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High-level disinfection, sterilization, and antisepsis: Current issues in reprocessing medical and surgical instruments

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High-level disinfection, sterilization, and antisepsis: Current issues in reprocessing medical and surgical instruments

Technology is rapidly changing many aspects of health care. The intricate design of instruments, the configuration of instrument trays, and evidence-based practice have resulted in the need for complicated and specific reprocessing recommendations from instrument manufacturers. Patient safety depends on instruments that are appropriately cared for and adequately reprocessed. This article covers current issues that sterile processing and operating room professionals must deal with regarding reprocessing of medical and surgical instruments.

Key Words

Technology is rapidly changing many aspects of health care. The intricate design of instruments, the configuration of instrument trays, and evidence-based practice have resulted in the need for complicated and specific reprocessing recommendations from instrument manufacturers.
Patient safety depends on instruments that are appropriately cared for and adequately reprocessed (ie, cleaned and disinfected and sterilized). This article covers some current issues that sterile processing and operating room professionals must deal with regarding reprocessing of medical and surgical instruments.

Manufacturers’ instructions for use

Manufacturers of reusable medical devices and surgical instruments must receive clearance from the Food and Drug Administration before the product can be made available for purchase and use in the United States. Part of the labeling claim process requires that manufacturers produce validated instructions for use (IFU) for reprocessing of the reusable device. The medical device manufacturer’s (MDM) validated IFU for each device must be provided in writing to the health care facility purchasing or borrowing these devices. The instructions should describe, in detail, the validated steps for disassembly, lubrication, cleaning, disinfecting, packaging, and sterilization.

Written recommendations from MDMs for reprocessing surgical instruments and medical devices should be on file and consistently followed by health care facilities.

 Extended cycle times

The MDM IFU may recommend sterilization cycle times beyond the standard procedures practiced in health care facilities. These are commonly referred to as extended sterilization cycle times. The need for additional processing times may be the result of the complex design of a device (eg, very long or narrow lumens) the dense configuration of a tray, multiple layers in the tray, the weight of the set, or the design of the containment device itself. To help ensure sterility the MDM-validated recommendations for cycle times must be followed.

Manufacturers of steam sterilizers validate their autoclaves according to specific cycles spelled out in American National Standards Institute (ANSI) and Association for the Advancement of Medical Instrumentation (AAMI) standard (ST) 8, Hospital Steam Sterilizers (see Table 1, Table 2).

This validation process does not include extended cycles; therefore, when facilities run longer exposure times to comply with MDM IFUs they are essentially performing an off-label use of the sterilizer.

https://www.ajicjournal.org/article/S0196-6553(13)00019-9/fulltext

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