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Instrument reprocessing best practices

Published Date
Author Val DuVernet

Follow these steps for best practices of instrument reprocessing in your medical practice:
 

1 | Instrument transportation

  • Handle contaminated instruments carefully to prevent exposure, using appropriate personal protection equipment (PPE)
  • Place in a sealed, leak-proof container with a biohazard symbol to prevent contact injuries during transport to the instrument reprocessing area

2 | Instrument cleaning and inspection

  • Perform cleaning as soon as possible, in a designated area, using appropriate PPE
  • Quick cleaning removes blood and other body fluids much easier and also minimizes instrument staining, corrosion and/or pitting
  • Clean instruments according to the manufacturers’ instructions for use (IFU) (i.e. detergent type, dilution, water quality, temperature, brush type and size)
  • Thoroughly rinse and inspect each instrument prior to packaging
  • If the instrument needs repair, set it aside and/or contact a supervisor to review
  • Lubricate hinged instruments and hand pieces, per the manufacturers’ IFU

3 | Instrument sterilization

  • Load the sterilizer with lighter items on the top shelf and heavier items on the bottom
  • Place peel pouches on the edge of the sterilizer, facing the same direction
  • Place wrapped trays at or on their side, depending on their design
  • Use steam sterilization whenever possible
  • Check the instrument manufacturers’ IFU to confirm the cycle type, exposure time, temperature and dry time
  • Packages typically need a dry time of 20-30 minutes at the end of the cycle to ensure all packages are visibly dry after processing

4 | Instrument packaging

  • Package instruments using FDA-approved products to maintain sterility until the point of use
  • Use peel pouches for single, lightweight items
  • Double-wrap and secure instrument trays or cassettes with sterilization indicator tape
  • Include an internal chemical indicator in each packaging system
  • Use a Class 5 chemical indicator for immediate-use steam sterilization (IUSS) cycles and when processing implant

5 | Instrument storage and delivery

  • After sterilization, inspect all packages for proper color change of the external chemical indicator
  • Do not handle any package that is visibly wet, as this will compromise sterility of the items inside
  • Store sterile packages in a clean, dry location
  • The shelf-life of sterile items depends on the quality of the packaging material, storage conditions, the conditions during transport and the amount of handling
  • Prior to distribution, inspect sterile packages and do not use any that are damaged, wet or opened

6 | Quality assurance

  • Verify sterility using three types of indicators: physical, chemical and biological
  • Physical indicators record the time, temperature and pressure after each cycle
    • NOTE: Keep sterilizer print-outs as part of formal infection prevention records
  • Use chemical indicators on the outside and inside of every package
  • For increased sterility assurance, use a Class 5 integrating chemical indicator daily or with every load for steam sterilization
    • NOTE: Use a Bowie-Dick type test daily to test prevacuum dynamic air removal steam sterilizers (also known as Class B sterilizers)
  • Use biological indicators (BI), or spore tests, at least weekly (preferably daily) and with every load with an implant to test for sterilizer failure
  • BIs are available in either a mail-in service or an in-office system for user convenience
  • While sterilizers can and do mechanically fail, the leading cause of sterilizer failure is operator error (i. e. running from a cold start, wrong cycle, overloading or improper packaging)

This describes best practices for instrument reprocessing in medical offices. For more comprehensive information, refer to AAMI Standards and CDC Guidelines.

Unless otherwise noted, the recommendations in this document were obtained from: AAMI and CDC Guidelines. Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information. All trademarks and registered trademarks are the property of their respective owners.