IAP Zone and Environmental Monitoring

IAP Zone

• A clean area within a CSSD where surgical instruments are inspected for cleanliness, functionality, and intactness.
• Critical for final instrument handling before dispensing to OR or clinic.
• Staff: Trained decontamination specialists and technicians.
• Work adheres to Manufacturer's IFUs.
• Purpose:
  • Optimize sterilization effectiveness
  • Minimize contamination of RMD sets.
• Environmental Control:
  • Positive pressure to prevent air flow from outside to inside.
  • Comfortable working environment: 20-23°C and humidity 30-60%.
  • Cleaning: Follows infection control policies and procedures.
  • Furniture must be smooth, non-porous, and easy to clean.

Environmental Monitoring

• Monitoring:
  • Contact or settle plates placed around the room.
  • Plates cultured and analyzed.
  • Results compared to baseline contamination levels.
  • Testing should match or exceed the baseline.
• Monitoring Frequency:
  • Daily basis. Also performed when the facility is unoccupied to establish a baseline.
• Purpose: Early warning system to detect and address contamination trends.

Dress Code

• Protective Clothing:
  • Reduces contamination risk of clean RMDs and environment.
  • Freshly laundered scrub suits: Minimize bacterial shedding, comfort, and professional appearance. Changed daily or when visibly soiled.
  • Head/Hair Cover: Single-use, low-lint surgical hat or hood confining all hair, must be designed to minimize microbial dispersal.
  • Shoes: Dedicated sturdy shoes worn only in the IAP zone, with shoe covers when shoes are dedicated for the department only.

Unloading and Inspection of WD

• Method: Automated unloading mechanisms or manual removal
• Manual Unloading Risks:
  • Chamber temperature can exceed 90°C.
  • Utensils may contain hot water.
• Post-Unload Quality Checks:
  • Verify washer disinfector cycle selection and parameters.
  • Visual inspection of load: Moisture, staining, residue, damage.
  • Non-conformances must be documented and reported to the line manager.
• Manually Clean Devices:
  • Soil/staining, excessive wetness, damage, correct disassembly, and documentation.
• Functionality Test:
  • Inspect for cleanliness, stains, corrosion, damage, and free movement.
  • Devices should be inspected under magnification.
• Specific Functionality Testing:
  • Hinges, ratchets, jaws, teeth, cannulated devices, telescopes, light cables, cutting edges, insulation, and screwed joints.

Computerized Tracking System

• Purpose: Track devices and trays through the decontamination process.
• Components: Handheld barcode readers connected to PCs.
• Scan Barcode: Generates packing list and unique barcode label.
• New Processing Cycle: Generates a unique unit number for every cycle.

Tray Assembly

• Arrangement: Left to right in order of procedure use, size, surgeon/OR nurse preferences.
• Verification: Check all contents against the checklist.
• Instrument Pins: Used for holding and minimizing tangling of forceps.
• Ratchets: Open for all forceps unless stringers are not available.
• Placement:
  • Spread devices evenly to prevent condensate pooling.
  • Evenly distribute plastic items.
  • Use tip protectors for delicate or sharp items.
  • Tray liners or silicone mats for protection.
• Missing or Extra Devices: Report to supervisor and document.
• Overcrowded or Overweight Trays: Can lead to drying and sterility issues.
• Weight Limit: ANSI/AAMI ST77 and ST79 recommend 25 pounds.

Processing Metal Basins

• Placement: Position allows moisture drainage during sterilisation.
• Wicking Materials: Surgical towels facilitate drainage and drying.
• Spacing: Maintain 1 inch between multiple basins to avoid condensation build-up.

Packaging

• Re-usable Linen: Discouraged due to strike-through risk and linting.
• Common Packaging Materials:
• Rigid containers
• Peel pouches
• Packaging Function:
  • Protects and holds devices for sterilization.
  • Provides a microbial barrier and protects items from contamination.
  • Maintains sterility until use.

Sterilization Wrap Materials

• Common Materials: Spunbond-meltblown-spunbond (SMS) fabrics
• Standards: EN ISO 11607-1 and EN ISO 11607-2, 2006 and EN 868 parts 2-10,
• Minimum Requirements: Adequate barrier against microorganisms and particles, compatible with sterilization process, maintains sterility, allows sterilant penetration and removal, aseptic delivery, minimal wrap memory, complete enclosure, protects contents from damage, secure sealing, tear, abrasion, and puncture resistant, tamper-proof, air removal

Sterilization Wrap Techniques

• Sequential Wrapping: Two layers wrapped individually and folded, package within a package
• Simultaneous Wrapping: Both layers wrapped together simultaneously, single or double-layer wrappers
• Sequential Wrapping: Most commonly used in CSSD
• Square Fold technique: Items placed parallel to the wrapper, suitable for heavier items
• Envelope Fold technique: Items placed in a diamond shape to the wrapper, frequently used for smaller items

Rigid Containers

• Advantages: Almost indestructible, sterility and reassurance if handled properly, easily disassembled for cleaning, compatible with sterilization and cleaning methods, lockable, tamperproof, non-resealable, allows sterilant penetration, removes contents without contamination
• Disadvantages: Creates ergonomic challenge due to weight, requires additional storage space, longer cycle time required for wet packs, cleaning effort required, potential filter dislodgement risk
• Checks before Sterilization: Filter/valve systems must be in proper working order, examine filter plate for integrity, clean containers between each use, check seal for damage, regular servicing by manufacturer

Peel-Apart Pouches

• Self-Sealing Pouches: Adhesive manufactured into the open end, heat sealing machine or autoclave tape required for sealing
• See-Through Peel Packaging: Time-saving, easy to pack and close with heat sealer, allows identification of packed devices
• Uses: Small, lightweight, single instruments
• Types: Medical-grade paper/plastic, spunbond polyolefin-plastic (Tyvek pouch)
• Choice Depends On: Sterilization method being used
• Paper Pouches: Used for Steam and Ethylene Oxide sterilization
• Tyvek Pouches: Used for Hydrogen Peroxide sterilization
• Available in: Rolls or precut sizes, heat-sealed or self-adhesive seals
• Packing Technique: Instruments placed with opened hinge for complete sterilant contact, 1/4’’ space on each side, air removal
• Air Removal Importance: Trapped air interferes with sterilization
• Labeling: Only on the plastic side using approved pen

Tip Protectors

• Prevent instruments from puncturing the pouch

Double Pouching

• Required for aseptic presentation of items in the sterile field
• Item placed in a pouch, sealed, then placed in a larger pouch and sealed
• Avoid folding the inner pouch to allow for air removal and sterilant penetration
• Proper temperature needed for sealing Tyvek or medical grade paper pouches

Package Labeling

• Necessary for proper identification and selection
• Label Contents: Package contents, lot number, sterilization date, pack complete name, assembler/packager name, requesting department, sterilizer number, used cycle
• Label Placement: Sterilization tape, commercially available adhesive labels, or the plastic side of peel pouches

This quiz covers the IAP Zone's importance in maintaining surgical instrument hygiene, along with the protocols for environmental monitoring. Learn about the best practices for optimizing sterilization effectiveness and ensuring a contamination-free environment for surgical procedures.