It seems like robotic surgery is here to stay. In a study published in the Journal of Minimally Invasive Gynaecology, it was concluded that patients who underwent robotic assisted hysterectomy were less likely to need to be readmitted to hospital than those who underwent open surgical procedures. These patients also had less blood loss during surgery and were able to be discharged from hospital sooner than those who had open surgery (Martino et al., 2013). In South Africa we are more familiar with the use of robotic surgery in urological procedures. Read more

An ultrasonic cleaner is made up of the following components:

• Ultrasonic generator
• Transducers
• Cleaning tank

What is ultrasonic cleaning:

Ultrasonic cleaning works through cavitation. The transducers in the base of the tank generate a sonic wave. The sonic waves make tiny bubbles on the surfaces of the instruments. These bubbles expand until they become unstable and then collapse or implode. The resulting implosion produces localized vacuum areas responsible for dislodging soil from surfaces. The soils are literally sucked off the instruments.

Benefits of using Ultrasonic Cleaners

Ultrasonic cleaners are designed for fine cleaning of medical devices to remove soil from hard to reach areas like crevices, joints, grooves, hinges, box locks, lumens, etc. Gross soil should be removed from instruments before processing in the ultrasonic cleaner because heavy soil can inhibit the cleaning activity.

• Reliable effective cleaning capacity
• Remove debris from less accessible surfaces
• Can be used to clean, unblock lumened instruments (some cleaners have lumen flushing attachments)
• Minimises staffs exposure to aerosols  

Examples of Types of instruments that benefit from Ultrasonic cleaning

Virtually all smartphones and tablet computers used by healthcare workers are contaminated with at least 1 organism, research from a German hospital shows.

“We might be transferring these pathogens to patients, increasing their risk for infection,” said investigator Romy Wendler, a medical student at Klinikum St. Georg in Leipzig, Germany.

“Nurses and physicians use their private phones while working in high-risk areas, such as in operating rooms and ICUs,” she told Medscape Medical News. “Our behaviour might be putting patients at risk because we are not thinking about good hygiene in these critical settings.”

The study results were presented here at the 16th International Congress on Infectious Diseases.

Bacterial Contamination

The objectives of the study were to assess the surfaces of smartphones and tablets for bacterial contamination, and to determine whether a 14-day intensified cleaning period would affect the subsequent burden of microbial contamination.

The entire touchscreen of each device tested was swabbed before and after the cleaning protocol was implemented. Cultures were analysed using a semi-quantitative colony-forming unit count, and bacteria were identified using classic microbiologic methods.

When the samples were evaluated at baseline, 100 of the 101 smartphones and 19 of the 20 tablets tested were positive for at least 1 pathogen. Approximately 55% of the touchscreens were contaminated with more than 1 species.

Many of the pathogens were bacteria that can cause serious infections in critically ill patients, including Staphylococcus aureus, Enterococcus, and Enterobacteriaceae. The investigators defined such pathogens as relevant.

At least 1 relevant pathogen was present on 15.8% of all smartphone screens and on 25.0% of all tablet screens. One tablet was contaminated was methicillin-resistant S aureus.

16th International Congress on Infectious Diseases (ICID): Abstract 61.014. Presented April 5, 2014.

NEW YORK – A hospital on Long Island says only about 200 people have signed up for free blood tests, after it warned 4,247 patients about potential exposure to HIV and hepatitis.

South Nassau Communities Hospital sent out letters to patients who received insulin, due to possible blood contamination related to the use of an insulin pen.

Hospital officials say they are working with the health department and that the risk of infection is low, but insulin recipients may have received it from an insulin pen reservoir that could have been used with more than one person.

“Insulin pens are injector devices with a built-in insulin reservoir designed to be used multiple times, but for one person,” Eyewitness News Dr. Sapna Parikh said. “Insulin pens should never be used in more than one person because with each injection, there’s a small risk a small amount of blood can go backwards into the cartridge, creating a risk the next time.”

The hospital released a statement saying, “South Nassau has already implemented a hospital-wide policy that bans the use of insulin pens and permits only the use of single-patient-use vials to administer prescribed insulin treatments to patients.”

The full statement released by the hospital: “Working closely with the New York State Department of Health, South Nassau is voluntarily notifying a specific group of patients that may have received insulin from an insulin pen reservoir (not the pen’s single-use disposable needle) that may have been used with more than one patient. The risk of infection from this is extremely low, nonetheless, out of an abundance of caution, the hospital is recommending that patients receiving the notification be tested for hepatitis B, hepatitis C and HIV. While the testing is voluntary, it is recommended. To facilitate the process, the hospital is offering the patients free and confidential blood testing services. It has established a dedicated toll-free telephone number that the patients may call to schedule a blood test within 60 days after receiving the letter. South Nassau has already implemented a hospital-wide policy that bans the use of insulin pens and permits only the use of single-patient-use vials to administer prescribed insulin treatments to patients.”

Visit ABC News for the story.

The current SafMed Tracking and Documentation system allows the CSSD and Theatre to trace and record the link between items used on patients and theirsterilization process.

SafMed is introducing an additional, complementary system to trace the link between medical devices used on patients and their cleaning process.

This system allows users to create a label containing vital reprocessing information. The label is affixed to the instrument check list. The check list is then placed inside the cleaned set ready for packaging. (Alternatively the label can be applied to the packing of a single packed instrument). The label is linked to the proof that the instrument washer was working correctly, or linked to information regarding the manual cleaning of that device (who cleaned it and when).

The label is removed from the instrument check list only when the sterile set/pack is opened and used on a patient. The label is then affixed to the patient’s perioperative document, linking the patient to the recorded cleaning process.

This additional label is attached next to the sterilization label in the perioperative document, facilitating a more detailed tracking system.

The system consists of the following items:

Labelling gun:

The labelling “gun”, with duplex tracking labels, enables the user to adjust the dial on the gun in order capture/document the date on which the medical device was cleaned, who the operator was, which washer and which cycle of the day it was. This information is applied via the duplex tracking label onto the instrument set check list.

Tracking labels:

The duplex tracking label is pre-printed with the term: DECONTAMINATED.

STF Load Check:

This device is designed to test the cleaning efficacy of the washer disinfector in accordance with ISO 15883 part 5. The STF load check is recommended to be used when medical devices are cleaned in an instrument washer.

Archive Envelopes:

This enables the user to archive all relevant data related to the performance of the instrument washer

This is an easy to understand, simple to implement, complementary system to enhance your ability to provide evidence of device decontamination.

Healthcare personnel engaged in direct patient care in non-operating room settings should possess two or more white coats and have access to a convenient and economical means to launder them no less frequently than once a week or when visibly soiled, states new guidance on healthcare personnel attire from the Society for Healthcare Epidemiology of America (SHEA) published in the February 2014 issue of Infection Control and Hospital Epidemiology.

According to SHEA, there is limited data on the optimal approach to healthcare personnel attire in clinical, nonsurgical areas, and until appropriately designed studies can be funded and performed to better define the relationship between attire and healthcare-associated infections (HAIs), priority should be placed on evidence-based measures to prevent HAIs and attire choices should attempt to balance professional appearance, comfort, and practicality with the potential role of apparel in the cross-transmission of pathogens resulting in HAIs. In addition to possessing multiple white coats and laundering them more frequently, SHEA recommends that white coats always be washed in a hot-water cycle with bleach, followed by a cycle in the dryer.

SHEA also recommends that personnel remove their white coat (or other long-sleeved outerwear) and place it on a hook prior to any contact with patients or the patient’s immediate environment. Another recommendation in the guidance is that facilities adopt a “bare-below-the-elbows” approach, which involves wearing only short sleeves, no wristwatch, no jewellery, and no ties during clinical practice. SHEA notes that while the incremental infection prevention impact of this approach to inpatient care is unknown, the practice is supported by biological plausibility and studies in laboratory and clinical settings.

Other recommendations in the guidance include that all footwear have closed toes, low heels, and non-skid soles; that name tags or identification badges be clearly visible on all attire for identification purposes; and that shared equipment, including stethoscopes, should always be cleaned between use on patients. SHEA concludes that no guidance can be offered in general regarding prohibiting items such as lanyards, identification tags and sleeves, cell phones, pagers, and jewellery, but those items that come into direct contact with the patient or environment should be disinfected, replaced, or eliminated.

Additional coverage of the guidance is provided by a January 20, 2014, NBC News article

Medical devices/surgical instruments are used throughout the hospital to perform procedures on patients on a daily basis. These procedures are performed in theatre, the ward, maternity and doctors rooms. Contaminated devices need to be transported safely to the CSSD to be decontaminated. Contaminated devices should be transported in a manner that will ensure the safety of the staff and other patients. For this reason it is best to transport contaminated devices in closed, durable, and easy to decontaminate trolleys. It is not acceptable to transport contaminated items on open trolleys only covered with a piece of linen. Linen is not impermeable and will not contain pathogenic soils and microorganisms.

Once medical devices/surgical instruments have been decontaminated (cleaned, packed and sterilized) they need to transported and stored in a sterile store. The Centre for Disease Control state in their guidelines that medical devices/surgical instruments that have been sterilized must be handled using aseptic techniques in order to prevent contamination.  A pack will only stay sterile if it is not exposed to any adverse events. It is difficult to say how long an item will remain sterile for on a shelf as contamination is event related. The chances of a pack becoming contaminated are greater if a pack is handled frequently (Rutala and Weber 2008). Other factors  that could compromise sterility include; poor storage conditions, conditions during transport and quality of packing materials (Mc Donnell and Sheard 2012). For this reason packs should be stored on shelves that are easy to clean and slotted to allow for adequate circulation of air. Sterile packs and sets should not be compressed. Sets should rather be stored one per shelf, and gowns, linen and bowl packs can be stored on their sides to prevent compression. They should be arranged in a manner that they are easy to locate and handling is reduced.

It is critical that contaminated and sterilized medical devices are transported in safe manner and stored correctly to prevent cross contamination, to protect the staff, the patients and to ensure sterility is not compromised.  

Mc Donnell, G. and D. Sheard (2012). A practical guide to Decontamination in Healthcare. United Kingdom, Wiley-Blackwell. 

Rutala, W. A. and D. J. Weber (2008). Guideline for disinfection and sterilization in healthcare facilities, 2008, Centers for Disease Control (US).

This question was recently asked by a member of a LinkedIn discussion group called Sterile Processing Department Professionals.  In response to this questions a few members of the group discussed the concept lining wire basket (instrument trays) with a tray liner.  According to the American national Standard published by AAMI (Association for the Advancement of Medical Instrumentation)AAMIST79, 2010, tray liners can be used to wick condensate away from instruments. This disperses the condensate over a bigger surface facilitating more efficient drying. If an excessive amount absorbent material or the wrong type of material is used it can impede air removal and steam penetration. Participants in the LinkedIn discussion state that they no longer use linen towels to line trays as they contain lint and residual cleaning chemicals. Follow the link to read the rest of the discussion.

https://www.linkedin.com/groupItem?view=&gid=3714898&type=member&item=5956767125476503552&trk=groups_search_item_list-0-b-ttl&goback=%2Egmr_3714898%2Egna_3714898

AAMIST79 2010. Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington Association for the Advancement of Medical Instrumentation.