What is the optimal instrument cleaning procedure between patients?

By: December 30th, 2009 Email This Post Print This Post

Q: What are the best options for instrument cleaning for our outpatient hand clinic? We see a variety of infections on a consistent basis and perform debridement frequently as well. What is the optimal method for instrument cleaning between patients: Use of an instrument soak, disposable instruments, or use of an autoclave after each use or after a specified period of time with soaking in between patients?

A: Any reusable instrument that comes in contact with open tissue or blood must be sterilized between patient usages. Sterilization can be done many ways such as the ones you noted: by use of steam sterilization (autoclave) or with a chemical soak. All of these methods are appropriate as long as you:

1) Follow the instrument manufacturer’s recommendation for sterilization

2) Follow the sterilization method’s protocols with appropriate chemical, physical and biological monitors

In outpatient clinics such as yours, it comes down to what is the easiest, cost effective method for your facility. It might be best to use disposables if the turnaround time would limit the procedures you perform. Chemical soaking sterilization may need specific air monitoring that is not cost effective for you to do in your facility. Steam may take too long.

Many factors can dictate which is best. It’s important to assess all your options first in terms patient safety and compliance with manufacturers instructions, and then for convenience and efficiency.

Comments

By Susan Harp M(ASCP) CIC on December 30th, 2009 at 8:28 am

I think this reply left off a major point of any instrument reprocessing and that is the mechanical cleaning of the device prior to the sterilization process. All debris must be removed and the device absolutely clean in order to reduce the bio-burden.
Steam sterilization is a good option for many heat tolerant devices, but the cycle must be monitored and should include weekly spore testing to be sure they are functioning correctly. One approach to using steam is to have extra instruments to allow for turn around.

By Stephen M. Kovach on December 30th, 2009 at 9:18 am

The article is titled “What is the optimal instrument cleaning procedure between patients?”

To add to first comment on cleaning. Cleaning is the first and most important step. Medical facilities need to make sure they are cleaning the item properly before sterilization regardless if done manually or mechanically or a combination.

The medical facility needs to follow the manufactures guidelines on cleaning,if not then the item might be properly sterilized.

The article was good but did not talk about cleaning only sterilization.

 

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