SP Techs: Are You Maintaining Your Clean Assembly Properly?
Following instrument decontamination, special care is required to ensure the devices are not recontaminated before the sterilization process begins. Sterile processing (SP) technicians must ensure that the clean assembly area stays clean, so contaminants are not introduced to the area or reintroduced to instruments coming from the decontamination area.
Although most facilities rely on the environmental services department (EVS) for general daily cleaning services—including trash collection, floor and fixture cleaning, and regularly scheduled cleaning of air vents, walls, ceilings, etc.—SP staff are responsible for cleaning their work areas and ensuring that high-touch areas (i.e., door handles, light switches, computer keyboards, and scanners) are routinely cleaned to limit microbial contamination. SP professionals are also responsible for cleaning inspection and testing equipment.
Technicians must also prevent contaminants from being brought into the work area. It is essential that staff members’ hands are washed thoroughly before entering the area to minimize the risk for microbial introduction and contamination. Employees should keep their hands clean while in the area by handwashing with soap and water or using an approved hand sanitizer. Additionally, SP professionals must avoid introducing items to the work area that could negatively impact the sterilization process. Personal items known to carry large amounts of microorganisms, including electronic devices, backpacks, bags, or purses, should stay out of all SP work areas. Even items inadvertently kept in pockets, such as money or tissues, can accidentally contaminate hands and jeopardize the integrity of the clean assembly area. Note: If a facility provides electronics for use in certain areas, there must be clear instructions provided to staff on how (and how often) to clean them.
Introducing food and beverages to the department’s work areas also goes against standards, guidelines, and best practices. Oils from snack foods, for example, could be transferred from a technician’s hands to the item or items being sterilized, creating a barrier that could impede the sterilant’s contact with the instrument and result in an unsterile device. What’s more, food and beverages can also invite insects and rodents, which pose further contamination risks.
Visitors must also abide
It is important to remember that the clean assembly area is semirestricted. Other individuals entering the clean assembly area can pose a threat to instrument and surface contamination; therefore, the same strict requirements that apply to SP professionals also apply to anyone entering the area.
SP technicians assigned to the area are responsible for monitoring traffic in the area. General traffic flow should be minimized and limited to only authorized personnel who are properly attired. Anyone entering the semirestricted area should have thoroughly washed hands and wear clean surgical scrubs provided and laundered by the facility (street clothes should never be worn in the semirestricted area).
Personal cleanliness is imperative for anyone entering the clean assembly area, as well as any other area of the department. Hair, body, and fingernails should be clean, and hand hygiene should be performed several times per shift (or more, as needed). Fingernails, which can harbor soil and bacteria, must be kept short and not extend beyond the fingertips, and artificial nails and nail polish must never be worn in SP work areas. Jewelry, including rings and watches, can also harbor microorganisms and damage gloves and other personal protective equipment (PPE) and must never be worn in any SP work area.
Surgical scrubs should be donned (put on) clean and laundered between uses, and employees should never wear scrubs outside the building. Street clothes must be changed before leaving the facility for the day or when traveling between facilities. Attire approved for the clean assembly area is designed to protect the area from contaminants that could be brought in on clothing. Hair coverings reduce the risk of hair falling into a tray or wrap; all hair (except eyebrows and eyelashes) should be completely covered. Beards of any length should be covered with a beard cover. Scrub attire should be changed if it becomes contaminated or soiled, and shoes should be kept clean. Note: The dress code for the clean assembly area may seem straightforward, but basic requirements are often not met. When attire is worn inappropriately (e.g., caps that do not cover all hair or wearing appropriate PPE while also wearing jewelry), the action goes against the intention of the requirements and increases the risk for contamination, subsequent sterilization failure, and patient infection.
SP technicians must also be aware that contamination can occur whenever soiled instruments are discovered in the clean assembly area during the inspection process. If soil is found on an instrument, the device should be sent back to the decontamination area for recleaning and the clean assembly area must be thoroughly cleaned and disinfected before work continues. Technicians should never attempt to reclean an instrument in the clean assembly area.
Ensuring that a clean assembly area stays clean and minimizes the risk of recontamination begins by ensuring that the physical area meets standards and requirements and is maintained properly. SP technicians assigned to the clean assembly area must always remember that they are the caretakers of this work area and must remain fully committed to maintaining its integrity in the name of safety.
For specific standards related to clean area integrity and maintenance, please refer to ANSI/AAMI ST79:2017 & 2020 Amendments A1, A2, A3, A4, Comprehensive guide to steam sterilization and sterility assurance in health care facilities, and the Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice (2020): Surgical Attire.
Natalie Lind, CRCST, CHL, FCS, serves as director of education for the Healthcare Sterile Processing Association (HSPA).