Every day, surgical instruments and other critical devices—those that enter sterile tissues—are reprocessed and reused in hospitals, ambulatory surgery centers, and other healthcare facilities. Consequently, the costs of physical space, supplies, equipment, and personnel to reprocess and sterilize reusable devices can become burdensome, and some organizations choose to use disposable instruments and devices for critical procedures in some or all areas of their facility.
For organizations performing reprocessing, ensuring that those instruments and devices are reusable—meaning they are in good condition and can be cleaned and sterilized following validated manufacturer instructions—is critical to patient safety. Issue 64 of The Joint Commission’s Quick Safety—“Ensuring critical instruments and devices are appropriate for reuse”—examines this topic.
The newsletter notes that “careful inspection of critical instruments and devices for soil or damage, including but not limited to bioburden, oxidation, corrosion, pitting, discoloration, cracking, peeling, chipping, lifting or improperly applied identification tape, or etching that leaves rough or frayed edges, is a critical step in protecting patients from potential cross-contamination.”*
Effective Interventions
The Quick Safety newsletter notes that effective interventions to prevent reprocessing of instruments or devices that are inappropriate for use include:
- Standardized instrument and device visual inspection occurring during each step of the decontamination, cleaning, and sterilization processes with final inspection before use and removal of any instrument inappropriate for use
- An infection preventionist review of critical instruments and devices during the purchasing process
- Having the manufacturer’s instructions readily available for use and review
- Education, training, and competency of staff who are responsible for reprocessing, oversight, or supervision of reprocessing sterile products regarding their role in the reprocessing of reusable instruments and related job duties
- Effective maintenance and refurbishment processes, as well as replacement plans for items that cannot be refurbished or are no longer suitable for use
- Use of rinse water that meets the device manufacturer’s instructions for use
- Compliance with maintenance instructions for all devices and equipment used for reprocessing, such as automated dilution and flushing devices, ultrasonic cleaners and washer decontaminators, sterilizers, and water treatment systems
- Education, training, and competency of staff handling instruments at the point of use to ensure that they understand which instruments should or should not be reused and what to do if an item that should not have been reprocessed is identified
- Understanding of the key issues that can lead to damaged instruments and devices and how to avoid instrument damage, including:
- Using fragile instruments meant for delicate procedures for other procedures
- Exposing instruments for prolonged periods of time to blood and other body fluids or allowing those substances to dry on instruments
- Using saline, corrosives, or abrasives
- Transporting instruments in a way that could lead to damage
The issue of Quick Safety also lists special considerations for single-use devices.
