Sterile Processing Case Study(ANSWERED)

QUESTION

Choose two of the four topics as listed below: Decontamination Principles, Sterilization Methods, Preparation of Medical Equipment and Supplies, and Inventory Control and Distribution Systems. Once the two case studies are chosen, answer the questions using your own vocabulary and address the conflicts or issues with solutions specific to your topics of choice. To fulfill the requirements of this case studies project, you must employ research techniques. You can utilize your text or other credible sources from the internet to build a thorough paper that contains at least six main ideas with supporting details regarding the topic chosen and a minimum of three credible references. The paper must be written in APA format with an extensive introduction, body, and concluding statement per case study. Minimum of four pages, double-spaced excluding title and reference pages per case study. Please refer to the rubric regarding specific grading criteria.

Now that you understand the basic goals of this project, let’s get started.

CASE STUDY SCENARIOS

Decontamination Principles: Dr. Sarmiento is a well-known neurosurgeon at Baptist Medical Center. He is known for working on complex cases that involve the spine and other neurological tissues. This past week, his private scrub tech has discovered that dirty neurological instruments have made it into the OR. The technician consults with the patient care manager of surgical services because the incident has been reoccurring over the past few months. With this knowledge, respond to the following questions:
What issue(s) have occurred, and what may be the cause of these errors?
What other special precautions may the sterile processing tech need to take with instruments exposed to neurological tissues?
What might the sterile processing department have to do to resolve this issue?
Thoroughly explain the decontamination process. What extra efforts should be made to ensure that clean instruments are delivered to the surgical suite?

Sterilization Methods: Kristine, a technician in the sterile processing department, has noticed that after the sterilization of surgical equipment and supplies that at least two out of every four loads sterilized for the day have been moist. She has consulted with her supervisor on effective ways in which she could troubleshoot the concerns with wet loads, because it has now affected the department’s work efficiency and quality control.
Define a wet pack.
Define a wet load.
Why might the loads be wet?
What solutions can Kristine apply to ensure that the processed instrument sets aren’t moist?
Discuss how this issue can affect both the operating room and the sterile processing department. How should Kristine handle the wet packages to ensure quality control?

Preparation of Medical Equipment and Supplies: Over the last month, the operating room has received rigid containers without filters, assembled instrumentation such as Poole suction devices in sterilized sets, and closed versus open packaged and processed instruments on the stringer and within the instrument sets.
Discuss in detail how these occurrences can impact safe and efficient patient care.
Discuss the instrument preparation process. What can the sterile processing technician do to ensure that all items are prepared and packaged correctly?
How does this situation impact the operating room staff?

Inventory Control and Distribution: The sterile processing department at Hershey-Chocolate Medical Center has an excessive amount of inventory. Management has decided to restructure the inventory system used in their facility and has asked you to research at minimum four different inventory systems that may help with the safe and efficient distribution of medical supplies and is also cost-effective.
What inventory system may work well for their department? Discuss at least four types of inventory systems and how each could initiate a more controlled environment of inventory for the facility.
How can distribution be affected by excessive inventory?

ANSWER

Sterile Processing Case Study Project

Sterilization Methods

Define a wet pack.

The Association for the Advancement of Medical Instrumentation defines a wet pack as the internal or external presence of moisture in a package after complete sterilization. In most cases, the wet pack portrays three leading scenarios (Wattal & Oberoi, 2014). These scenarios include; the pack is damp, has water droplets, has remaining moisture in the pack, or the trays have visible waters. After sterilization, a wet pack may result in millions of microorganisms remaining on the pack. The microorganisms are likely to breed further and multiply on the objects, making the things unsuitable for procedures.

Various reasons may cause wet packs after sterilization. The most common reasons for moist packs include wrapping the instruments with poor quality materials, steam quality, rigid containers with faulty valves, and sterilizer malfunction. In addition, wet packs may cause increased workloads to the staff, possibly contaminated instruments, procedure cancellations, and poor patient outcomes. These may all cost a health care organization a lot of funds and money.

Define a wet load.

A wet load is when several sterilized trays from the same load are wet. Wet load is the present moisture in a load after the complete sterilization process (Seavey, 2016). In most cases, a wet load is an indication of a problem. Therefore, when one notices a wet load after sterilization, the organization must thoroughly investigate the same. A wet load is the result of a wet pack.

Why might the loads be wet?

Various reasons may lead to the loads being wet. The most common reasons causing this problem may include the following;

Poor quality of packaging materials

The leading importance of packaging material is to maintain sterility and act as a sterile barrier until the instrument is used. Therefore, it is necessary to wrap packaging materials so that air and steam can be received in the package, but bacteria stays out always. However, some facilities use reusable linen for their sterilization processes. Because of cotton thread, there is a higher likelihood that moisture can be retained during the steam sterilization process. When condensation occurs after the procedure, this results in moisture retention, which causes wet packs (Basu, 2017). It is so because a metal instrument may contact hot steam at room temperature, resulting in condensation. It is essential to note that older metals have a higher metal mass with a higher condensation rate.

Rigid Container Systems Problems

In the post-vacuum phase, there may be condensation in the rigid containers. It happens when there is a drop in the maximum pressure to the atmospheric pressure after completing the sterilization cycle. Also, the difference in temperature between the inside container and the sterilizer chamber may result in condensation. It may be so in the surgical set. In the drying phase of sterilization, it may be impossible to evacuate steam completely. Therefore, a challenge is associated with the residual steam as the instrument may not be completely dry.

Faulty Packaging Techniques

The packaging technique is an essential aspect of the sterilization process. However, there are some packaging instruments and techniques used that may cause wet packs. For example, materials like cotton and gauze in the surgical set can hold moisture during their drying phase. Also, there are excess metal masses inside a surgical group that increases both the thermal unit and weight. However, condensation may occur during the cooling down process if there is a rapid decrease in the chamber temperature to room temperature compared to the set temperature. Another faulty packaging technique is the improper drying up of materials during packaging. It will cause the instruments to be packaged with moisture on them.

Improper loading technique

Wet packs cause wet loads. In addition, insufficient space between items may result in moist packs. Therefore, the loading principles should often be followed to ensure proper loading techniques:

1. For the surgical set, there must be a one-inch gap between the two groups. Doing so prevents condensation.
2. For the peel pouches, it is necessary to ensure that materials are vertically placed on the shelves of the sterilizer and not stack on one another.
3. A technician should ensure that the instruments on the upper shelf are loaded with linen for mixed loads.

The lower shelves, however, to avoid condensation, should compose of metal items. Failure to follow these principles may result in wet loads.

What solutions can Kristine apply to ensure that the processed instrument sets aren’t moist?

Kristine can apply various solutions to avoid moist instrument sets. Below are some of the answers she may use to ensure this problem does not exist;

• First, Kristine should ensure she follows all the loading principles. The principles are there for a reason, and Kristine must follow them. They will guide her on the best ways to load her instruments to avoid condensation and from being moist. In addition, following the principles may prevent her from overloading the sterilizer.
• Secondly, faulty packaging techniques are another common cause of most instruments. To prevent moisture on the tools, it will be essential that she follows all the guidelines related to instrument packaging and reprocessing. She can do this by indicating the reprocessing devices and testing them according to the compliance regulations.
• Kristine may also have a daily routine to check all the processes to ensure that they all function well.
• Lastly, after sterilization, she should confirm and ensure that the sets of instruments have adequate time to cool down before storage. If the device cools down, there will be no moisture left on them before packaging. They will, therefore, be packaged when dry hence no retained water.

Discuss how this issue can affect both the operating room and the sterile processing department.

Wet pack issues may have various impacts on the medical team and patients:

1. Moist packs may act as a pathway for microorganisms to move into the packaging materials from the external environment. When this happens, the instruments are likely contaminated. When contaminated devices are used on patients, they are likely to develop hospital-acquired infections, resulting in poor patient outcomes.
2. The operating room may be impacted because the whole sterilization process has to be redone once an identified wet pack is identified. Once a wet pack is noticed, recleaning and resterilization is the only way the team can solve the problem. This may result in the cancellation or postponement of operating procedures that have to be done with these instruments.
3. For the sterile processing department, the issue may waste effort and time and increase the workload. It is so because the department will have to redo the process all over again. Unfortunately, redoing the process will mean the department is doing the work again, which is tiresome.

How should Kristine handle the wet packages to ensure quality control?

Because she noticed the wet packs, it will be necessary for her to ask for a full investigation. A wet package indicates a problem, and once it is detected, it is essential to find the leading cause (Ahmed et al., 2017). Having a complete analysis will be necessary because she will be in a better position to find the source of the problem. After the investigation, she should be able to find the problem source, after which she should take various steps. The first step should be changing the sterilization services and procedures. She should also look for an expert to help her analyze the problem from the source and the possible favorable solutions. Following the above steps may control the problem and further prevent its reoccurrence.

Preparation of Medical Equipment and Supplies

Discuss in detail how these occurrences can impact safe and efficient patient care.

Every hospital is obligated to provide the safest care to the patients who visit them. It is, therefore, necessary for the hospital staff and team to ensure that their activities only impact the care given in positive ways. In the given case scenario, various occurrences are likely to affect the care given to the patients. For example, the operating room has, for the last month, rigid containers without filters. Secondly, they have also received Poole suction devices in sterilized sets. In the operating room, filters are essential because they are responsible for preventing particulates and contaminants from affecting the sterilized containers (Chauveaux, 2015). There is a reason for the manufacturers making the instruments with the filters. Therefore, when the operating room is receiving rigid containers without filters, it is essential to note that the received containers are contaminated. Once the operating room has received containers without filters, the patient’s lives are at risk. They are likely to be operated on and handled with contaminated devices. The harmful devices are likely to result in the patient having hospital-acquired infections. These impacts will likely result in patients overstaying in the hospital to get additional treatment for these new infections.

Also, the operating room has been receiving assembled devices in various sterilized sets. After completing the sterilization process, the dry equipment should be kept in covered and closed cabinets until they are needed for use. However, for the last month, the OR has received assembled devices for the department in sterilized sets. Operation instruments like knives and Poole suction devices should be set aside and handled differently. These devices should be protected and separated from the rest. It should be so because of their delicate nature and function in the operation room. Unfortunately, the facility has received among sets Poole suction devices meaning they were not separated from the rest of the devices during sterilization. It is necessary to remember that every device used in a health facility might be made in the same company, but their sterilization process is different. It is the case because each instrument is applicable in various department. Therefore, it is unfortunate that the OR has received these devices in sterilized sets. The most probable conclusion is that they were sterilized with other groups, yet they are for a different purpose. This may affect the care patients receive as the Poole suction devices may not be well sterilized. Therefore, it may result in contamination which will increase patient infections.

Discuss the instrument preparation process.

Instrument preparation is the cleaning and removing residual matters like tissue and blood from the instruments before the sterilization process (Rutala & Weber, 2016). Doing this is essential because, before the sterilization process, all the devices should be free from residual matters. Below is the instrument preparation process.

• Cleaning- this is the first step in instrument preparation. The cleaning process should be done immediately after the instrument is used. The most recommended cleaning way is the ultrasonic cleaning system with an enzymatic solution. The cleaning process allows the removal of residual matter from the instruments.
• The second step is rinsing the instruments to remove the solution and any remaining residual matters.
• The third step is following the manufacturer’s instructions for instrument lubrication and cleaning purposes.
• Separation- before any further decisions, separation of the instruments should take place according to their components. For example, steel instruments should be set aside as they are often bagged, unlike most tools put directly on steel trays.
• After separation, instruments sterilization instructions are again read to ensure every item undergoes proper sterilization. Doing this is essential because the manufacturer gives detailed information on what should and should not be done on the instrument.
• Sterilization:This is the final step after all the instructions and separations are complete on every instrument. The sterilization process is necessary for complete elimination of the present germs on the devices.

What can the sterile processing technician do to ensure that all items are prepared and packaged correctly?

The sterile processing technician can ensure every item is correctly prepared, sterilized, and packaged by taking various actions. The most valuable and possible factors the technician can do may include; first and foremost, the technician should separate every instrument used in the operating room before cleaning. Doing this will allow him to sterilize and package the devices correctly because he will have used the most effective sterilization way for each instrument. When each instrument is separated before starting the cleaning process, the devices are likely to receive a suitable sterilization process. Also, once the process is complete, the technician will easily package them together, avoiding unnecessary confusion or mishandling of the devices. The second precaution the technician can take is reading all the manufacturer’s instructions on all the devices. If the technician does this, he will complete the sterilization process without cross-contamination from one instrument to the next.

During sterilized instrument packaging, the technician should ensure that he carefully evaluates each packaging material. Also, he should ensure every package is carefully and correctly labeled on packaging evaluation to prevent wrong package delivery. Lastly, the technician should provide that he double-checks the instruments after sterilization before packaging. If he had double-checked the equipment before their delivery to the operating room, he would have noticed that the Poole suctions in the wrong place and are likely not well sterilized. Following these precautions will prevent further complications in the operating room for both the patient and the operation room staff.

How does this situation impact the operating room staff?

The situation impacts the operating staff because their patients are likely to be affected by using rigid containers without filters. It is so because containers without filters are contaminated. The filters act as covers that prevent microorganisms from getting to the containers. Using these contaminated containers on patients will result in patients acquiring a new infection which means the operating staff will have to treat one patient more than once. Apart from the patients, the operating room staff has constantly been coming into contact with contaminated instruments. It also puts them at risk of acquiring new infections from their patients.

References

Ahmed, N. H., Satpathy, G., & Aron, N. (2017). Quality Control and Surveillance. Ocular Infections: Prophylaxis and Management, 73.https://www.researchgate.net/publication/329029595_PIIS0140673618322037

Basu, D. (2017). Reason behind wet pack after steam sterilization and its consequences: An overview from Central Sterile Supply Department of a cancer center in eastern India. J Infect Public Health, 10(2), 235-239.https://www.sciencedirect.com/science/article/pii/S1876034116300983

Chauveaux, D. (2015). Preventing surgical-site infections: measures other than antibiotics. Orthopaedics & Traumatology: Surgery & Research, 101(1), S77-S83.https://www.academia.edu/79854462/Multidrug_resistant_bacteria_isolated_from_surgical_site_of_dogs_surgeons_hands_and_operating_room_in_a_veterinary_teaching_hospital_in_Brazil

Rutala, W. A., & Weber, D. J. (2016). Disinfection, sterilization, and antisepsis: An overview. American journal of infection control, 44(5), e1-e6.

Seavey, R. (2016). Troubleshooting failed sterilization loads: Process failures and wet packs/loads. American journal of infection control, 44(5), e29-e34.https://www.researchgate.net/publication/301738836_Troubleshooting_failed_sterilization_loads_Process_failures_and_wet_packsloads

Wattal, C., & Oberoi, J. K. (2014). Decontamination and Sterilization Procedures. In Hospital Infection Prevention (pp. 103-120). Springer, New Delhi.

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