Sacred Cows and Patient Safety: An SPD Detective Story

Uncover outdated assumptions and unfounded biases

Uncover outdated assumptions and unfounded biases

A sacred cow is an idea, custom, or institution held, especially unreasonably, to be above criticism. When you're hesitant to raise objections to something—maybe a badly planned but popular school fundraiser, for example, or using a caustic environmental wipe to clean containers—you may be dealing with a sacred cow. The truth is that critical thinking, data, and good ol’ common sense are needed to implement sustainable solutions and to ensure that best practices are applied, as they are critical for patient safety. To get started, consider the scenarios below.

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The case of the “missing steps”

Sacred cows turn up in sterile processing practices, often in service of time savings. Have you ever noticed that some wash cycles are pre-set to eliminate rinse cycles? When detergents lift soil from instruments and containers, a rinse is required to wash away the soil. Failure to rinse allows the detergent residue and bioburden to settle right back on the instruments. Lubricants can further fixate the soil to the surface of devices. Eliminating rinse steps decreases cleaning efficacy and compromises subsequent disinfection or sterilization steps.

detective and problem solving 2-2876776_1920The case of the “close enough” reasoning

We know that actions performed in Sterile Processing have a direct effect on patient safety. That’s why there is no such thing as close enough. Beware of questionable claims that disinfecting wipes designed for environmental cleaning are just fine for cleaning containers and device surfaces. Don’t be taken in by the company that tells you that wet loads after sterilization are safe for long term storage. Trust your experience and training when you hear from vendors who tell you it’s safe to do something that you consider to be unsafe or, at the very least, questionable.

detective and problem solving 3-2876776_1920The case of the “fox guarding the hen house”

Quality monitors are an important component of the reprocessing cycle. Do you ever wonder about equipment companies that insist their quality test is the only one you can use? One washer manufacturer claims that their indicator must be used as it works with their detergent. A quality monitor, whether a chemical indicator or wash indicator, should ideally monitor all parameters including process parameters. 

For example, Case Medical manufactures its Case Soil® Indicator, with representative soils commonly found on surgical devices, to serve as an independent verification of all wash cycle parameters including equipment function, contact time, temperature, water quality, as well as any detergent used for processing.  A company offering a comprehensive indicator is focused on detecting anything that can compromise the effectiveness of the process, not just showing a passing result. Consider whether independent verification might provide more robust assurance of patient safety.

Trust but verify

When in doubt, raise the issue of a suspect instruction or questionable shortcut to your department manager. You can also check the manufacturers’ IFUs or refer to applicable standards and guidelines from organizations like AAMI, AORN, or others. Don’t depend on verbal assurances. If you are uncomfortable with instructions, ask for the IFU, the FDA 510(k), validation studies, or other data to back up the statements being made. Look for products displaying the U.S. EPA Safer Choice label which signifies a product that is safe for patients, safe for staff, safe for the environment, and compatible with your medical devices.

Case Solutions and SuperNova Instrument ChemistriesThere are no tricks when you are committed to best practices. At Case Medical, we care about patient and staff well-being, as demonstrated through our commitment to the Safer Choice program. We’re privileged to display the Safer Choice label on our Case Solutions® and SuperNova® instrument chemistries. We are also happy to share our numerous FDA 510k clearances for our reusable products, SteriTite® universal containers and MediTray® inserts.

Do you have any stories of taking on misconceptions in your department? We’d love to hear your comments!