DS 33 - Improving Point of Use Instrument Treatment in Five Operating Rooms: Translating Evidence into Practice

Background: Effective cleaning and sterilization of surgical instruments is critical to prevent surgical site infections. Pre-treatment of instruments includes removing bioburden and treating at the point of use (POU) to prevent gross soils from drying on instruments. If not removed, bioburden can inhibit complete sterilization and lead to corrosion. American National Standard Institute/Association for the Advancement of Medical Instruments (ANSI/AAMI) guidelines clearly indicate the necessity for POU treatment, but it is often not consistently performed. The Four E’s model (Engage, Educate, Execute, Evaluate) was utilized to improve compliance with POU treatment of instruments in five operating rooms (OR) at an academic medical center.

Methods: A multidisciplinary group consisting of perioperative nursing, sterile processing and infection control was assembled. Baseline performance was measured. Local barriers to POU treatment were identified through staff feedback and direct observation. Lack of access to necessary equipment and gaps in knowledge of appropriate enzymatic spray application were identified as critical barriers. Perioperative nursing staff who handle instruments were engaged and nurse-led education was provided. An intervention involving clarity of expectations (e.g., amount of enzymatic product needed to prevent drying) and consistent supply of required equipment (e.g., spray nozzles), along with real-time feedback was executed. Nursing and infection control collaborated to develop a tool to evaluate the effectiveness of the intervention.

Results: Over 4 months, overall POU treatment compliance increased from 54% to 99% (p=0.012). Compliance improved in all ORs: OR A=82% to 100%, OR B=73% to 96%, OR C=50% to 100%, OR D=10% to 100% and OR E=55% to 100%.

Conclusions: Engaging a multidisciplinary team, educating staff on recommendations, addressing barriers, executing a plan, and evaluating progress increases compliance with POU treatment of instruments. The Four E’s model is a useful tool to guide performance improvement in the perioperative setting.