Copy - Copy - Perioperative Template 2024 FY VUH Main Campus OR Licensed Competencie

Instrument Stewardship OR Main Campus

Presentation - 2026

Perioperative Services

• Describe the steps in two-person sterility verification of instrument pans
• Identify placement of chemical indicators
• Interpret results of chemical indicators and confirm they have met the appropriate sterilization standards
• Discuss proper handling of flexible endoscopes
• Understand importance of point of use cleaning
• Understand the importance of instrument tracking with Censitrac
• Describe instrument handling after procedure for used/dirty instruments
• Describe instrument return for clean/unused instruments after procedure
• Understand IUSS/ONE TRAY process overview

Objectives

• Verification of all indicators are made:
• Before opening the instrument set
• After opening the instrument set
• Before placing the instrument set on the sterile back table

This is always a two-person verification

Checking Sterility Before Use

Locks should present, intact, and process indicator color changed

Instrument pan should be fastened and sealed

Blue filter showing

External Verification- Rigid Pans

**If you discover moisture, foreign particles, or bioburden - Do Not Use the Instruments –they are contaminated.

Check for damage and moisture Moisture can consist of water standing in the bottom of the instrument pan or dampness in the set

• Once lid has been removed, release filter plate and check position of filter (paper should cover ridges on all 4 sides)
• Filter should be free of holes and moisture
• Discard filter paper and replace filter plate

Internal Verification- Rigid Pans

Sterile

Non-Sterile

• Placed on the bottom of the set, in opposite corners for large pans (small sets can have one indicator)
• On each level of a multiple level set
• Inside the popcorn bag with the count sheet
• Placed inside of the instrument roll or any other challenging area of the instrument set

Chemical Indicators or Integrators

If pans do not contain a popcorn bag, pass off indicators to circulator. The circulator will gather and keep all internal/external indicators until the end of the case.

• Found in trays that have been steam sterilized (pans that are sterilized by V-Pro Max or Sterrad will not have popcorn bags)

• The count sheet will be inside the popcorn bag along with an indicator of sterility.
• Integrators/indicators are placed inside one of the popcorn bags and handed off the field to the circulator.
• The circulator places the outside pan locks in the bag, writes the patient’s initials on the bag, and keeps it for the duration of the procedure.

• Once the procedure is over and the patient has left the room, the popcorn bag can be discarded.

Popcorn bags

• Before placement on the sterile field, the wrap must be checked for holes

• Verify that there are no visible holes, tears, or moisture before opening
• After opening verify indicators on the inside of the package are present with the acceptable color or sterilization range
• Before placement on the sterile field, the wrap must be checked for holes

• Verify color change on sterilization tape
• Package wrap intact
• Event Related Sterility issues have not occurred

Wrapped Instruments Sterility Verification

Non-Sterile

Sterile

Processing Method

• STERRAD
• V-Pro Max

Endo Instrument Containers Know the Difference!

This pan is Sterile!

This pan is NOT sterile!

Processing Method STEAM

Endo Instrument Containers Know the Difference!

• Wipe scope with moistened lap
• Flush lumens with 100cc sterile water
• Return scope to protective slots in container taking care to not to place anything on top of delicate scope
• Place used scopes back in container exactly as received
• Do not put heavy items such as a light cord or rigid instruments on top of scopes

Scope Handling

• Endo pans all have names starting with “Endo”​
• At the end of the procedure, endo instruments must be placed back into the protective designated slots in the container they came from, and placed in your case cart for reprocessing

• Flexible scopes with no pan do not go in your case cart​
• Flexible Endoscopes Do come in an Endoscope bucket (call ORTA for bucket if not on case cart)​
• Do wear gloves when handling (before and after use)​

If you must retrieve a scope yourself:

• Assure you are using the scopes with tags that correspond to the current day
• If there are no scopes in the cabinet with the correct colored tag, use a scope for the next day color
• Please assure you are using the scope closest to its expiration date first

Check colored tag:

• For date on the back - this is the date when the scope must be reprocessed
• For color of the tag to assure it corresponds with the day you are using the scope.

Flexible Endo Scopes

MCE dirty scope cart call 615-573-6700if dropping off a scope here from MCE

All flexible scopes should come with a tip protector​

• Intended to protect the scope tip in transport before and after the case

​ When the case is complete:​

• Use First Step to begin the decontamination process in the OR​
• Put the tip protector back on the scope ​
• ​Place a patient identification sticker on the colored side of the scope tag along with the time it was removed from the patient and return scope and colored tag to endoscopy for reprocessing
• Return the scope in the original bucket to the​designated area (either the dirty endo room for cases in the ​main OR or the dirty scope cart on the 3rd floor Skybridge for ​cases in MCE)

Flexible Scope Handling After Procedure

Spray instruments after surgical procedure enzymatic spray

• Keeps instrumentation moist during transport for decontamination process
• Reduces risk of bioburden
• Do not spray endoscopic telescopes, camera heads, light cords, or eye instrumentation

Flush instrument

• Instruments with lumens should be flushed only with Sterile water during surgery and post surgery.
• This is done to prevent clogging and drying of the gross soil.
• Saline must not be used, since the chloride ions can cause pitting and deterioration of the finish on the surface of instruments

Wipe instruments during procedure

• Prevents overaccumulation of blood and bioburden
• Decreases possibility of missed bioburden during CSP process
• Prolongs life of instrumentation due to corrosion

Instrument Point of Care

• Use the count sheet to ensure that the instruments are returned to the correct pan
• Remove all the towels from the pan
• Filters should have been checked prior to placing the pan on the back table and therefore should not be still in the pan
• Integrators, all outside load stickers (if present), and pan locks should be in the popcorn bag with the patient’s initials. This can be discarded once the patient leaves the room.
• All instruments in the pan must have box locks unlocked, be disassembled, and sprayed with transport gel
• Lock the rigid containers before placing on case cart
• Ultimate responsibility lies with the scrub person to make sure all is complete
• For the safety of everyone in decontamination, remove all sharps & clamp inserts

Instrument Handling After Procedure Used/Dirty Instruments

When returning the pan to the Clean/Unused cart:​

• Place the instrument on the case cart​
• Log in to Censitrac on the workstation ​
• Scan the location barcode on laminated sign​
• Scan the returned instrument pan​ barcode
• Then scan the wall barcode again to “send” the scanned data ​(meaning Censitrac captures the pan’s new location)

If you do not use a pan (i.e., it is still sterile - all external indicators are intact, and the pan is unopened):​

• Place on a prep stand outside your room and ask an ORTA to get it, or​
• Return it to the nearest Clean/Unused Instrument Pan Return cart (one located in each staging zone: Main 1, Main 2, Main 3, Robotic, MCE, and 4 South)

Sterile, Unused Instrument Return Process

Dont't Forget to click "Send Scanned Data" or scan room location again

Located on workstation computer or outside room door

Scan Case Barcode

Choose Workflow

Scan room location.

Scan your badge barcode

To log on, click the icon on the desktop

Did you pull an instrument pan from the shelf to use in your room? It must be scanned in Censitrac, so the location of the pan can be tracked along with the patient upon whom it was used.

Censitrac Scanning

Be specific

Located on your count sheet on bottom of paper

List of Quality Events

Any time there is an issue with an instrument or pan, please provide Quality Feedback in Censitrac. This provides paper documentation for instrumentation issues.

Censitrac Quality Feedback

How can you repair something if you don’t know what’s broken?

**A Censitrac Quality Feedback Report must also be completed**

• Quick & easy to secure
• Can be applied to all instruments
• Best of all, can stay with the instrument and go through the instrunment washer!

• Use Repair Tag for instruments or pans that need repair or are broken
• Use a sharpie and provide a detailed description – not “broken” or “doesn’t work”

Repair Tags

Censitrac

Looking for an instrument pan? Censitrac will show you where to find it!

• oneSOURCE is the source for the most updated information on cleaning, decontamination, and sterilization guidelines for Sterile Processing, Infection Prevention, and Decontamination of reusable surgical instruments, medical devices, equipment, and implantable biologics, materials, and devices.
• If asked during a survey, you will need to demonstrate how to find this resource.

• After sterilization, ONE TRAY provides for the safe transport and assure delivery for immediate use.

• This process uses a sealed container with tamper evident security and load record documentation according to AAMI and AORN guidelines. The performance and intended use of the ONE TRAY Sealed Sterilization Containers should utilize the:

• Device manufacturer's sterilization exposure parameters recommended practice guidelines, outline by the AAMI (Association for the Advancement of Medical Instrumentation) AORN (Association of periOperative Registered Nurses)

• ORTA's are responsible for a immediate-use steam, sterilization, IUSS and documentation of process

• IUSS is for emergent situation only and is not to be used as a substitute for insufficient instrument, inventory

• View chemical indicator for sterility prior to introducing to the sterile field

• Ensure ample cooling time before use of sterilized item to avoid burning the patient

• Per the sterilization practice processes SOP, IUSS for implantable devices is prohibited except in emergent situations

One Tray-IUSS

• Implants, except in a documented emergency situation when no other option is available.

• Approval of IUSS of implantable device is obtained by perioperative leadership (e.g., Operating Room Director) and surgeon.
• An Early Release Form is completed with appropriate signatures.
• Sterilization information is collected and includes sterilizer load, biological lot number, results of the biological, and patient information.
• An occurrence report is entered into VERITAS, outlining the situation.
• The Early Release Form is uploaded to the veritas event filed.
• Post-procedure decontamination of instruments used on patients who may have Creutzfeldt-Jacob Disease (CJD) or similar disorders.

• Devices or loads that have not been validated with the specific cycle employed.​

• Devices that are sold sterile and intended for single use only.​

IUSS is not performed on the following devices :

Immediate-Use Steam Sterilization (IUSS)

VUMC SOP. Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes https://vanderbilt.policytech.com/dotNet/documents/?docid=33888

VUMC SOP. Point-of-Use Instrument Cleaning and Spraying Compliance. https://vanderbilt.policytech.com/dotNet/documents/?docid=29806

VUMC SOP. Immediate-Use Steam Sterilization IUSS. https://vanderbilt.policytech.com/dotNet/documents/?docid=30310

VUMC SOP. Endoscope Reuse and Delayed Reprocessing. https://vanderbilt.policytech.com/dotNet/documents/?docid=29392

VUMC Policy: Sterile Processing: Sterilization Practices. https://vanderbilt.policytech.com/dotNet/documents/?docid=29804

AORN Essentials Sterile Technique. Opening Sterile Packaging Systems. https://www.aorn.org/essentials/sterile-technique

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References