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Industry: Email Alert RSS FeedCase cart decontamination
AORN Journal, July, 2007 by Sharon Giarrizzo-Wilson
QUESTION: We have just started using a closed-instrument cart system to transport instruments to and from the OR. Contaminated supplies are placed directly onto the unlined shelving after each procedure. Our manager wants us to use a premoistened, germicidal cloth to wipe down the case cart after transport of contaminated instruments. This is the only decontamination process the cart receives before it is used for the next clean delivery. I don't think this is a safe infection control practice. Shouldn't the case cart receive more than a wipe down before clean and sterile items are placed in it? Should we be using two separate case carts, one for dirty items and one for clean?
ANSWER: The care and cleaning of medical equipment, including transport carts, should follow manufacturer's recommendations and established infection control practices. Routine care of a case cart includes surface cleaning with an acceptable, hospital-grade disinfectant and lubrication of door hinges and wheel casters. Removal of debris (eg, suture, lint) from the castor assembly will prevent impedance of wheel movement. (1)
A two-cart system is not necessary if infection prevention guidelines are followed and monitoring of the cleaning protocols is in place. Sound infection control principles require case carts to be cleaned and decontaminated after transport of contaminated instruments. To minimize cart soiling and leakage of contaminated fluids, items with caked blood or infectious materials "must be placed in closeable, leak-proof containers or bags that are color coded, tagged or labeled as infectious." (2(p554)) When contained, these items should be transported in a covered or closed, washable transport vehicle. If contaminated items are not placed in a leak-proof bin or heavy duty plastic bag within the cart, the transport cart should be subject to the same processes used to clean and decontaminate a tray of instruments. A cart washer (eg, a device specifically designed to clean patient transport carts and case carts) is the best option for this process. Cart washers are designed to regulate water quality, temperature, alkalinity of detergents, and pressure during cleaning. Using a garden hose-type system to clean the cart would not be an acceptable alternative.
When a cart washer is not available, a process should be in place to monitor the effectiveness of manual cleaning. Blood and body fluids can seep into joints, seams, and under surfaces of shelving and doors, so thorough cleaning of the entire cart is necessary between dirty and clean transport. This includes the wheels and trader-surfaces of the transport cart. Selection of the decontamination process should reflect the design of the contaminated device. (1(p46)) During manual cleaning, case carts should be disassembled (eg, shelving and doors removed) and thoroughly wiped down with a cloth soaked in an Environmental Protection Agency-registered hospital disinfectant or detergent used in accordance with the manufacturer's recommendations. (3)
Regardless of where a procedure is performed or how equipment is transferred to and from that area, basic principles of environmental cleaning are universal and apply to all situations. Preventing surgical infection is a primary responsibility of perioperative nurses, and ensuring effective cleaning practices are in place for the protection of patients, coworkers, and family members is an obligation of professional practice.
Editor's note: At various times throughout the year, the Recommended Practices Committee seeks review and comment on proposed recommended practices from AORN members and other interested individuals. When available, these proposed recommended practices appear on the AORN web site at http://www.aorn.org. Proposed recommended practice documents are available for review and comment for a 30-day period after they are posted. Interested individuals who do not have access to the Internet may obtain copies of the proposed documents by calling the Center for Nursing Practice at (800) 755-2676 x 334. A deadline for comments is indicated with each document. Please check these sources frequently to locate proposed recommended practices. All comments received are considered as the document is finalized. Thank you for your participation.
REFERENCES
(1.) Association for the Advancement of Medical Instrumentation, ST79: 2006--Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation; 2006:46.
(2.) Recommended practices for environmental cleaning in the surgical practice setting. In: Standards, Recommended Practices, and Guidelines. Denver, CO: AORN, Inc; 2007:551-557.
(3.) Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Centers for Disease Control and Prevention. MMWR. 2003(52). http://www.cdc .gov/mmwr/preview/mmwrhtml/rr5210a1.htm. Accessed May 29, 2007.
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