Ori Prereq 6 - ALL

Instrument Tracking

Censitrac is used to keep track of instruments at VUMC

Censitrac

• Censitrac scanning is an inventory, location/case tracking, and quality tool

• Pans on your case cart are already scanned to the cart, and pans are scanned to the room once the ORTA has brought the cart to your room
• If you get additional pans, you must scan them to their new location

1. To log on, click the icon on the desktop
2. Scan your badge barcode
3. Click Workflow
4. Click Case Tracking
5. Scan the Case Barcode
6. Scan the Location Barcode (on the workstation or room door)
7. Scan the Instrument Pan Barcode
8. Scan Location again (or click Send Scanned Data)

Instrument Prioritization

• This form is an alert to remove pan from case cart to wash and sterilize for another case later in the day (quick turnover)
• Call Dispatch (615-322-4133) when finished with the pan to alert sterile processing of an orange card/quick turnover pan

Verifying Instrument Sterility

Indicators

• Verification of all indicators are made:

• Before opening the pan (external/outside indicators)
• After opening the pan, before the scrub person touches it (internal/inside indicators)
• Before introducing it to the sterile field (internal/inside indicators)

Chemical indicators verify that there was exposure to a sterilization process

Verifying Instrument Sterility

Rigid Containers

• Criteria to verify on the outside of a rigid instrument pan
• Load stickers are on the luggage tags but, if missing, not necessary for verifying sterility

Verifying Instrument Sterility

Rigid Containers

• Criteria to look for inside of a rigid instrument pan before the basket is removed

• Check the filter papers for holes and proper placement
• Check all visible integrators for appropriate color change — "sacrifice" a hand if you cannot see any indicators
• Place all integrators from the setup in the "popcorn bag" that the count sheet comes in — one bag needed per case
• Write the patient's initials on the bag and then hand it off to the circulator

Note: If there is no popcorn bag in any pan opened for a case, integrators are still passed to the circulator in another container/bag

Verifying Instrument Sterility

Rigid Containers

• Criteria to look for inside of a rigid instrument pan after the basket is removed

• By running a bare hand inside the pan, check for:
• Water standing in the bottom
• Dampness in the set
• Perforations through the pan

• Once the circulator obtains the popcorn bag, all external indicators must be added to the internal indicators in the bag
• The popcorn bag is retained until the end of the case for subsequent indicator verifications/audits

Verifying Instrument Sterility

Disposal Packaging

• Criteria to look for outside of a wrapped instrument pan/peel pack

• Wrap/packaging cannot have any holes, tears, or moisture (and the seal of peel pack must be intact)
• Check before opening (if pan not too heavy) and again after the tray/contents have been lifted/moved by sterile team member
• Indicator tape of wrapped items or indicator on peel pack must be intact and have appropriate color change

• Observe event-related sterility (if an event has occurred, the contents are unsterile)

• Lift — DO NOT SLIDE — wrapped pans on and off wire racks

Instrument Stewardship

• Opening large trays to get a single instrument causes delays downstream for other cases
• Single Instrument Sterile Carts ("SIS Carts") are where we store single instrument peel packs to avoid popping a pan that could be used in another case
• Do not throw away corner protectors unless you are certain they are disposable

• During a procedure, instruments should be wiped using sterile water to keep instruments in good condition

• The sterile water can be kept in a basin in a ring stand so as not to confuse it with irrigation (Cardiac standard)

Reusable

Disposable

Immediate-use Steam Sterilization (IUSS)

ONE TRAY

• IUSS is for emergent situations only and is not used as a substitute for insufficient inventory

• IUSS of an implantable device is prohibited except in the most emergent situation, must be approved by the surgeon and perioperative leadership (OR director), and include completing an Early Release Form and a VERITAS report

• Operating room technical assistants (ORTAs) are responsible for IUSS (including its documentation)

• Visually verify sterility as with other containersprior to introducing these items to the sterile field (pan will be hot to touch and may contain water)

• Save all IUSS indicators for the ORTA to complete documentation and do NOT add these to the popcorn bag as with other indicators!

• To avoid burning the patient, ensure ample cooling time before using the sterilized item
• ONE TRAY® uses a sealed container with tamper evident security (allowing for safe transport)

Instrument Handling After Case

• Ensure all instruments are returned to the correct pan at the end of the case (use the count sheet to assist)
• All box-locks should be unlocked and instrument pieces disassembled
• Be sure towels, trash, clamp inserts, and sharps (for the safety of staff in decontamination) are not in the instrument pan

• Filter papers should have been removed when verifying sterility and therefore should not be in the lid/pan
• Integrators and pan locks should be in the popcorn bag with the patient's initials and can be discarded once the patient leaves the OR

• Applicable instrumentation must be sprayed with transport gel/spray

• Not cameras, scopes, light cords, or eye instrumentation

• Lock the rigid container lids
• The ultimate responsibility lies with the scrub person to make sure these tasks are completed

Endo Pans & Endoscopes

• Endo pans all have names starting with "ENDO"
• Endo instruments, like other instruments, must be placed back into the original pan and be placed in your case cart at the end of the case

• Some flexible endoscopesdo not come in a pan butrather come in an endoscope "bucket" with a green plastic cover

• These buckets are assembled by an ORTA and also contain supplies needed for scope use (buttons, bowls, water, suction tubing, First Step, etc.)
• If an endoscope bucket is missing from your case cart, call Dispatch to request one (or you may build your own)

• All flexible scopes should come with a tip protector, intended to protect the scope tip from damage in transport before and after the case
• Always wear gloves when handling endoscopes (before and after use)
• The serial number of endoscopes used on a patient must be documented in eStar/Epic (scope scanned to the chart)

Scope Handling After Case

• Endoscopes that do not come in a pan are reprocessed every 7 days unless used on a patient before that deadline
• If you must retrieve an endoscope yourself, select a scope closest to its expiration date:

• Choose one with "today's color" tag first (if none, select a scope with "tomorrow's color" tag and so on)
• Check the expiration date listed on the back of the tag to be sure the scope is still within timeframe to use

Do not reuse a scope if it has sat idle for longer than 30 minutes

Scope Handling After Case

• For flexible scopes, when the case is complete:

• Use First Step to pre-clean in the OR (removes gross contaminants and prevents hardening of secretions)
• Suction the fluid in the pack through the scope
• Wipe the scope with the sponge
• Put the tip protector back on the scope
• Place a patient sticker on the back of the scope tag along with the time it was pre-cleaned with FirstStep
• Place in original bucket and apply the red plasticcover from the bucket (found in the scope bucket)

Do not use transport gel/spray on scopes

• Flexible scopes that come in a bucket DO NOT go in your case cart after the procedure

• For cases in the main OR: return to the dirty Endo room near OR 25
• For cases in MCE: return to the dirty scope cart on the 3rd floor Skybridge (you must call the Endo Hot Phone immediately when you drop off a scope here)

Scope Handling After Case

• For scopes that come in a pan, when the case is complete:

• Flush lumens with water
• Wipe scope with moistened sponge
• Place scope back into its container exactly as received
• If present, secure it in the protective silicone brackets within the container
• Place in the case cart
• Do not place anything (like light cords or instruments) on top of the scope
• These are very delicate and expensive
• The extra weight can damage the scope

Returning Unopened Pans

• If a pan in your room is unused (i.e., it is still sterile and unopened):

• Call Dispatch to ask an ORTA to pick it up, or
• Return it to the nearest Clean/Unused Instrument Pan Return Cart
• There is one located in each case cart staging zone:Main 1, Main 2, Main 3, Robotic, MCE North, MCE South, and 4 South

• Real-time scanning decreases delays for other cases and the need for IUSS

Instrument Issues

• For routine instrument needs, contact the ORTA in your closest staging zone or call Dispatch (615-322-4133)

• If you do not get an answer when calling Dispatch, call the appropriate supervisor

• For instrumentation/instrument pan concerns like bio-burden, wet trays, broken instruments, wrap/filter paper holes, call the relevant Hot Phone

• Someone from that department should be dispatched to your room
• If you have a hole in the pan wrapper or filter, circle it and save for the respondent!
• If needed, call Dispatch to request an ORTA bring a replacement pan
• Use an instrument repair tag if applicable to your instrument issue

Instrument Issues

• If there is an instrument or pan problem, a Censitrac Quality Feedback report should be completed about it as soon as possible

Chapter Complete!

Flexible Scope Scanning Process

• Scan flexible scopes to your location in Censitrac as you would pans you retrieve

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

Endo Room

First Step

• First Step is pre-cleaning for endoscopes

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

First Step

• First Step is pre-cleaning for endoscopes

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

Sterile Water for Point-of-Use Cleaning

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing

References

[Policy] Sterile Processing: Sterilization Practices

[SOP] Sterile Storage Practices

[SOP] Immediate Use Steam Sterilization (IUSS)

[SOP] Sterile Processing: Point-of-Use Instrument Cleaning and Spraying Compliance

[Policy] Preparation and Transport of Sterile or Soiled Instruments, Medical Devices, and Endoscopes

[SOP] High-Level Disinfection: Modified Flexible Endoscope Reprocessing