Surgical site infections (SSI) are multifaceted, meaning that there are many intrinsic and extrinsic factors that contribute to them. Unfortunately, many times it is difficult to track down the source of the infection because of all the factors in play. Is it the traffic in the OR that disrupts the laminar air flow, the shedding of squamous cells by the OR staff, or is it the case going longer than anticipated? Where did the contamination take place, in the OR or after surgery?  Bioburden/biofilm left on surgical instruments after reprocessing is an extrinsic factor that plays into SSI. The Centers for Disease Control and Prevention indicates that over 30,000 patients die annually from surgical infections. Today we are going to discuss methods to reduce bioburden/biofilm left on instruments after reprocessing.

When you leave your dishes in the sink without rinsing them and then later put them in the dishwasher, what happens? We all have been there and had to rewash those dishes because of “stuck on” food. The same theory can be applied when we think of instrument bioburden. AORN’s Instrument Cleaning Guideline  reports that moistening and removing gross soil at the point of use can help prevent organic material and debris from drying on instruments. Organic material and debris are more difficult to remove from surgical instruments when allowed to dry and residual soil can affect the efficacy of subsequent disinfection and sterilization processes. Soil that is allowed to dry on surgical instruments permits the formation of biofilm which is difficult to remove and more resistant to inactivation by steam sterilization. There are several things that can be done at the sterile field and the OR to eliminate drying of organic material on instrumentation.

  1. Keep water on the back table to soak dirty instruments while not in use (Saline will corrode the instruments.)
  2. Wipe the instruments with a moist sponge as they are being used.
  3.  Keep the instruments moist so that blood and body fluids do not dry and adhere to them (Place a moist towel over them.)
  4. Treat the instruments with an enzymatic pretreatment before sending them to central processing.

Instrument cleaning is not the job of the sterile processing department alone; it is a collaborative effort that extends between them and the OR. When bioburden appears on the instruments on the sterile field or instrument pan, investigate whether pre-cleaning is routinely being done. A simple check list can be incorporated into your workflow and imbedded into your time out and debriefing. Also, reminders during the time out to “keep sterile water on the field” and again during the debrief to “make sure all gross soil has been removed from the instruments” will help to eliminate these problems.

Pre-cleaning instruments decrease the risk of SSI, so every effort must be made to eliminate any risk to ensure the best patient outcomes.