Professional Documents
Culture Documents
Latoya Rone
delivery, error prevention and ensuring a culture of safety by both health care providers and
patients. Health care delivery evolves at a fast pace owing to changes in other related factors
such as care measures and technological functions. Inadequate cleaning of the complex reusable
instruments is among the leading health care issues. This is because the use of contaminated
medical instruments can easily lead to deadly infections or instrument malfunctions (Boyce,
2016). The use of complex reusable clinical instruments such as cannulated drills, endoscopes
and arthroscopic shavers have raised a major medical concern due to their complicated nature
that makes them difficult to clean and disinfect or even sterilize. If these instruments are not
cleaned between uses, there is a likelihood of the presence of contamination, which might prove
difficult to detect by clinicians and might be passed from one patient to another (McGrath et al.,
2017, 38).
It is also estimated that many incidents associated with patient infections are as a result of
inadequate cleaning, which is also attributed to user error, lack of training on handling
techniques and device cleaning methods. The issue has many implications, which range from
breakages and premature equipment failures, hence hindering patient care delivery and quality
health services. The issue is of major concern, therefore of need to explore because apart from
being ranked among the top ten health technology hazards, it is also among the leading cause of
patient risk issues. It is also evident that the health issue holds a potential danger to patient health
and safety because it is the leading cause of patient-infection outbreaks, hence warrants the
cleaning of complex reusable instruments such as infections, outbreaks and other effects of
contaminated reusable clinical instruments. The paper will also explore severity of the issue,
frequency, profile and its preventability including factors such as training clinicians on cleaning
steps, procedures, and other actions to be taken to prevent or minimize the health hazard.
Literature Review
concern in health care. In a study conducted by Southworth (2014), surgical instruments were
identified as potential routes for the transmission of pathogens between patients in health care
facilities. Southworth (2014) believes that the decontamination process when a patient uses these
concerned. This idea is supported by Wade et al., (2015), who believes that over 45 million
inpatients and 30 million outpatients in the U.S. undergo surgical procedures annually. During
these procedures, some of which involve complex reusable surgical instruments, patients and
families entrust their welfare to health professionals. Some of these professionals, unfortunately,
do not take necessary measures related to cleaning of surgical instruments. Medical professionals
are required to clean millions of reusable medical instruments that come into contact with
patients’ blood, skin, tissues, and body fluids, but excessive workload means that some of these
Concerns about inadequate cleaning of complex reusable devices have also been raised in
hospitals that loan complex design surgical devices and implants (Costa et al., 2018). In
orthopedic surgeries, reusable surgical instruments (RSI) are often acquired through loans. In this
case, loaners tend to set conditions when high-complex designs of RSIs are involved. Lopez et
INADEQUATE CLEANING OF COMPLEX REUSABLE INSTRUMENTS
4
al. (2018) and Costa et al. (2018) concur on the issue of cleaning highly complex reusable
complex instruments that are acquired on loan. RSI often prove very complex to clean because
they are sometimes made of single-use implants, such as screws. The problem with these screws
is that they remain in the surgical jar for some time, and as such, are subject to multiple cycles of
reprocessing before they are implanted. Altogether, studies have shown that inadequate cleaning
of reusable surgical devices, as well as exposures of single-use implants to chemical agents can
compromise their quality and safety standards (Wade et al., 2015). The issue of cleanliness of
In its organizational article, Kimberly-Clark (2016) argues that complex reusable medical
devices can be contaminated in two ways: visibly and through hidden bio-burden. Bio-burden,
also known as soil, contains millions of potentially infectious agents. Inadequate cleaning means
that bio-burden would be left on the surfaces of complex reusable devices and this would pose a
risk to patient outcomes. Lopez et al. (2018) concur with this view in his study that links
can be reassembled, biological residues, or soil, that accumulate on the lumen of some of these
reusable instruments cannot easily be removed. Lopez et al. (2018) content that the current
design of reusable surgical instruments obstructs removal of bio-burden and this may have
Kimberly-Clark (2016) highlights different steps that must be taken in place to ensure
that complex reusable instruments are kept adequately clean. One of these steps includes
ensuring that complex reusable devices are sprayed frequently or soaked to keep them sterile
INADEQUATE CLEANING OF COMPLEX REUSABLE INSTRUMENTS
5
while they are being transported and stored. Nevertheless, because cleaning of complex reusable
medical instruments takes place in hospital settings, future research should investigate systemic
failures that heighten the risk of cross-infection when cleaning and sterilizing reusable surgical
instruments.
Solution
effective cleaning of the reusable medical equipment, which includes training of personnel,
quality of water, appropriate use of the personal protective equipment (PPE), and adherence to
manufacturer’s guidelines and directions of use. Among the mentioned solutions, training of the
Ling et al. (2018) recommend that all supervisors and managers who are involved in the
qualification in a reprocessing, or related course. Other than the initial training, there needs to be
in place, a plan to ensure that those without necessary training obtain it as soon as possible.
Moreover, arrangements for continuous training and re-certification of the already qualified
personnel should also be pursued. The assertions by Ling et al. (2018) are also confirmed by Fast
et al. (2017) who recommend both ongoing and formal training of all the staffs who are both,
directly and indirectly, involved with the decontamination of reusable medical instruments.
Further, Fast et al. (2017) argue that the staffs working within the units involved with the
decontamination processes should be trained on how to use and handle the relevant equipment.
The need for sterilization of the reusable medical instrument is almost an obvious
knowledge among several medical staffs, and indeed, most medical institutions have in place
dedicated units for the same. However, humans are often vulnerable to complacency. As such,
INADEQUATE CLEANING OF COMPLEX REUSABLE INSTRUMENTS
6
training is the most appropriate method to set the appropriate foundation for ensuring adequate
decontamination. Further, it ensures that the relevant staffs are abreast of the most appropriate
critical to the staffs since it breaks the monotony and provides knowledge about emerging
cleaning trends in an industry that is always fast changing. Knowledgeable staff with regards to
technique meant for the analysis of failure, prior to implementation. Being the first step in the
study of the system reliability, for this study the item of failure to be analyzed is the training of
the personnel for effective cleaning of the medical equipment that are reusable. The most
appropriate solution that has been considered for the analysis is the training of the personnel. The
figure below unveils a flow diagram depicting the components of the steps involved in the
processing area.
reusable instruments are to ensure appropriate usage of the protective equipment, training the
staff, ensuring quality water is used and ensuring staff adhere to manufacturer’s directions of use.
The indicators that can be of use in the process to assess the success of our technology are as
follows: The percentage of trained personnel who adhere to the systematic education on cleaning
surgical tools. Additionally, another indicator would be incidences of the appropriate usage of
personal protective equipment (PPE). There is also a good percentage of staff who use water
appropriately to clean the instruments. Finally, there is the actual number of staff that adhere to
manufacturer’s direction of use. The indicators will be monitored by healthcare personnel of the
INADEQUATE CLEANING OF COMPLEX REUSABLE INSTRUMENTS
15
hospital who will be in charge of measurements of performances so that they can evaluate and
afterward communicate on how the various indicators meet the goals of the hospital.
The outcomes of the evaluation process will be based on the responsiveness of the
training process on how to clean the medical instruments (Smith, Mossialos & Papanicolas).
There will be a productivity assessment to monitor whether the resources used are effective in
meeting key strategies of the hospital (Smith, Mossialos & Papanicolas). The data will be
collected through observational study that will involve monitoring how the staff members
participate in cleaning medical equipment (Sarkies, Bowles, Skinner, Mitchell, Haas, Ho &
Plumb, 2015). There are other ways of data collection such as electronic administrative data and
manual data collection from the staff members. The data will be collected before and after
administering the training exercises with a duration of six months between the periods.
Conclusion
Since patient safety is the prevention of harm to patients by laying great emphasis on care
delivery and adequate cleaning of complex reusable instruments must be executed to avoid
infections, outbreaks and other effects of contaminated reusable clinical instruments. Solutions to
ensure effective cleaning of the reusable medical equipment include: training of personnel,
quality of water, appropriate use of the personal protective equipment (PPE), and adherence to
manufacturer’s guidelines and directions of use (Kimberley-Clerk, 2016). The most appropriate
solution that has been considered for the analysis is the training of the personnel. Future course
of action will be measured through staff training survey; number of contamination outbreaks
prior to training being implementation verses number of current outbreaks. Results will assist in
10.
Costa, D. M.., Lopes, L.K., Vickery, K., Watanabe, E. & Deva, A.K. (2018). Journal of Injury,
49(11): 20-34
Fast, O., Fast, C., Fast, D., Veltjens, S., Salami, Z., & White, M. C. (2017). Limited sterile
experience in the Republic of Congo, Madagascar and Benin. BMJ global health, 2(Suppl
4), e000428.
Kimberly-Clark (2016). Cleaning re-usable medical devices, a critical first step: The Clinical
Ling, M. L., Ching, P., Widitaputra, A., Stewart, A., & Sirijindadirat, N. (2018). APSIC
Lopes, L. K., Costa, D. M., Tipple, A. F., Watanabe, E. & Castillo, R. B. (2018). Complex
McGrath, B. A., Ruane, S., McKenna, J., & Thomas, S. (2017). Contamination of Single‐Use
Rutala, W. A., & Weber, D. J. (2016). Disinfection and Sterilization in Health Care Facilities: an
127-131
Sarkies, M. N., Bowles, K. A., Skinner, E. H., Mitchell, D., Haas, R., Ho, M., ... & Plumb, S. (2015).
Data collection methods in health services research. Applied clinical informatics, 6(01), 96-
109.
Smith, P. C., Mossialos, E., & Papanicolas, I. measurement for health system improvement:
Wade, W. S., Higgins, E. L., Arcement, L., Connors, B. F., & Duane, E. G. (2015). Beyond