EFHSS Questions and Answers - Answer to Question Q00544

Are there any hospitals which have sanctioned a 'Dropped Instrument policy'? I am of the view that this policy should be avoided and controlled by removing little sisters, identifying shortfalls with instrumentation and concentrating on reprocessing dropped instruments through the recommended decontamination channels.

There are several points which I feel must be taken into account:

1. If Benchtop sterilisers are kept in Theatres could they be used routinely? (I'm thinking about the ortho surgeons here)
2. If an instrument is dropped how would it be cleaned prior to placing into benchtop steriliser?
3. Has the cleaning been validated?

I would be very interested to hear your views on this.

Kind Regards
Simon

Hi Simon,

In Australia we have a Standard, AS/NZS 4187 for reprocessing of reusable items. Clause 4.2.3 of this Standard clearly states

"The use of a flash steriliser shall be restricted to situations where a single instrument has been dropped and there is no sterile duplicate available. Cannulated, complex instruments, suction and other tubing shall not be processed by this method. This type of sterilizer can only be used for unwrapped, non-porous items....

Notes:

1. The use of a flash steriliser as a convenience or cost saving mechanism is not acceptable. Having an adequate supply of instruments is more appropriate.
2. Where other types of sterilisers are used as a flash steriliser, the principles of this clause continue to apply."

We have had many questions about using benchtops in theatres to "get around" the restriction on flashing instruments -since this would mean that normal validated reprocessing procedures are being bypassed -this isnt an acceptable alternative.

In the case of the dropped item -it is expected that the decontamination unit would be responsible for cleaning of the item. Obviously in these cases, it isnt feasible to mechanically clean it due to time limitations -however, trained reprocessing personnel manually cleaning the instrument is prefereble to the instrument being given a quick swish under a tap at the back of theatres!.

I hope this helps

Simon,

I am with you one hundred percent on this. I believe that any hospital that has a Centralised Sterile Supply unit should not be encouraging a dropped instrument policy or infact any form of sterilization outside that provided centrally. The controversy lies in the lack of proper disinfection which is ultimately missing in areas where bench top sterilisers are used. In fact what is really happening is that one portion of the patient population are being provided with a high quality decontaminated product and another portion with a product that is infact inferior.

We are an acute hospital with seven operating theatres and we do not have any bench top sterilizers. We also reprocess trays for another acute hospital thirty six miles away that has four operating theatres and they also do not have any bench top sterilizers. Of course we do have good stock levels as far as instrumentation goes but this is a far better solution than compromising the quality of care given to patients.

Don't forget also that if you are using a dropped instrument policy the traceability of the item is infact altered every time that you choose to place it in a bench top sterilizer. Is there a record of the instruments that are placed into the bench top sterilizers what cycle that they go through and if the cycle has been validated? Are the staff using the bench top sterilizers fully trained in their use and do they recognise the parameters of sterilization? The answer to these questions in most cases is invariably no.

Recent guidlines have stated that in order to achieve the highest standards of decontamination all reusable instrumentation should first be disinfected in an automated washer-disinfector that is regularly maintained and tested to HTM 2030 and then sterilised in an autoclave that is maintained and tested to HTM 2010. I think in todays legal conscious society we should be sticking to this at all costs.

Aisling Bonner
Altnagelvin Hospital
Derry City
Northern Ireland