Ramona Conner, AORN Marilyn Hanchett, APIC Sue Klacik, IACHSMM Eileen Young, Olympus America, Inc.

Barriers to Competency Setting resource limitations Hospital Ambulatory GI Endoscopy Office-based Personnel Education Pay Scope/focus of practice

Sterilization and Disinfection Recommended Practices Anesthesia equipment High level disinfection Flexible endoscopes Instruments & powered equipment Packaging Sterilization

Perioperative RN Education No education in basic RN programs AORN postgraduate programs Periop 101 module Films CBL Module (online learning) Competency Evaluation Tool (in press) 12% CNOR Certification exam

Limited State CS Certification Requirements Source: http://www.iahcsmm.org/governmentaffairs/legislativemap.html#pab1_4

Infection Prevention What is the IP Role? IPs: do not perform reprocessing but participate in process & outcome monitoring and follow up investigations when failures occur. IP participation more common in hospitals than in non-hospital settings. IP knowledge, experience & competency related to reprocessing varies by practice setting and individual role.

Common Reprocessing Issues for IPs Reprocessing of single use devices Correct & consistent use of process monitors Missing documentation Variations in pre-cleaning practices Use of loaner or physician-owned instruments PM for equipment (non hospital settings) Workarounds and time savers Exceptions and their rationale

A Common Issue in Staff Training & Competency Do You Consider This Basic Information? Procedure (Process Instructions) How Procedure Relates to Workflow (Process Integration) Or This? Aseptic Principles Supporting Procedure (Foundational Knowledge)

APIC Support for Reprocessing An On Going Commitment! NEW IP Competency Model under development; to be introduced in 2012 Strategic planning to meet targeted and expanding IP role requirements NEW online disinfection & sterilization course introduced in 2011 NEW webinar program added to IIPW 2011 commemoration; accessible via APIC archives after initial viewing in October

Range of Services Supported Decontaminati on Disassembly Inspection Assembly Surgery General ENT Orthopedic Neuro Peripheral Vascular Robotics Cardiovascular GYN Plastic Cysto/GU Eye Prep & Packaging Sterilization or Disinfection Cardio Vascular Lab Labor & Delivery Emergency Dental Clinic Outpatient Clinics Nursing Units Critical Care General Specialty Carts

Range of Medical Devices Deconta m Disassemble Inspectio n Assembly Prep & Packagin g Sterilizati on& Packaging Implants Scopes Flexible Rigid Power Equipment Specialty Inst General Instrumentation Loaners Robotic Cameras Eye Instruments Laparoscopic Diagnostic Cords Nursing Units Equipment Instrument sets Specialty carts

Equipment in CSSD Equipment Sterilizers Ethylene Oxide Ozone Plasma Steam Steris System Decontam Equipment Washer/disinfector Ultrasonic Washer Cart Washer AER Testing Equipment Operational Matters Operation Preparation Load & Unload Cycle Selection Quality Monitors Connectors Care & Cleaning Required Documentation Chemical Use

CSSD In Services Issues Sales Rep in-services Surgery may not come to CSS Sales Rep versed in the use of the device not the processing. Often instrument purchase decision and receipt done in Surgery w/o communication to CSSD.

CSSD In Services Issues IFU from medical device manufacturer in conflict with CSSD processing New medical device just shows up in CSSD Rarely used device appears in CSSD

CSSD Technicians High turnover Entry level CSSD techs do not have experience or training No education requirements for new CSSD Technicians or Managers Support to correctly perform tasks

Loaners

Posters Dish Soap Baking Soda

CSSD Competency Review Steam Sterilization Operation Trainee Name Date Trainer Name Date Rating: 1= Acceptable 2= Needs Improvement N/A= Not Applicable Return Demonstration Steam Sterilizer Operation Task Identifies sterilizer to use Checks physical parameters from last load to assure operation/functioning Checks packages for the correct sterilization load identification Checks load for correct loading Reviews load contents for implants and special cycle concerns (IE Extended sterilization or dry times) Checks cart for PCD if required Loads sterilizer cart into the sterilizer No packages are sticking off of the cart Checks to assure packages are not touching the sides of the sterilizer Closes sterilizer door & tightens Selects cycle and initiates cycle Monitors physical parameters Rating Comments: Trainee Signature Trainer Signature

Internet Use IFUs on manufacturers website Step by step instructions on website U-Tube videos on website

Mandate CSS Certification Provides baseline education for reprocessing medical devices Consistency of education level Higher competency level Required annual continued education Provide critical thinking skills

Reality Instrument decontamination is a team sport Device handling at point of use Procedures in central processing Eliminate blame

Facility Limitations Clinics and surgical sites have different standards of practice Physical or structural limitations Soiled or decontamination area may not be close or available Floor plans may limit flow of process Equipment limitations Sink size Availability of automated cleaning processes Appropriate supplies

Personnel Limitations Education and training Personal protective attire Used intermittently Used improperly Established procedures Not followed No accountability

Pre-cleaning Actual Observations Performed intermittently, if at all Potential drying of bioburden Detergents Not mixed properly with regards to concentration and temperature Devices not cleaned consistently Trays may not be cleaned at all, contents cleaned intermittently

Observations Scopes Leak testing was not standardized Detergent was not always mixed to the correct dilution and temperature Some sinks were not adequate in size Transportation of scopes to SPD delays reprocessing Trays may not stabilize devices sufficiently to protect Tray size was insufficient for amount of devices contained

Discussion