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COVID-19 Conversation with Cori Ofstead

By: Julie Williamson

March 24, 2020

Given the many concerns and questions surrounding COVID-19 (Coronavirus) and its impact on Sterile Processing, IAHCSMM reached out to epidemiologist Cori Ofstead, MPH, President & CEO of Ofstead and Associates for her professional observations and insights. This Q&A will answer some of the top questions SP professionals may have, while also offering some tangible advice to help keep you and your co-workers safe (not just during the pandemic, but every day on the job).

Q. Do we need to clean our instruments any differently to eliminate COVID-19?

A. COVID-19 is a special kind of virus called an “enveloped virus.” The outside of the virus is covered by an envelope made of lipids (fats), which are easily damaged by disinfectants. Once the lipid envelope is compromised, the virus is neutralized. This is good news, as it means that the threat can be eliminated by methods routinely used in Sterile Processing departments -high-level disinfection and sterilization.

However, there’s now evidence that COVID-19 can survive on surfaces for hours or days if they are not cleaned and disinfected. This means we have to think about the potential for environmental contamination and personal exposure as we transport, handle and manually clean instruments and endoscopes that may have been exposed to COVID-19. The truth is that the risk is no higher than it has always been with other serious pathogens, and everyone will be safe if they follow the practices needed to prevent exposure to HIV, hepatitis, bacteria and fungi.

But let’s face it: healthcare personnel - including reprocessing technicians - have been doing a terrible job of hand hygiene, and very few SPD personnel use proper techniques when donning and doffing PPE. In fact, we have NEVER been to an institution where all of the reprocessing technicians were wearing the proper PPE in the correct way. Furthermore, technicians rarely use proper technique when taking off PPE, which could expose them to COVID-19. We need to recognize that transport containers, decontam areas on the dirty side, and the PPE worn when handling instruments may be contaminated, and the virus is more likely to survive in wet conditions. During manual cleaning, technicians often get splashed, and it’s absolutely essential that they’re wearing impermeable gowns, face shields, masks, and extended cuff gloves. The stakes are higher than ever before, as nobody has immunity to this particular virus. I’m concerned that continued complacency could cause serious illness among reprocessing personnel.

Q. What are some of the most important steps Sterile Processing professionals should take to keep themselves and future patients safe in regard to this virus?

A. Managers and trainers should make sure that every reprocessing technician is trained and competency tested on hand hygiene and PPE donning and doffing. Everyone should practice with someone, giving them feedback to make sure they get it right. We absolutely have to make sure those masks and goggles/face shields are on properly. The top needs to be pinched snuggly on the nose so it doesn’t drift down and expose the nose or lips, and no more letting the mask dangle around your neck and pushing it back up throughout the day! And I know that PPE is hot and uncomfortable, and masks make your face itch, and face shields get all steamed up, and it’s awful. But still, you need to wear them properly, all day, every day.

By the way, the outside of the mask is presumed to be contaminated after use, and once you touch it, your hand is contaminated, too. Same with the gowns and gloves. Once they get wet or splashed, they’ve been contaminated, and you need to be extremely careful when taking them off. And then you need to wash your hands and your forearms, and when you’re done and you’ve rinsed off the soap, wash your face.

Also, make sure to clean and disinfect work areas and transport bins. And please, never handle a flexible endoscope with bare hands, as they are notorious for harboring germs, even after reprocessing. Note: A CDC study found the virus survives up to 17 days on surfaces that haven’t been disinfected.

Lastly, I’m concerned that SPD personnel may be asked to use less PPE or reuse PPE. If that happens, they should sit down with stakeholders and figure out how they’re going to decontaminate the PPE before reuse. Anything used in manual cleaning is highly contaminated and should not be reused, unless it can be cleaned and disinfected or sterilized in ways that do not compromise the materials. Vendor consultations may be necessary for this.