Critical Steps for Point of Use Pre-cleaning Compliance

PART I

The advocacy for initiating instrument processing at point of use is gaining momentum. It takes a team with perioperative management, infection preventionists AND SPD leadership to keep pressing for compliance after the latest survey visit. 

Compliance involves two important steps:

(1) Pre-cleaning with sterile water and sterile sponges DURING procedures; and (2) Pre-treatment with wet towels or chemical sprays to prevent residual soils from drying during transport. 

The first step is education to motivate teams at point of use in surgical, labor/ delivery, endoscopy and other critical departments with heavy soil loads. Clinical teams need to understand how dried soils lead to biofilm, corrosion and instrument damage. 

Next step is making compliance as easy as possible. For example, non-saline sterile water should be readily available with a method to collect soiled sponges and excess liquid. Contaminated items should NOT be transported in any type of liquid bath. 

A third critical step is factoring the transit time from point of use to central sterile processing. If always under one hour, covering contaminated instruments with wet towels may be sufficient as a moisturizing method. Delays are much more common due to overnight procedures (labor/delivery), processing log jams in SPD, transport from off-site clinics and personnel shortages to transport or process instruments. Delays in transit may create the need for effective pre-treatment chemical agents. 

Healthcare facilities should first reduce and eliminate delays as much as possible. Chemical agents are a secondary strategy to deal with delays over one hour or overnight. Labor and delivery presents a common challenge when the facility has a 12 hour sterile processing department. 

An effective pre-treatment agent should be compatible with the device. Device processing instructions (IFU) may state “mild, neutral pH or enzymatic”. Chemical information is available on the product label and in the Safety Data Sheet section 3 with pH information in section 9.

Disinfectants are rarely indicated as appropriate pre-treatment agents. The disinfectant chemicals are often incompatible. Alcohol is a common ingredient and will fixate protein soils making it harder to clean items at final processing.

Most pre-treatment sprays will keep soils wet and prevent drying. The ideal pre-treatment agent will also offer anti-corrosive or non-corrosive action and active sustained soil breakdown during transit. Active soil breakdown requires enzymatic agents in the formula or bio-generated enzyme activity. Be sure to thoroughly review chemical features when selecting a pre-treatment agent.