54 - Do Contaminated Instruments Pose a Risk to Clean Instruments in a Set?
Description: Problem/PurposeSurgical Site Infections (SSIs) are a substantial source of morbidity and economic burden in the United States. Inadequate instrument reprocessing of reusable medical devices has been identified as the likely culprit in several infection outbreaks. Current practice guidelines of reprocessing entire instrument sets when finding a single contaminated instrument lacks evidence. Literature ReviewA literature review was conducted to identify evidence supporting instrument processing practices following the identification of contaminated instruments. The literature supports a link between inadequate cleaning and post-procedure infections. However, aside from anecdotal evidence that recommends reprocessing the entire set if a contaminated instrument is found we were unable to identify any research regarding the transfer of bioburden during the sterilization process. Given this gap in the literature we conducted a pilot study to explore if reprocessing of all instruments is necessary.Research Question/HypothesisIs the practice recommendation to remove, reprocess and sterilize all instruments in a “contaminated” set necessary?Conceptual Framework Kolb’s experiential learning theoryMethodologyPathogenic bacteria were intentionally placed on surgical instruments and allowed to dry. The “spiked” instrument was steam sterilized with three clean instruments (flat, grooved, and cannulated). This process was repeated in 30 open and 30 wrapped sets using three bacterial strains creating a total of 240 instrument samples. All instruments were sampled for bacterial growth when the instruments had cooled following steam sterilization (approximately 10 minutes).Data AnalysisBacterial growth was quantified as colony forming units (CFUs). A Fisher’s exact test was used to assess whether percent of sets with residual target bacteria differed between unwrapped and wrapped sets. ResultsPseudomonas aeruginosa was not isolated from any instruments post-sterilization. Bacillus spp was isolated on 14 instruments post sterilization and Staphylococcus aureus was isolated on 11 instruments post sterilization. Viable bacteria was identified in 5 of 16 (p>0.05) wrapped sets post-sterilization. Levels of CFUs in open sets were lower than wrapped sets.Conclusions/DiscussionWhile wrapping of instruments has become standard of practice, this study showed a tendency for increased survivability of target bacteria in wrapped versus unwrapped sets. Future investigation is warranted to explore factors contributing to pathogen survival based on wrapped/ unwrapped configurations. Perioperative Nursing ImplicationsFindings suggest inadequate efficacy of steam sterilization on air dried debris and provide evidence that contaminated instruments pose a risk to clean instruments in the set.
Co-Authors: Andrew Hover, Michael Lustik, Timothy Horseman, Marisol Resendiz, Gordon West