Four Critical Steps in Instrument Processing

(Updated June 2019) Patient safety is at the center of many conversations in the health care community. While many processes may impact the safety of a patient, appropriate instrument processing should rank at the top of the list of safety priorities.

In this article, we will address four critical steps in instrument processing, but before we start, the impact of manufacturer’s instructions for use should be discussed. Instruments to be processed, equipment used, sterilization wraps, and any chemicals used in the processing cycle all have instructions for use. It is imperative that these instructions are reviewed and followed. For instance, sterilization pouches may have directions that establish an end date on the use of the instrument once it is sterilized and stored appropriately. These dates may range from one to three years. Ensure that you have a copy of all pertinent instructions and only then are you ready to begin!

• All instruments must be appropriately cleaned. After the safe transport of instruments from the clinical area, removal of any residual debris, including blood, bloody fluids, and tissue is the first step in instrument processing. Cleaning can occur by using a mechanical means such as an ultrasonic or washer with an added detergent, or by hand. Because of the risk of a sharps injury try to limit handwashing of contaminated instruments. The appropriate personal protective equipment must be used and may include face protection, cover gown, and heavy-duty utility gloves. Once the instruments are clean they should be dried prior to being wrapped for sterilization.

• All instruments should be packaged in an FDA cleared product. There are many different packaging types available on the market. Choose the type that is appropriate for the type of sterilization process and instruments to be sterilized. Examples of packaging include peel packs, rigid containers, and woven and non-woven wraps. Once wrapped, all packages must be labeled with the sterilizer number if more than one unit is used, the load number and the date. Using an ink that does not run, label packages on the sterilization tape or on the plastic side of the peel pack. The packages are now ready to be appropriately loaded into the sterilizer.

• Ensure the sterilization process is appropriately monitored. There are three different monitoring process that must occur:

1. Manual indicators for steam sterilizers – Time, temperature, and pressure are required for steam sterilization to work effectively. These elements should be recorded for each sterilizer and on every load run during each workday. Documentation should include the date, the time the load began and whether the unit successfully met all the required parameters.
2. Chemical indicators – Chemical indicators are designed to detect local problems associated with incorrect packaging, incorrect loading or a problem with equipment functioning. Each package must have a chemical indicator located inside the package if the internal indicator is not visible.
3. Biological indicator – A biological indicator must be run at least weekly and with any implantable device. A failed spore test can be an indication of improper functioning of the unit which may impact sterilization of instruments. It is important to determine the cause of the failed test to ensure instruments are safe for use.

• Ensure instruments are properly stored prior to use. Instruments must be cool and dry prior to removal from the sterilizer. If instruments are handled when they are damp, contaminants from the worker’s hand may wick through the packaging and contaminate the instruments making them unsafe for use. Processed instruments should be stored in a cool, dry area and handled as little as possible prior to using to reduce the likelihood of contamination. Based on the manufacturer’s instructions for use, dates vary on how long packaged instruments can be stored and used in the delivery of care.

Correct sterilization of instruments is critical to the overall success of many practices. Hopefully, your practice is following these basic guidelines. If not, begin now to change your processes to protect both your employees and patients.

If you would like more information on this very important process, please check out some of TMC’s webinars on these subjects and consider signing up for our newsletter to stay on top of the latest news in compliance and infection control.