Point-of-use cleaning in the or: What does supply chain need to know?

Point-of-use cleaning, recommended by numerous industry organizations, is an OR process of rinsing instruments during the operation and preparing them for transportation to the decontamination area or sterile processing department after the procedure concludes. A number of industry organizations advise that all reusable instruments should be wiped—and any lumens flushed—with sterile water between uses during the procedure. After the operation concludes, instruments are disassembled, packed in containers, and kept moist—sometimes with enzymatic gels that loosen soil, debris, and body fluids—until they can be fully decontaminated.

While point-of-use cleaning responsibilities are the direct responsibility of scrub technicians and OR personnel, the supply chain has a vested interest in ensuring instruments are properly handled at each stage of the life cycle, especially for reusable devices. If surgical devices are not properly rinsed and bioburden remains on the device, corrosion may occur. There is the potential for biofilm to form on the device, which may reduce the effectiveness of sterilization once the instrument reaches the sterile processing department. Biofilm is not necessarily visible to the naked eye, which makes it difficult for sterilization technicians to identify. When found, it is tough to remove. Additionally, if a device is rinsed with an agent other than sterile water—like saline solution or bleach—it can cause corrosion, rusting, pitting, or other damage to the device’s surface.

For these reasons, point-of-use cleaning can negatively impact the sterile processing department and the supply chain’s budget if not properly enforced, says Marjorie Wall, the director of sterile processing at Citrus Valley Health Partners. If an instrument is damaged, it is not able to be properly cleaned for reuse and a replacement item must be purchased. Instruments that come to the sterile processing department with dried debris will require extra sterilization actions, which has the potential to cause workflow issues in the department.

“Supply chain should be very interested in the compliance of point-of-use cleaning, because instruments that are improperly maintained have a shortened life expectancy and can significantly increase the expenses of the organization,” Wall says. “Simply put, failure to properly clean instruments at the point of use will increase maintenance expenses, increase pitting and rust on instruments, and ultimately increase replacement costs of nonrepairable instruments.”

At Citrus Valley Health Partners, Wall says, OR scrub technicians and other staff members complete online training modules as a part of the onboarding processes and annually thereafter. Sterile processing conducts audits on devices coming in for sterilization and also does unannounced observations to determine whether the OR is compliant with point-of-use cleaning. As a result, the OR department has achieved a very high compliance rate for proper processes.