Point of use processing includes all operations performed on reusable medical devices before their transfer to the reprocessing room or sterilization department.
Objectives of point of use processing are to:
- Separate RMD from single-use and waste. Single-use items and waste are disposed according to applicable waste management regulation.
- Isolate RMD concerned by specific prion risks measures according to applicable local regulation (see reusable medical device)
- Prepare RMD for their transfer to the sterilization department, in accordance with medical device manufacturer instructions for reprocessing. Medical devices are placed in containers that protect them and avoid accidental contamination of operators in charge of transfer. Measures are implemented to prevent drying of soils on medical device surfaces.
If left to dry, soils stick to the device and become difficult to remove thereby rendering their cleaning more difficult.
Lumens can become obstructed with organic material.
Leaving the RMD overnight or over the weekend must be avoided. Long delays in processing contribute to the formation of biofilm that will shield microorganisms from routine cleaning procedures.
Blood, other bodily fluids, and saline are highly corrosive and can cause pitting of instruments.
Drying of soil is avoided by limiting the time before cleaning (below 6 hours), soaking or pre-cleaning at point of use (see below)
Point of use processing is performed by trained employees
- Point of use operators wear adapted protective equipments.
- They know the medical devices and are aware of injury risk with sharp items and know measures to be applied in case of accident.
- They handle RMD with care in a manner that avoid dispersion of contaminant in atmosphere and environmental surfaces.
Point of use processing - implementation
Point of use processing operations are performed according to RMD Manufacturer instructions for reprocessing.
- Throughout the surgical procedure, as needed, RMD’s are wiped with sterile moistened surgical sponges to remove gross soil, lumens are irrigated with sterile water.
- Immediately after use, outer debris are wipped off, working channels are flushed. Flexible endoscopes require specific measures (see flexible endoscopes). RMD composed of more than one piece and surgical motors are disassembled according to RMD manufacturer’s IFU’s. Missing or incomplete devices are identified. Process to be apply in case of dropping is known. Damaged devices are sorted.
- Soaking can be recommended for complex devices (for examples, devices with lumen or complex geometries). If implemented, point of use soaking takes place as follows:
Cleaning and disinfection formulations complies to applicable regulation and international standards. Fixative processes such as dry heat or aldehydes are avoided. Soaking baths are prepared in basins dedicated for this use. Concentration and exposure time are according to manufacturer’s IFU’s. Renewal is acording to local recommendatons (after each patient, every 24 h or before if visibly soiled).
Point of use automated washer-disinfector might be recommended by some local guidelines when the transfer time to the sterilization department is long (for example during week-ends or overnight). It does not replace cleaning&disinfection by the sterilization department.
- RMD are placed in transport containers in an orderly fashion to avoid shifts and damages during transport
Sharp instruments are segregated inside the container.
Retainers may be required for microsurgical instruments and endoscopes.
Optics are placed in special containers.
Heavy instrumentation is on the bottom and lighter, delicate instruments on top.
Instrument trays are not overloaded. Size of containers avoids excessive kinking of flexible items.
Transport containers are closed and preferably locked.
Containers carry clear indication that the content is biohazardous. Biohazard indications may be defined by local regulation.
When the outside of a transport container is visibly soiled, it is careful decontaminated, before transport
- If point of use soaking did not take place and if time before cleaning and disinfection is long, RMD are (1) covered with a towel moistened with water (not saline) over the instrument, or (2) transported in a container able to maintain humid conditions.
Moisture-retaining products are available on the market but their added value has not been established yet.
- If time to cleaning is short (maximum 6 hours) “dry disposal” is preferred to “wet” disposal to limit RMD corrosion.
- Containers are closed and preferably lockable.
Point of use processing and quality
Point of use processing standard operating procedures (SOP’s) are prepared in partnership with surgical and medical users, in accordance with quality management principles.
Process validation of point of use processing controls that:
- Trainings are executed.
- Occupational health & safety measures measures are in place.
- Waste management rules are known and applied.
- Traceability is operational.
- Standard Operating Procedures (SOP’s) are up to date.
WFHSS recommendations for point of use processing
- Point of use standards operating procedures are prepared in accordance with medical device manufacturer instructions for reprocessing and in partnership with surgical and medical users.
- Point of use reprocessing is performed by trained employees who know the RMD, are protected to manipulate soiled devices with sharp edges, aware of prion and waste management rules.
- RMD are adequately installed in transport containers clearly identified as containing soiled items and preferably locked.
- Drying of soils is avoided by wiping, flushing of lumen, as needed, soaking in a cleaning disinfection bath. If time before cleaning is long additional precautions are taken to avoid drying (e.g; humid towels or point of use pre-cleaning in automated washer-disinfectors)
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