Avoid using brush to clean instruments during procedures

Q A member of our nursing staff has sug- gested we include a sterile scrub brush in the supplies for long procedures where there is a lot of fatty tissue or blood on instruments. The scrub nurse or technician could use the brush to remove gross debris from instruments re- turned to the Mayo stand so that they would be clean when passed back to the surgeon. Sev- eral of us object to this, because we think it will produce increased aerosol contamination dur- ing the procedure. What do you think?

A I agree with your concern regarding the use of a brush to clean instruments during a procedure.’ Organic debris such as fat, blood, and bone should be removed from an instru- ment each time it is passed back to the Mayo or other working surface. This can be done with a wet gauze sponge or towel and a careful dip- ping in a basin of water, if necessary. Using a scrub brush, unless it was kept under water, would produce aerosolized particles that would spread throughout the room. This vio- lates the principles of confinement and con- tainment of contamination to as small an area as possible in order to decrease environmental contamination and facilitate cleanup after the case.2

Keeping the brush under water is not as simple as it may sound. First, the water in a splash basin would have to be deep enough to allow the brush to be used under water. This means the scrub nurse or technician would

a: The experts research

have to guard against submerging the sleeves of the gown. This could lead to contamination unless the material was absolutely imperme- able to water. Only plastic or rubber with no sewn seams would give this assurance.

Second, the scrubbing action would have to be gentle to avoid splashing onto the surround- ing drapes and the front of the gown. Third, all of this would require careful attention, distract- ing the scrub nurse or technician from the progress of the procedure.

There has been a long-standing debate oil the microbiological safety of splash basins, not just because of concern about splashing, but because the organic material rinsed off in the basin undoubtedly contains some organisms. Others will settle out of the air onto tho water surface. If L i e cdsa IS Q iurty u ~ I ~ , a putelmi reservoir for bacterial contamination is estab- lished as the vegetative cells begin to multiply e~ponentially.~

If the scrub nurse or technician uses a wet gauze sponge or towel to wipe the instru- ments, care should be taken to contain the moisture and debris. Waterproof draping on the Mayo stand is a must when dealing with bloody instruments. Using a small basin to contain the sponge and serve as work area would be an additional confinement measure. Sponges or towels should be changed as fre- quently as necessary to provide a reasonably clean wiping surface. If counted sponges are being used on the field, the sponge used for cleaning should be of the same type and be included in the count.

Q A surgeon at our hospital uses one of the nonstick coating sprays made of vegetable oils to lubricate the insertion tube of the flexible

26 AORN Journal, July 1980, Vol32, No 1

fiberoptic bronchoscope. Is this a recom- mended practice?

A I checked with several manufacturers of flexible fiberoptic endoscopes, and while none of them has specifically tested this type of product, none of them recommended this prac- tice. The covering on the flexible scopes is made of a material that does not withstand all types of chemical onslaught. It is quite possible that the vegetable oil or propellant residue could cause deterioration of the insertion tube over a period of time.

Another question is the safety of this com- mercial food product in the lung. I have been unable to locate data indicating such a practice is safe. While the amount of the coating spray used is undoubtedly small, the non-water- soluble nature of the coating could contribute to the respiratory problems that necessitated the bronchoscopy.

Scope manufacturers advise using a water soluble lubricant if needed. Given the complex and expensive nature of this equipment and the delicacy of the human tissue that it con- tacts, it appears prudent to follow this recom- mendation.

Q Our hospital has just built a new central supply with a decontamination area. The equipment in this area includes a large utensil washer but no washer-sterilizer. The water in the washer reaches 180 F. How should in- struments be processed since there is no washer-sterilizer?

A It is not uncommon to find this type of equipment in the decontamination area of a central processing department. Some large hospitals that process surgical instruments within the OR suite have similar equipment. The important thing to note is that the equip- ment referred to as a utensil washer is in the decontamination area. The proper name for this apparatus is a washer-sanitizer. Its pur- pose is to process instruments or utensils that are grossly contaminated to lower the biobur- den to levels that allow safe handling. The 180 F water temperature will kill most vegetative bacteria and most, if not all, viruses and fungi. It will not kill spores. However, spores should

not be of concern since the instruments will be handled by presumably healthy workers with uncompromised host defense mechanisms. The diseases that we know to be caused by spore formers, such as tetanus and gas gan- grene, require a suitable host environment to produce disease. This would not exist in these workers.

instruments and utensils will undergo addi- tional cleaning and inspection within the cen- tral processing department. If they are to be sterile for patient use, they will be assembled, packaged, and sterilized.

The washer-sanitizer is usually a large au- tomated, pass-through device designed to handle large numbers of a variety of instru- ments or utensils in a short period of time. Prior to processing in the washer-sanitizer, instru- ments and basins from the OR should be treated as grossly contaminated. They should be transported from the operating room in plas- tic bags or closed containers. If the time be- tween use and decontamination will be lengthy, the instruments should be kept moist to prevent drying and caking of organic de- bris.4 Workers handling these contaminated instruments in the decontamination area should wear gloves, masks, and waterproof aprons. Hair covering is also re~ommended.~

Janet K Schultz, RN and the Professional Advisory Committee

Notes 1. “Standards for cleaning and processing anes-

thesia equipment” in AORN Standards of Practice (Denver: Association of Operating Room Nurses, Inc, 1978) section 3, 7. 2. Phyllis Wells, “‘Confine and contain’ approach

to OR cleanup,” AORN Journal 25 (January 1977) 61. 3. Stephen L Corson et al, “Sterilization of

laparoscopes: Is soaking sufficient?” Journal of Re- productive Medicine 23 (August 1979) 54.

4. “Standards for OR sanitation” in AORN Stan- dards of Practice (Denver: Association of Operating Room Nurses, Inc, 1978) section 3, 16.

5. Good Hospital Practice: Steam Sterilization and Steriliiy Assurance (Arlington, Va: Association for the Advancement of Medical Instrumentation, 1980) 2; Guidelines for the Hospital Central Service Department, publication number 3M-7/78-6312 (Chicago: American Hospital Association, 1978) 3.

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