcare-associated infections have no significant impact on patients or hospital finances. a. True b. False 4. Which of the following is not an element in the chain of infection: a. Reservoir b. Susceptible host c. Cross contamination d. Mode of Transmission 5. In the chain of infection, what is the method of transfer of an infectious agent from the reservoir to a susceptible host? a. Reservoir b. Susceptible host c. Cross contamination d. Mode of transmission 6. In the chain of infection, where is the place that an infectious agent can survive? a. Reservoir b. Susceptible host c. Cross contamination d. Mode of transmission 7. The portal of exit is the path by which an infectious agent leaves the reservoir. a. True b. False 8. When an infectious person transfers an infectious organism directly to another person, this is referred to as: a. Direct contact b. Indirect contact c. Airborne transmission d. None of the above 9. Tiny particles in the form of droplets that are spread in the air and find a susceptible host represents which type of transmission? a. Direct contact b. Indirect contact c. Airborne transmission d. None of the above 10. An object that is involved in the transmission of an infectious organism represents which type of transmission? a. Direct contact b. Indirect contact c. Airborne transmission d. None of the above 11. Which of the following can be transmitted through airborne transmission? a. Mycobacterium tuberculosis (TB) b. C. difficile c. Rotavirus d. All of the above 12. Hand hygiene is the most effective method for reducing cross contamination and the transmission of infectious microorganisms. a. True b. False 13. When should hand hygiene be performed? a. Before starting a work shift b. After a lunch break c. When visibly soiled or contaminated d. All of the above 14. Which action should be taken immediately after removing gloves? a. Don a new pair of gloves b. No other action needed c. Remove other personal protective equipment d. Hand hygiene 15. What is the best method for transporting dirty instrumentation and equipment? a. By hand, as long as proper hand hygiene is performed b. With an open case cart system c. With a closed case cart system d. Using a wire rack REQUEST FOR ONLINE SCORING (payment and scoring made directly online at REQUEST FOR PAPER/PENCIL SCORING (please print or type information below) m I have enclosed the scoring fee of $15. (please make checks payable to Purdue University. We regret that no refunds can Name be given) m Check here if you have a change of address Mailing Address (be sure to include apartment numbers or post office boxes) m Check here if you wish to have your results ed to you DETACH QUIZ, FOLD AND RETURN TO: Purdue University PEC Business Office Stewart Center, Room Memorial Mall West Lafayette, Ind City State Zip Code ( ) Daytime telephone IAHCSMM Membership Number Address If your name has changed in the last 12 months, please provide your former name. Purdue University is an equal access/equal opportunity institution.