I need help!

Editorial Team / Admin · Apr 2, 2021

The expectation is that staff are removing blood and bioburden during the procedure with sterile water. At the end of the case, the instruments are checked for a need for another rinse. They are placed back in the carriers and sprayed with PreKlenz. Are they 100% blood free? No, but they aren’t grossly soiled either.

FurBabyMom, MSN, RN · Apr 12, 2021

On 4/1/2021 at 10:06 PM, MereSanity said:

So what is your process with instrumentation in the OR? Does every speck of blood need to be off the instruments before sending them to SPD? Or just the majority and then spray before sending them? Our SPD has started requiring us to scrub every speck of blood off the instruments (and in ortho cases that can be difficult). Nurses hunched over a basin in the back of the room scrubbing the blood off instruments, techs and nurses missing their breaks and lunches because they had to scrub all their instruments before they could send them to SPD (and getting written up if they don’t pass inspection). I need to know what other hospitals are doing (especially bigger facilities) and if you have any written information or pictures to back it up that would be very helpful (and the name of your facility if possible). Half of our staff is ready to quit. We got yelled at because we sent blades down for reprocessing that had blood on them (like we are going to scrub blades!?!?). Thanks!

MS-BSN, RN, CNOR

Wow. I *literally* never spent "all my time" cleaning instruments.

I know RoseQueen mentioned it, but where I worked, especially on the team I worked, we were expected to clean our instruments during the case. I worked primarily neuro. The biggest tip is wiping things off as you use them. You get scissors back, wipe them off, same thing with the tumor forceps, the bipolar, etc.

Once we opened and removed the bone flap (which means switching to finer tools and suctions) I put all the instruments used for bony and opening work into the water bath. I finished arranging things needed for the finer part of the case (even if no microscope the tools are different). After about 5 or so minutes I began taking the instruments out, and wiping any residual "stuff" off. It's easier to wipe them off using a lap pad (18 or 12) than it is to use a raytec. Take the tumor out (or work on whatever - we did a LOT of neurovascular), put those finer instruments in the bowl to soak while starting to close. Repeat the soak and wipe down process (plus passing implants, suture and counting). When close to starting skin I "sucked up" most of my remaining irrigation and water, leaving just enough water to soak the needle drivers and suture scissors. Side note: there's rarely stuff after a few minute soak, it's water not saline (so it won't damage the metal), and it takes almost no effort. The only other consideration is keeping finer instruments from bigger or heavier instruments.

By the time we finished closing, I usually only had a few instruments to clean. In my facility, the scrub person stayed scrubbed until after extubation (and after anesthesia had determined they could either bag the patient or the patient was breathing spontaneously). Your primary set - that would include a blade, forceps, scissors and hemostats - had to stay sterile and not broken down until your patient left the room in the event of airway emergency/compromise (I have played that game on induction and on extubation which is why I always dig out instruments which could be used for an emergent cric / trach). Supplemental sets - micro instruments, retractors, drills, implants, etc., could be re-assembled and passed off. I did this by stacking my non-primary tray(s) on a second back table, then when anesthesia was good with airway, I would spray and load those instruments on my case cart. After the patient was out of the room, I would break down my primary set.

I did the same things with almost all cases. I think the only times I ever sent down instruments in the wrong trays and bloody were from mega traumas. The most vivid being from the day I scrubbed a trauma with 20+ trays open. Half the time we spent in the room was spent running a code plus operating.

Question - when you say blades - do you mean scalpel blades? I'm not familiar with reusable blades.

Editorial Team / Admin · Apr 12, 2021

29 minutes ago, FurBabyMom said:

Question - when you say blades - do you mean scalpel blades? I'm not familiar with reusable blades.

We have a reusable diamond blade that we use in cardiac surgery. That’s the only reusable blade that I know of.

FurBabyMom, MSN, RN · Apr 13, 2021

On 4/11/2021 at 9:51 PM, Rose_Queen said:

We have a reusable diamond blade that we use in cardiac surgery. That’s the only reusable blade that I know of.

That makes sense. Now that you mention it, I believe one of our older (now retired) docs used something that was reusable that sounds like what you're describing. It's just been long enough since then that it's not at the top of my memory ?