Every Day Every Patient Everytime

13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:02 AM Page 1

Volume 7 | Summer 2013

INSTRUMENT REPROCESSING Every Day Every Patient EveryTime

instrument top ten essentiaLs decontamination reprocessing for effective Life cycLe See pages 2–6 instrument See page 10 cLeaning See page 7 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:02 AM Page 2

Instrument Reprocessing By Joe Tulpinski, Director of Research and Development, Metrex Research

surfaces of the instruments can be kept moist by using Table of Contents Introduction In the past several years, much attention a gel, spray, or foam intended for this purpose and to Editorial: Instrument Reprocessing has been focused on patient safety and begin the break down process of the soil. Joe Tulpinski, Director infection prevention. Reports of exposure Alternatively, the used device can be covered with a of Research and Development, to inadequately or improperly reprocessed towel that has been moistened with tap water or sterile Metrex Research...... 2–6 medical devices tell of patient risk of water. Saline solutions should not be used for exposure to infection. As information is moistening or soaking as it may damage devices. more freely available to the patient, their Keeping the soil moist is crucial for proper cleaning. Top 10 Essentials for Effective awareness has increased. The risk of Dried and hardened soil can be impossible to remove Instrument Cleaning ...... 7 acquiring such an infection from an and will directly inhibit high-level disinfection or inadequately reprocessed medical device is sterilization. Decontamination Products ...... 8–9 relatively low given the number of such medical devices in use.1 However, outbreaks When choosing cleaning products or methods, always due to exposure remain a public health take into account the special requirements of the Decontamination Life concern. device. New devices should be evaluated to ensure Cycle Chart...... 10 that the devices can be effectively cleaned. Reusable medical devices are medical Sometimes, even when a thorough process is used, devices that can be reused to diagnose and some instruments, due to their design, can be deemed Miltex–Healthy treat patients. As these devices are used, unable to be cleaned. Staff involved in instrument Instrument Program ...... 11 they become soiled and contaminated with reprocessing should follow the manufacturer’s organic matter and microorganisms that instructions and use products that are appropriate for Packaging Products ...... 12–13 must be removed between patients to cleaning instruments. Hand soaps, laundry, or dish avoid risk of cross contamination. detergents should not be used to clean instruments. These reusable devices are reprocessed Follow the detergent or enzymatic detergent’s Sterilization Products...... 16–17 between patients. Reprocessing is a manufacturer’s instructions for proper dilution and use multistep process that ensures reusable for optimal cleaning. medical devices can be cleaned and Ultrasonic Cleaners disinfected without impairing its The most common type of instrument cleaning is & Sterilizers ...... 18 function. manual cleaning. Manual cleaning is a more flexible method of cleaning in that any type of instrument can Henry Schein Brand Products ...... 19 We will look at the key steps for the be cleaned manually. The down side to manual proper reprocessing of reusable medical cleaning is that the consistency of cleaning can vary instruments as it relates to cleaning, between technicians and that the employees are at risk Quality Assurance ...... 20–21 disinfection, and storage of a of exposure to possible contamination since they are in reprocessed instrument. contact with contaminated instruments. It is for these SPSmedical Biological Indicators reasons that a health care facility establishes protocols for Steam Process ...... 22 for instrument cleaning and the disinfection process. Cleaning of Used Instruments A brief overview of the cleaning process is described in The most important step in instrument Table 1. These procedures should also emphasize that reprocessing is cleaning. Studies have appropriate personal protective equipment (PPE) be demonstrated that dirty instruments cannot worn by the employees when performing instrument be effectively disinfected.2 Cleaning is the cleaning. Additionally, proper training, qualification removal of visible soil (organic and and re-qualification of the cleaning process should be inorganic material) from instruments and is implemented to ensure consistency between normally accomplished manually or technicians, ensuring consistent outcomes. automatically using water and detergents with or without enzymes.3 When the instruments are received for cleaning, technicians will take the instruments apart prior to Following the use of a device, gross soil is cleaning (except when the manufacturer’s instructions removed and the device is sent to the say otherwise). The instruments are disassembled, central processing area where cleaning sorted, and allowed to soak. Soaking the instruments will occur. If cleaning is unavoidably makes it easier to remove soil by softening the delayed, devices can be treated to organic and inorganic matter on the instruments. prevent a hardening of the soil. The

2 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:02 AM Page 3

Table 1: Manual Cleaning of Used Instruments

step procedure Why this is done

1 Disassemble used instrument according to This is done to eliminate areas that are manufacturer’s instructions for use. difficult to clean. These areas can build up organic and inorganic debris over time making disinfection impossible. JOE 2 Soak the used instruments in warm water for 10 This step softens and loosens much of the TULPINSKI minutes. (Time may vary depending on the soil soil that may have dried on the instrument type and degree of soil drying that has taken between the time it was used and the time JOE TULPINSKI is Director of Research and place.) cleaning has started. Development at Metrex/Kerr TotalCare, a subsidiary of Danaher Corporation, located 3 Completely brush the instrument with a medium- Brushing is the physical removal of the soil in Anaheim, California. He holds a soft bristle brush while it is in the soak bath. from the instrument. Bachelor’s degree in Biology and a Master’s To avoid damaging the instrument, follow Degree in Biological Sciences from manufacturers’ recommendations as to the type Note: the insides (lumens, channels, etc.) California State Polytechnic University, of brushes to use for cleaning. Brushing should of tubed devices, like dental handpieces Pomona. Joe has research experience in be performed under the surface of the water or endoscopes should be brushed out formulation chemistry, microbiology, food to minimize aerosolization-cleaning away from as well. microbiology, molecular biology, and in the operator. pharmaceutical quality control. A professional member of ASTM, ASM, APIC 4 Rinse with clean water Water can be either deionized water or and SGNA, Joe has experience in the reverse osmosis water from the facility. medical device, disinfection, and reprocessing areas. Prior to joining If difficult-to-remove soil remains, another enzyme detergent soak followed by brushing and rinsing Metrex/Kerr TotalCare in 2005, Joe was the Laboratory Manager at N-terminus Research should be done. Laboratory, a research facility dedicated to both basic and applied research in the Sorting the instruments allows for the and monitor the water temperature, detergent area of novel antimicrobial technologies. separation of sharps and staging for the or enzymatic dosing and cleaning cycle time. appropriate cleaning process. Cleaners and Some of these automatic cleaning systems References enzymatic detergents should be used when employ a combination of water jets and 1. FDA, 2013, “Reprocessing of compatible. The enzymatic detergents work to ultrasonics to uniformly and thoroughly clean Reusable Medical Devices,” U.S. Department of Health & Human break down proteinaceous soils. Detergents a soiled instrument. Regardless of the Services–Food and Drug dissolve dirt and grease and break down or automatic washer type or system used, Administration. dissolve oils better than soaps. The detergents instruments must be prepared for processing 2. Alfa, et al. 1998, “Comparison of contain wetting agents that allow water to flow (i.e., sorted) before being placed into a washer. liquid chemical sterilization with freely into difficult-to-clean areas like hinges The actual preparation should be done in peracetic acid and ethylene oxide and crevices. Prolonged soaking of instruments accordance with the washer manufacturer’s sterilization for long narrow lumens”. or devices in detergents or enzymatic instructions and facilities standard operating American Journal of Infection detergents can cause damage to an item or procedures. Control. cause biofilm to form on the instrument. 3. Rutala, 2008, CDC: “Guideline for Always ensure that the detergent or enzymatic Disinfection and Sterilization in Healthcare Facilities, 2008” detergents are approved by the device Choice of Disinfection Process 4. Spaulding, 1972, “Chemical manufacturer. It is important to choose the correct method of Disinfection and Antisepsis in the disinfection for the device being reprocessed. Hospital”. Journal of Hospital Automated cleaning is another way to In addition to following the device Research. reprocess instruments. There are many manufacturer’s instructions for use, facilities 5. Spaulding, 1972, “The role of different types of automated cleaning methods can also follow industry standards. One widely chemical disinfection in the and types of cleaning/decontamination accepted view on the reprocessing of reusable prevention of nosocomial infections”. equipment. They include the ultrasonic as well medical devices is a classification system first In Brachman and Eickof, eds. as the use of different types of proposed by Dr. E.H. Spaulding in the early Proceedings of International washers/disinfectors. Many of these machines 1970’s. This is a strategy for the reprocessing of Conference on Nosocomial resemble household dish washers. Some contaminated medical devices. This system Infections. automated cleaning systems are device specific. divides medical devices, equipment, and 6. Friedmen and Petersen, 2004, “Endoscopy” in Infection Control These automated systems for cleaning regulate surgical materials into three categories based in Ambulatory Care. 3 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:03 AM Page 4

Instrument Reprocessing

Table 2: Spaulding’s Classification of Medical Devices and required Level of disinfection

classification minimum Level of patient contact example of device disinfection

Critical devices Sterilization (High Devices come into Surgical Retractors, activity) contact with blood or Surgical Forceps or normally sterile tissue Clamps

Semi-critical devices High-level disinfection Devices come into Endoscopes, (Medium activity) contact with mucous Vaginal Probes membranes

Non-critical devices Hospital or general Devices come into Stethoscopes, disinfection (Low contact with unbroken Blood Pressure Cuffs, activity) (intact) skin General Surfaces

on the potential risk of infection involved in such as anesthesia or respiratory equipment, their use. The three categories are critical, endoscopes, and diagnostic probes, come into semi-critical, and non-critical. This system contact with mucous membranes and are the also established three levels of germicidal types of devices that should be high-level activity (high, medium, and low) for disinfected. High-level disinfection destroys disinfection strategies with the three classes all microorganisms with the exception of a of medical devices4, 5. Table 2 summarizes the high number of bacterial spores. classification and minimum level of disinfection required. Chemicals commonly used for high-level disinfection of medical devices are; Glutaraldehyde, ortho-Phthalaldehyde, Hospital or General Disinfection Peracetic Acid/Hydrogen Peroxide. of Reusable Medical Devices Typically this type of disinfection may be used for the decontamination process in which the Glutaraldehyde used devices are deemed safe to handle by a Glutaraldehyde has gained wide acceptance as reprocessing technician. A hospital a high-level disinfectant and liquid chemical disinfectant is one that is EPA registered sterilant. It kills microorganisms by altering (having an EPA registration number) and is RNA, DNA, and protein synthesis within effective against Staphylococcus aureus, microorganisms. Glutaraldehyde has excellent Pseudomonas aeruginosa and Mycobacterium biocidal activity. It is easy to use, and does not spp. A general disinfectant will also have an damage equipment. It is active in the presence EPA registration number, but does not list a of organic matter and is non-corrosive to claim against Mycobacterium spp. Hospital or metals, rubbers, and plastics. Glutaraldehyde general disinfectants do not kill spores. can be used in manual and automated reprocessing protocols. The major problem A hospital or general disinfectant can be used associated with glutaraldehyde is that it is a to reprocess non-critical medical devices such known respiratory and dermal irritant and as stethoscopes, blood pressure cuffs or other sensitizer, and adverse health effects may occur medical device surfaces found in and around a in exposed workers. Glutaraldehyde vapor is health care facility. required to be monitored in the endoscope reprocessing area. Proper fume management system for glutaraldehyde products is desirable. High-Level Disinfection of Reusable Medical Devices Ortho-Phthalaldehyde Manual and automated methods Ortho-Phthalaldehyde (OPA) has shown High-level disinfection is the minimum superior biocidal activity (except against disinfection type used for heat sensitive semi- bacterial spores) compared to glutaraldehyde, critical medical devices. Semi-critical devices with a shorter contact time. OPA solutions do 4 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:03 AM Page 5

not require activation. To achieve high-level systems must be routinely maintained for disinfection using MetriCide OPA Plus, a proper function and documented. minimum of 12 minutes at a minimum of 20°C is required for manual reprocessing; and a Another aspect to consider in the selection of minimum of five minutes at 25°C is required a high-level disinfecting solution, aside from for an Automated Endoscope Reprocessor compatibility, is the use of surfactants in the (AER). Rigorous rinsing is required to remove disinfectant formulation. Surfactants can cause the OPA from the surfaces of the endoscopes. air bubbles that prevent the solution from OPA is contraindicated for the reprocessing of completely contacting the entire surface of the endoscopes that will be used on patients with instrument.6 Additionally, surfactants can recurrent bladder cancer. OPA was identified cloud the lenses of lensed instruments. as the cause of serious allergic reactions in some bladder cancer patients who underwent To ensure that high-level disinfectants are repeated cystoscopies. OPA vapor is not working properly, one must monitor for the required to be monitored in the endoscope Minimum Effective Concentration (MEC) or reprocessing area. OPA will stain protein and Minimum Recommended Concentration this can uncover inadequate cleaning (MRC) required (the terminology will vary practices. If staining occurs, the cleaning depending on product). Typically this is practices should be revisited. performed using chemical indicating test strips appropriate for the high-level disinfectant used. Peracetic Acid/Hydrogen Peroxide Peracetic acid/Hydrogen Peroxide are oxidizing Perform routine testing of the liquid high-level agents that kill microorganisms by disrupting disinfectant to ensure at least the minimum their cell-wall permeability and by denaturing effective concentration (MEC) of the active proteins, enzymes, and other metabolites. ingredient. Check the solution before each use Peracetic acid/Hydrogen Peroxide has a rapid, and document the result. If the chemical broad-spectrum antimicrobial activity. indicator shows that the concentration is less Peracetic acid (especially at elevated than the minimal effective concentration (or temperature) can be corrosive to some metals minimal recommended concentration), the but additives and pH modifications can reduce solution should be discarded. The liquid high- this effect. level disinfectant should be discarded at the end of its reuse life, regardless of the minimal A high-level disinfectant (HLD) should be effective concentration or minimal selected based on the follow considerations: recommended concentration. Upon opening a The area and equipment available, the fresh bottle of test strip and at pre-defined components that make up the high-level intervals (per facility procedure), a quality disinfectant, the compatibility with the devices assurance test should be performed on the test in use, proper ventilation, training, and strips. education of staff. If additional liquid high-level disinfectant is All high-level disinfectants are dangerous added to an AER (or basin, if manually chemicals and need to be handled accordingly. disinfected), the reuse life should be HLDs should not be used as hard surface determined by the first use/activation of the disinfectants or for routine cleaning. When original solution (i.e., the practice of “topping using a high-level disinfectant for reprocessing, off” of a liquid high-level disinfectant pool fumes and vapors must be properly managed. does not extend its reuse life). Use only test Containers containing high-level disinfectants strips indicated for the product and document should remain closed or covered except when the test strip expiration date on the product placing a device in or removing the device out bottle. The test strips will have two expiration of the solution. Containers must be located in dates; the date after opening and the a well-ventilated area or in a fume manufactures’ expiration date. management system. Fume management

5 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:03 AM Page 6

Table 3: Sterilization cycle type and applications.

cycle type typical application

Gravity Glassware, Unwrapped Surgical Instruments, Unwrapped Goods, Utensils

Pre-Vacuum and/or Post-Vacuum Wrapped Instruments, Packs, Cassettes

Liquids Water, Media

Flash Unwrapped Instruments

Sterilization of Reusable process must be compatible as to not Medical Devices cause damage and must be efficacious to Overview ensure sterility. Steam sterilization is the gold standard when the reusable devices are heat and pressure tolerant. It is the most commonly used process Device Storage for sterilizing instruments, trays, and cassettes. Reprocessed instruments should be stored in a Steam sterilization is considered safe, fast, manner that reduces the potential for and most cost effective when compared to contamination. Sterile instruments should other methods of sterilization. The steam remain in their wrapping until ready for use. sterilizers come in a variety of sizes and the Sterile items are considered as such unless the sterilization cycles can vary among packaging is opened or damaged. Prior to use, manufacturers. The cycle type depends on the a sterile package should be inspected for typical application or load type for sterilization. integrity. If it is suspected that a breach may Table 3 summarizes some different cycle types have occurred with a package, the items should and the typical applications. not be used and should be reprocessed.

Prior to sterilizing instruments, proper and High-level disinfected instruments such as appropriate wrapping or covering must be endoscopes can be hung in appropriate utilized. Commonly, instruments are placed in cabinets so they can dry in a timely manner. materials such as pouches, wraps, or ridged Reprocessed instruments and devices should be containers. Pouches are commonly used for kept clean, dry, and at a constant temperature small, lightweight instruments. Wraps are and out of highly traveled areas of the medical commonly utilized for instrument trays or or reprocessing facilities. cassettes. Ridged containers are commonly used for heavy or layered instrument trays. It is important that all reprocessed instruments Care must be observed to ensure that sharp be carefully handled, ensuring that the devices edges or pointed objects do not penetrate this are not crushed, bent, or punctured. When protective packaging. If this occurs, the sterility instruments are transported to their place of of the instrument has been compromised. use, the devices should be protected from various environmental contaminants. Another type of sterilization for the reprocessing of reusable medical devices are low temperature methods of sterilization such Conclusion as gas, plasma, vapor, or liquid chemicals. Proper instrument reprocessing following the These are intended for reusable devices that devices’ instructions for use is an important cannot tolerate high temperatures or pressures. factor to prevent health care associated Each process has its advantages and infections (HAIs). Careful and thoughtful disadvantages. The choice about which adherence to process, procedures, and practices sterilization process the health care facility ensure successful outcomes. Appropriate should choose lies with the instrument cleaning and disinfection selections allow manufacturer as to what was validated in their reusable devices to be reused with confidence instructions for use. For patient safety, the for both the patient and health care personnel. 6 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:03 AM Page 7

Millions of people each year acquire infections while receiving treatment in healthcare organizations, and some of these people never recover. According to the Centers for Disease Control and Prevention (CDC), 1.7 million infections annually are related to healthcare settings, and these infections lead to 99,000 deaths each year. Source: APIC

Top 10 Essentials for Effective Instrument Cleaning

Each day, health care facilities’ sterile processing departments manage the preparation of countless surgical instruments for upcoming procedures. If devices are not properly cleaned before they are disinfected and sterilized, tissue, bone, or other organic material can remain in or on the instrument. This was demonstrated in the February 2013 issue of PSO Monthly Brief which explored inadequately reprocessed devices.

Consequences of inadequate reprocessing can be relatively minor, such as a delay in surgery while new instruments are sought if the contamination is identified before a procedure begins, or more significant, such as possible infection.

Healthcare staff members often mistakenly believe that sterilization alone adequately prepares equipment for reuse; this is simply not true. In fact, reprocessing is a multistep practice that includes thorough cleaning as well as disinfection or sterilization. Part of the increase in reprocessing complexity may be contributed to advances in technology. Today’s instruments have complex, movable parts that are difficult to disassemble and clean thoroughly, says Gail Horvath, MSN, BS, RN, CNOR, CRCST, a patient safety analyst at ECRI Institute PSO.

Facility leadership must be aware of processes and challenges within the sterile processing department and view them as part of the delivery of safe patient care. Changes in equipment, personnel, or procedures can affect the organization’s ability to provide properly reprocessed—and safe—instruments. Therefore, ECRI Institute PSO has created a list of its Top 10 Essentials for Effective Instrument Cleaning:

1. Provide adequate trained staff, facilities, and resources for the sterile processing department. 2. Standardize and simplify procedures in all areas where instruments are reprocessed. 3. Monitor the quality of instrument reprocessing through postcleaning inspections. 4. Seek input from reprocessing department staff on instrument and equipment purchases. 5. Limit the operating room’s dependence on immediate-use sterilization. 6. Establish delivery criteria for loaned instruments and prohibit immediate-use sterilization of them. 7. Require regular competency assessments of staff who reprocess instruments. 8. Foster collaboration and teamwork among reprocessing department and operating room staff. 9. Recognize and respect the contribution by reprocessing staff to patient safety and quality care. 10. Encourage prompt reporting of events or near misses involving contaminated instruments.

Source: ECRI Institute

7 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:03 AM Page 8

Guidelines & Recommendations Instrument processing functions should be performed in one central department for safety and cost-effectiveness. A. Personnel doing the reprocessing should be capable of critical thinking. EmPower™ Foam B. The supervising organization is Enzymatic Spray Benz-All® Germicidal responsible for ensuring appropriate Foam covers instruments, Concentrate training, education, and competency reducing splashing and Each 40-cc envelope of the staff. messy spills. Breaks down C. Sterilization cycles with little or no makes 1 gal of 1:750 bioburden on instruments solution. dry time are efficacious when used in to speed up cleaning compliance with validated written process. Ready to use. (100-8321) ...... 15/pkg instructions provided by the device manufacturers, sterilization 24-oz Touch-n-Spray Trigger equipment manufacturers, and (if (176-9974) ...... ea applicable) container manufacturers and when done in accordance with professional guidelines. D. Cleaning, decontamination, and rinsing are critical and users must follow and complete all required processing steps regardless of the sterilization exposure parameters being used. E. Aseptic transfer from the sterilizer to MetriZyme® the point of use is critical to protect Extra-Strength Dual items from contamination. Enzymatic Detergent F. Only items sterilized and packaged Instrument Prep Enzyme Foam in materials cleared by the FDA Efficiently dissolves organic Ideal for applications where instrument for maintenance of sterility can solids. Noncorrosive and cleaning is not immediately available. be stored. low foaming; safe for instruments. 24-oz Bottle G. The device manufacturer’s written (953-9364)...... ea instructions for reprocessing any 32 oz reusable device must be followed. (173-0332)...... ea The cycle parameters required to 1 achieve sterilization are determined /2 gal by the design of an instrument, the (173-9446)...... ea characteristics of the load, the sterilizer capabilities, and the 1 gal packaging (if used). (173-7048)...... ea H. Survey personnel involved in evaluating organizations that sterilize medical items should be knowledgeable and capable of exercising critical thinking and judgment. The regulatory or accrediting agency should evaluate

whether the organization’s leaders ™ ensure that training, education, and ZymeX Concentrated resources are provided and the Enzymatic Cleaner competency of staff is validated. Low-foaming enzymatic cleaner can be I. Quality management is important to used in ultrasonic cleaners, evacuation ensure compliance with processes systems, reprocessors, and and relating those processes to washers/sterilizers. Free-rinsing formula outcomes. doesn't leave a film. Patented formulation J. Sterilization process monitoring is MetriCide® 28 breaks down 3 times more bioburden than essential to ensure that sterilization 2.5% Glutaraldehyde Solution market leaders within 5 minutes. practices are efficacious. 28-day, long-life, high-level disinfecting and Bacteriostatic to prevent additional microbial K. Examples of process monitoring tools sterilizing solution with activator. Excellent growth. Corrosion inhibitor prevents are physical indicators, biological compatibility with a variety of devices. corrosion on metal instruments. 1 oz makes indicators, and chemical indicators. Solution is not corrosive to instruments. 1 gal of solution. L. Instrument inventories should be Rapid and broad-spectrum kill. 1-qt Bottle sufficient to meet anticipated surgical 32-oz Bottle Makes 32 gallons of solution. volume and permit the time to (312-3920) ...... ea complete all critical elements of (173-2446) ...... ea reprocessing. 1-gal Bottle 1-gal Bottle (173-3976) ...... ea Makes 128 gallons of solution. Source: www.apic.org (312-1086) ...... ea

8 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:03 AM Page 9

With greater attention being placed on the role of the environment in infection prevention, there is a greater focus on sterile processing and its impact on patient safety. The Association for Professionals in Infection Control and Epidemiology (APIC) offers disinfection and sterilization resources to help you ensure that your facility is in compliance with guidelines and regulatory standards for sterile processing. For more information, please visit www.apic.org.

The Help Center: CDC Guidelines

Cidex Plus® 28-Day Solution APIC ANYWHERE® online course 3.4% alkaline glutaraldehyde solution with and webinar offerings an odor suppressant. Built-in corrosion/rust inhibitor. Testable. www.apic.org/anywhere • Rapid 20-minute soak time at 25ºC • Noncorrosive to instruments APIC ANYWHERE® online courses • Contains 3.4% glutaraldehyde with 1-qt Bottle provide convenient access to odor suppressant ...... ea • Effective in the presence of 2% (555-0498) accredited infection prevention organic soil continuing education. The affordable, • Test strips available to verify minimum 1-gal Bottle interactive courses augment APIC’s effective concentration (555-4973)...... ea live courses and conferences with on-demand availability.

Course Registration • Continuing the Care: Infection Prevention in the Long-Term Care Setting • Disinfection and Sterilization: Best ® MetriClean 2 Practices in Reprocessing Surgical MetriClean2 is a multipurpose instrument Instruments ENZOL® Enzymatic cleaner, polisher and • Infection Prevention Competency Detergent cart-washer agent. The Review course alkaline pH, low-foaming, Low-foaming Presoak • Microbiology 101 for Infection and Cleaner concentrated cleaner is ideal for stainless steel instruments and cart washers. It Preventionists Proteolytic enzyme helps reduce the need enhances functionality and life of the • Essentials of Infection Prevention™ for manual cleaning. Fast acting–begins to instruments by helping to remove stains and work in 1 minute. Mild pH formulation. reduce corrosion. For use in manual (EIP) 1-gal Bottle cleaning systems, washer sterilizers, • Healthcare-Associated IP Training (555-1112)...... ea washer decontaminators, ultrasonic Critical Access Hospitals cleaners, and cart washers. #10-8100, 1 Gallon • EPI Primer (804-5688)...... ea • Infection Prevention in Hemodialysis #10-8150, 5 Gallon Settings course (616-8397) ...... ea On-Demand Webinar Categories • Construction and Renovation • Disinfection and Sterilization • Emergency Preparedness & Pandemic Planning (H1N1) • Environmental Services Cidex® Activated Dialdehyde Solution • Basic Infection Prevention ® Wavicide-01 • Clean Spaces Health Patients Enables quick instrument turnaround to High-Level help maximize scheduling of daily Disinfectant • Infection Prevention procedures. With its broad kill spectrum, this reliable, high-level disinfectant is effective Wavicide-01® • IP Competency: Novice and safe for a wide variety of medical sterilant is a 2.65% • IP Competency: Moderate glutaraldehyde soaking instruments and devices, including • IP Competancy: Proficient endoscopes. 2.4% alkaline-based solution for use with endoscopes and glutaraldehyde formula provides superior stainless steel surgical instruments. It is • Legal, Legislative and Regulatory microbicidal and anticorrosion properties ready to use and requires no activation. Issues versus acid glutaraldehydes. Minimum With a neutral pH of 6.3, it is stable and effective concentration (MEC) is easy to test noncorrosive. Provides 30-day reuse. Use at • Surgical Site Infection (SSI) using Cidex® Activated Dialdehyde Solution room temperature. • Surveillance Test Strips. Activated solution can be reused 32 oz • Tuberculosis for up to 14 days, or until otherwise (583-4947)...... ea indicated by the test strip. 1 Gallon 1/ (555-0126)...... 1 4 gal (120-3619) ...... ea 9 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:03 AM Page 10

DECONTAMINATION LIFE CYCLE The decontamination life cycle model highlights the extent to which decontamination affects the whole of any healthcare facility and not just those areas processing equipment. Traditionally, decontamination has been the

responsibility of the departmental heads of specialist units, for example sterile services, endoscopy units, theatre surgical suites, etc. Management arrangements within health care facilities often divided these functions and made it difficult for a totally coordinated approach to the application of decontamination standards and $ practices to be achieved. Effective decontamination requires the attainment of acceptable ACQUISITION standards at all stages of the life cycle. Failure to address issues in 1. Purchase any of these stages will result in inadequate decontamination. At all 2. Loan stages of reprocessing, the following issues need to be taken into account:

CLEANING 1. The location and activities where decontamination takes place; TRANSPORT 2. Instrumetnt reprocessing facilities and equipment at each DISINFECTION location; 3. Ensuring that equipment used is validated, maintained, and USE At all stages tested in accordance with manufacturer’s guidelines and Location legislation; Facilities INSPECTION 4. The existence of effective management arrangements; Equipment 5. The existence of policies and procedures for all aspects of Management decontamination work. STORAGE Policies/Procedures

PACKAGING The aim of decontamination is to make reusable medical devices safe for use on a patient and for staff to handle without presenting TRANSPORT an infection hazard. STERILIZATION DISPOSAL 1. Scrap Source: Depot Health Fig 1.1 2. Return to lender

PROVEN PERFORMANCE Fast-acting high-level disinfectant • Cost-effective • Time-saving • Proven

For product support and educational in-service kits, contact your ASP Representative or visit www.aspjj.com.

Item Code DESCRIPTION SIZE QUANTITY/CASE 555-6446 CIDEX® OPA Solution 1-Gallon (3.785 L) 4 Gallons 555-2497 CIDEX® OPA Test Strips 60 Strips/Bottle 2 Bottles

10 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours $ 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:04 AM Page 11 CUT ALONG THE DOTTED LINE THE DOTTED ALONG CUT $

CUT ALONG THE DOTTED LINE THE DOTTED ALONG CUT 11 www.henryschein.com/infectioncontrol incontrol $ 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:04 AM Page 12

Guidelines & Recommendations #62024, 24" x 24" Storage Recommendations for (943-9024) ...... 240/case KimGuard One-Step Autoclaved Medical Instruments Sterilization Wrap #68024, 24" x 24" 1. Allow packages to dry in the autoclave Strength: KC200 (643-2451) ...... 500/case before handling to avoid KC200 is the second #62030, 30" x 30" contamination. of six strength levels (608-5474)...... 144/case 2. Store packaged sterile instruments in a in the KimGuard #68030, 30" x 30" clean, dry, and dust- and lint-free area One-Step line. It is often used to package (643-4934) ...... 300/pkg (covered or closed cabinets are linen towels, packs and gowns, light basin sets, and single instruments. One-Step is #62036, 36" x 36" recommended. made of two sheets of SMS fabric bonded (761-5652)...... 144/case 3. Store clean and sterile materials at least together on the edges, enabling users to #62048, 48" x 48" 8 to 10 inches above the floor, 18 wrap and open packages in about half the (812-1222)...... 48/case inches below the ceiling, and 2 inches time of sequential wrap. The SMS fabric Sterile delivers barrier and strength properties that from the outside walls. #62018, 18" x 18" help prevent contamination after (806-8305) ...... 480/case 4. Keep like items together—sterile with sterilization. sterile and clean with clean. • Simultaneous (nonsequential) wrap #68036, 36" x 36" (643-8345) ...... 300/case 5. Rotate stock with older items being • One application equivalent to 2 sheets of wrap used first. #62248, 48" x 48" • Low-lint SMS fabric (303-4845) ...... 24/case 6. Do not store sterile supplies under sinks • Steam- and EO-compatible • Latex-free #62654, 54" x 54" or other locations where they may (613-6497) ...... 24/case become wet, or on the floor, • Non-sterile windowsills or other supply areas than #68018, 18" x 18" #62645, 45" x 45" (627-3565)...... 48/case designated shelving or cabinets. (643-0529)...... 1000/case 7. Do not store sterile supplies with items not intended for clinical use, e.g., office or cleaning supplies. 8. Do not handle sterile packages Bio-Shield II CSR Wraps unnecessarily to avoid contamination. Complete sterilization wrap systems in nonwoven, low-linting fabrics. Excellent 9. Items stored and not used within 12 antimicrobial barrier. months should be evaluated as to the #4012 condition of the packaging as well as 12" x 12" the necessity of stocking infrequently (153-2942)...... 1000/case used items. 15" x 15" 24" x 24" (153-4867) ...... 500/case (153-8657) ...... 500/case Checklist for Sterility Before 20" x 20" 30" x 30" Opening Package (153-9442) ...... 500/case (153-0701)...... 250/case 1. Check the expiration or #853, 24"x 24" sterilization date. (788-7325) ...... 500/case 2. Check for the indicator color change. #855, 36" x 36" 3. Check how it had been stored. (788-9877) ...... 250/case 4. Check the general condition #856, 40" x 40" of the wrapper. (715-6566) ...... 250/case 5. Check for any holes or moisture CSR Wraps #857, 45" x 45" damage. (990-2859) ...... 250/case A comprehensive, single-use wrapping system that is unparalleled for quality, #858, 54" x 54" versatility, and cost-effectiveness. Busse (788-5387)...... 100/case SOURCE: CSR wrap offers superior barrier properties Physician Convenience Packs Centers for Disease Control and against both air- and water-borne bacteria, Each pack contains 100 sheets. Available Prevention (CDC) combined with excellent water repellency in the four most commonly used sizes. and high wet or dry tensile strength. #845, 12" x 12" Joint Commission on the Accreditation Standard Packs (788-1865)...... 100/pkg of Healthcare Organizations (JCAHO) An economical wrap ideally suited for general purpose use in hospitals, #843, 15" x 15" physician's offices, clinics, etc. (990-1220)...... 100/pkg #851, 15" x 15" #846, 18" x 18" (788-7835) ...... 500/case (788-9718)...... 100/pkg #852, 20" x 20" #847, 24" x 24" (788-6238) ...... 500/case (788-9701)...... 100/pkg 12 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:04 AM Page 13

All healthcare facilities should choose either an event-related or date-related policy for managing the process of “shelf-lives” for the autoclaving of medical instruments. Each health care facility should have a written policy that addresses the shelf-life of packaged sterile items based on the quality of the wrapped material, storage conditions, conditions during transport, and the amount of handling. The processing of instruments requires care be taken to avoid contamination of the instrument(s) during storage; instruments need to be stored in a way to preserve the package; and packages must be examined before use to ensure integrity and dryness. Source: Centers for Disease Control and Prevention (CDC). Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)

The Help Center: 3M™ Comply™ Lead Free Steam Indicator CDC Guidelines Tape Designed to seal packs and provide visual Joint Commission Resources evidence that packs have been exposed to the steam sterilization process. Indicator • Webinars: exclusive monthly tapes are Class 1 process indicators used video training sessions delivered for exposure monitoring, which assures the to you online. operator handling the processed items that the pack has been exposed to the • E-News: receive the most up-to-date sterilization process without the need to information all by e-mail. Enjoys KimGuard One-Step KC500 open the pack or check load control special offers, promotions, and Sterilization Wrap records. discounts offered exclusively • Simltaneous (nonsequential) wrap #1322-12MM to e-mail subscribers. • One application equivalent to 2 sheets (777-0445) ...... ea of wrap www.jcrinc.com • SMS fabric #1322-18MM (777-0447) ...... ea #62118, 18" x 18" Association of Perioperative (451-0741)...... 288/case #1322-24MM (777-0446) ...... ea Registered Nurses (AORN) #62124, 24" x 24" Perioperative Standards (876-0028) ...... 120/case #1322-48MM (777-0451) ...... ea & Recommended Practices #62130, 30" x 30" The 2013 edition introduces the first (928-6012)...... 120/case ever evidence-rated recommended #62136, 36" x 36" practices with new and significantly (181-3907)...... 72/case revised content on: #62145, 45" x 45" • Prevention of Transmissible Infections (181-3909)...... 48/case • Safe Environment of Care #62148, 48" x 48" (102-2483)...... 24/case STERILIZER • Sterile Technique #62154, 54" x 54" INDICATOR TAPE • Sterilization (181-3910)...... 24/case 60-yd Rolls www.aorn.org #62160, 60" x 60" Individually wrapped. Seals autoclave bags, (791-5301)...... 24/case tubing, pouches, and CSR wraps, indicating that sterile conditions have been attained on packages that have been sterilized by steam. SPSmedical has developed a series of 1 /2" educational CD-ROMs on a variety of (104-8181) ...... ea Infection Control topics that can be 3 /4" used for group or individual training. (104-6133) ...... ea Each program is presented in a slide 1" presentation and utilizes an abundance (104-8993) ...... ea of pictures to provide viewers a better understanding of the subject being covered. Accredited through multiple CSR Wrap organizations, test questions and a CEU Highly permeable sterilization wrap. Certificate are included with each Outstanding liquid repellancy against water, program. alcohol, iodine. For use with EtO, steam, • Cleaning, Packaging & Sterilization gamma radiation, E-beam sterilization Sterilization Tape technologies. Exceptionally strong. Lead-Free, Latex-Free of Instruments; CEUs 1.0 – 1.5 12" x 12" Consistent with • Decontamination, You & Biofilms; (107-1428) ...... 1000/case 2008 AORN Latex CEU 1.5 Guidelines, and because latex can 15" x 15" negatively affect both healthcare workers • Selection & Use of Packaging (107-8142) ...... 500/case and patients, this steam indicator tape is Systems; CEU 1.0 18" x 18" latex-free as well as lead-free. Lead is not • Steam Sterilization: The Process (108-9992)...... 500/case biodegradable, so it is difficult to remove once it enters the environment. of Choice; CEUs 1.0 – 1.5 20" x 20" (107-7093)...... 500/case Also provides: • Immediate identification of processed Visit the SPS Medical website for more 24" x 24" items while securing sterilization packs (108-0896)...... 500/case information and a full listing of programs • Color-change indicator to verify www.spsmedical.com/education 30" x 30" sterilization exposure (108-0898)...... 250/case (112-6361) ...... ea 13 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:04 AM Page 14

Is Your Autoclave Really Sterilizing?

ProSure® Sterilization Monitoring Service Helping Ensure Sterility For You And Your Patients

Why Wait? Get Your Results ProTest Fits* the 3M™ in 24 Hours Attest™ Incubator** Instead of 48 Hours (*Fits 3M™ - 1261, 1261P, 1262 & 1262P) **3M™ and Attest™ are registered trademarks of the 3M Corporation

(436-4128) ProSure® 12 tests/box (991-3994) ProSure® 26 tests/box Visit us at www.hlk.cc (331-2136) ProSure® 52 tests/box ©2013 Clorox Professional Products Company 1221 Broadway, Oakland, CA 94612. (780-3685) ProTest Steam BI 25 tests/box Always use products as directed. To order call Henry Schein: 800-772-4346 (335-0392) ProTest Steam BI 100 tests/box

SUPERIOR INSTRUMENT REPROCESSING PRODUCTS Sterilization Wrap and Durawick™ Towels

QTY/ QTY/ ITEM # DESCRIPTION ITEM # DESCRIPTION CASE CASE

DuraWick Towel 3 ply/poly+ Sterilization Wrap 8950019 100 1002016 100 13x18 Blue 36x36 Blue

Sterilization Wrap Sterilization Wrap 1003347 100 9007447 500 12x12 Blue 12x12 Blue Sterilization Wrap Sterilization Wrap Sterilization Wrap 1025193 100 9004294 500 Durable, water-repellent material allows penetration for 15x15 Blue 15x15 Blue various sterilization methods. Sterilization Wrap Sterilization Wrap 1004683 100 9004295 500 18x18 Blue 20x20 Blue ™ Sterilization Wrap Sterilization Wrap Durawick Barrier Towels 1006950 100 9007450 500 24x24 Blue 24x24 Blue DuraWick™ towels were specially created to be used to last through several rounds of tools being placed on Sterilization Wrap 1008187 100 30x30 Blue them from your ultrasonic cleaning. The top layer of material wicks away moisture, which is then absorbed into the middle layer of the product, keeping your sterilization area clean and sanitary.

www.tidiproducts.com / 1.800.521.1314

14 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:04 AM Page 15

BECAUSE YOU CAN’T SEE STERILE

Use promo code UAE 5+1 Buy 2 Boxes of to receive free goods. OF SAME FREE! EVERY WEEK. 25 Indicators, EVERY LOAD. SHIPPED WITH ORDER receive an incubator FREE! Sure-Check®Sterilization Pouches ($300.00 value) (See below for details) Internal/external multi-parameter chemical indicators only change color when all 3 criteria ConFirm®10 Hour for sterilization have been met... Time / Temperature / Steam In-O#ce Biological 3.5 X 9 112-0088 10 X 15 774-0116 Patent Pending Monitoring System 5.25 X 10 110-9530 12 X 18 110-5115 A breakthrough in biological monitoring 7.5 X 13 110-5122 ADDITIONAL SIZES AVAILABLE ... ﬁnal results in just 10 hours! Meet CDC biological EVERY DAY. monitoring guide- 2+1 lines for steam ™ FREE! sterilizers in less SteamPlus Class 5 Integrators SHIPPED WITH ORDER than half the time. Use with your steam sterilization cycles Mail-in service also to receive a distinct pass/fail result available. - allowing you to release non-implant loads before receiving spore test results. PROCESSED 774-0124 | ConFirm 10 Biological Indicators 25/box 100/pack 613-4050 UNPROCESSED 991-0035 | ConFirm 10 Incubator (special order item)*

*To take advantage of the ConFirm 10 Promotional Package, order Henry Schein Item 774-0124 For the best in sterility assurance include a Class 5 Integrator at least once daily. (2 boxes of biological indicators). Free incubator shipped directly from Crosstex with proof of purchase (Henry Schein invoice). E-mail invoice to: [email protected]

Buyer’s price may constitute a ‘discount or other reduction in price’ under 42 U.S.C. § 1320a-7b(b) and 42 C.F.R. 1001.952(h). Buyer is solely responsible for (i) accurately reporting all discounts and price reductions claimed or charged to any Federal or State health care program, and (ii) determining whether to report or pass on savings or discounts to payors.

Products manufactured by or for Crosstex.

(777-0154)

15 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:04 AM Page 16

Guidelines & Recommendations Chex-All® Instant The manufacturer’s written instructions Sealing Pouches should be used to determine how Self-sealing, see-through pouch provides to replicate the validated cleaning a hermetic seal. Sterilization indicators and processing methods. The are on inside and outside of pouch. manufacturer’s written instructions 3" x 8" should identify requirements related to (141-7290)...... 250/box 1 • Utilities (e.g., type of water, 3 /2" x 24" compressed air) (141-1372)...... 500/case 5" x 10" 8" x 16" • Cleaning equipment (141-9031)...... 250/box (141-3608)...... 125/box accessories (e.g., adaptors) for 5" x 15" 9" x 16" creating a proper connection (141-3809)...... 250/box (600-7348) ...... 500/case between the instruments and 7" x 12" 12" x 18" equipment, utilities, and cleaning (141-2723)...... 250/box (141-3347)...... 125/box equipment • Accessories for cleaning lumens, ports, and internal parts • Cleaning agents • Lubricants Duo-Check™ Sterilization Pouches • Processing methods Self-sealing sterilization pouches with color- changing dual indicators. Easy-to-read, blue-tinted, medical grade paper. Offers Instruments should be triple seals, chevron safety seal at base of decontaminated in an area pouch for added protection, and a thumb notch for easy opening. For use in steam separated from locations where and EtO sterilization. Made in the USA. clean activities are performed. 1 Latex-free. 3 /2" x 9" Cleaning soiled instruments in a scrub Sterilization Pouches (774-0101) ...... 200/box sink can contaminate the sink and 1 2 /4" x 4" 1 5 /4" x 10" faucet, which also may be used for (774-0098) ...... 200/box clean activities (e.g., hand washing, (774-0104)...... 200/box 3 2 /4" x 9" 1 surgical hand antisepsis). The 7 /2" x 13" decontamination area should be (774-0099) ...... 200/box (774-0102)...... 200/box physically separate from clean areas 1 1 3 /4" x 5 /4" 12" x 18" and include a door. This area should (774-0100)...... 200/box contain, but not be limited to the (774-0103) ...... 100/box following equipment: • Sinks to manually clean instruments • Hand washing facilities • Eye wash station • Automated equipment consistent

with the types of instruments to be 3 2 /4" x 10" decontaminated (312-0686) ...... 200/box • Adaptors and accessories to 1 connect instruments with cleaning 3 /2" x 10" (312-1228) ...... 200/box equipment and utilities 1 1 • Compressed air supply 5 /4" x 7 /2" (312-9506) ...... 200/box Assure Plus® Pouch 1 The design of the decontamination Self-sealing sterilization pouch with unique 5 /2" x 11" area facilitates the appropriate peel-off internal indicator. Class IV indicator (312-1817)...... 200/box decontamination of instruments. meets CDC recommendations and ensures Having equipment and utilities in place that the pouch's contents have undergone 7" x 13" facilitates desired infection control the sterilization process. Quality, medical- (312-2815) ...... 200/box practices. grade paper allows steam and gas to penetrate. Lead-free inks and solid seals for 10" x 15" (312-3236) ...... 200/box SOURCE: AORN Recommended added strength and confidence. 1 1 Practices Committee 3 /4" x 6 /2" 11" x 16" (312-8361) ...... 200/box (312-0636)...... 100/box

16 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:04 AM Page 17

In the United States, there are more than 46 million surgical procedures, and 5 million gastrointestinal endoscopies performed every year. Unfortunately for many patients, procedures too often result in healthcare- associated infections. The reasons? Inadequate cleaning of instruments and devices, improper selection of a disinfecting agent, and failure to follow recommended cleaning and disinfection guidelines procedures.

Source: Metrex.com

The Help Center: Self-Seal Sterilization Pouches Packaging products are manufactured using heavy-gauge, medical-grade paper. Guide to Selecting and Using Balanced seal strengths facilitate ease of Metricide OPA Plus – YouTube Video opening while preventing “blowouts” during #SSP-390, 5" x 15" This video outlines protocols when sterilization. Products are also approved for (218-6862) ...... 200/box EO gas and chemical vapor processes. using MetriCide OPA Plus solution, so 1 that you can protect your patients, your Each pouch features a perforated adhesive #SSP-382 , 5 /4" x 10" seal to minimize errors associated with (120-6578) ...... 200/box staff, and yourself. sealing, a thumb notch for ease of opening, 1 http://www.youtube.com/watch?v= #SSP-383-1, 7 /2" x 13" clear poly film for ease of viewing contents, 71uu9Uw9H6o and chemical indicators to show processing (120-8321)...... 100/box 1 has occurred. #SSP-383, 7 /2" x 13" Cleaning Instruments – Self-Seal Pouches (120-6392) ...... 200/box 1 1 Educational Articles #SSP-380-1, 3 /2" x 5 /4" #SSP-387, 8" x 16" (120-1889)...... 100/box (257-2327)...... 200/box View a listing on various topics of 1 1 instrument reprocessing and #SSP-380, 3 /2" x 5 /4" #SSP-388-1, 10" x 15" (960-1590)...... 10/case (120-0440)...... 100/box sterilization. 1 http://www.spsmedical.com/ #SSP-381-1, 3 /2" x 9" #SSP-389-1, 12" x 15" (120-9767)...... 100/box (120-0441)...... 100/box education/educationarticles.html 1 #SSP-381, 3 /2" x 9" #SSP-391-1, 12" x 18" (120-2039) ...... 200/box (120-0442)...... 100/box Guideline for the Use of High Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes (2011) http://www.sgna.org/Portals/0/ Roll Stock Tubing HLD.pdf Designed to be cut to any length prior to packaging and then Standard of Infection Control in mechanically sealed Reprocessing of Flexible or taped closed. All tubing Gastrointestinal Endoscopes (2012) is individually packaged in 100' rolls. http://www.sgna.org/Portals/0/ #RST-002, 2" Roll sgna_stand_of_infection_control_ (608-5573)...... ea 0712_FINAL.pdf #RST-003, 3" Roll (120-3191)...... 10 rl/ca Reprocessing of Single-Use Devices - U.S. Food & Drug Administration Chex-All® Tubes #RST-004, 4" Roll (120-5596) ...... ea (FDA) free e-mail subscription 100' Rolls service. Heat-sealable tubes are premium-quality, #RST-006, 6" Roll sterile packaging products designed to (608-5515) ...... ea http://www.fda.gov/MedicalDevices/ reduce the cost of sterilization processing #RST-008, 8" Roll DeviceRegulationandGuidance/ by including independent indicators (966-5352)...... ea ReprocessingofSingle-UseDevices/ imprinted on both the inside and outside of every tube. While external indicators serve as process indicators, the internal indicators Steam Sterilization Process Risk monitor the penetration of steam and Sani-Roll® Sterilization Assessment – Webinar CD ethylene-oxide gas on the inside of the Paper/Plastic Tubing A comprehensive guide to steam package. Not having to add separate 100' Rolls sterilization and sterility assurance in indicator strips in the pouches is a cost See-through, medical-grade tubing with health care facilities. saving. Made of premium-quality, high- easy-to-read color-changing indicators for http://www.aami.org/meetings/ resistance, 2.5-mil plastic and triple- use in steam, chemical vapor, or EtO bonded, 75-g medical-grade papers, which sterilization. Extra-thick, medical-grade webinars/webinar.cds/030311. guarantees the integrity of the packaging in paper with triple seals for added protection. steamsterilization.html prevacuum and gravity sterilizations cycles, Blue-tinted plastic aids in the detection of even with heavy instruments. puncture holes. Made in the US. Latex-free. Surgical Instrument Reprocessing 2" 2", 5 cm Guidelines – FREE Poster (141-2630) ...... ea (107-1782)...... ea http://www.surgicalinstruments.com/ 3" 3", 8 cm instrument-reprocessing-guidelines- (141-3312) ...... ea (107-0694) ...... ea poster-1003-299.html 4" 4", 10 cm (141-3627) ...... ea (107-6496) ...... ea 6" 6", 15 cm (141-4058) ...... ea (107-4915)...... ea 17 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:04 AM Page 18

Ultrasonic cleaning is usually one in a multi-step process that begins with manual cleaning to remove gross debris. This step is performed immediately after the instrument's use to prevent patient soil from drying. Once manually cleaned, the instrument is then placed in the ultrasonic cleaner. This cleaning step is particularly important for removing ﬁne debris that may not have been removed during manual cleaning.

Source: Infection Control Today

DRy HEAT STERILIZERS MAXITABS® “Heat and hold” • Provide safe and effective capability for continuous cleaning properties in use. Rapid heating multiple cleaning cycles for fast operation, M9 UltraClave® throughout the day automatic timer. Will not dull sharp & Sterilizer • Does not leave a residue instruments. All stainless steel. 60 minutes This reliable and efficient sterilizer features on instruments or inside tank sterilization set at 320°F or 160°C. a sleek look, quiet-door operation, and • 1 tablet makes 1 gallon of solution #200 Unit 1 1 pulse-air-removal technology. Front fill-and- • 1 box makes 32 gallons Dimensions: outside: 15 /2"W x 10 /2"H x 1 1 drain tube feature means you never have to General Purpose Cleaner 9 /2"D; inside (useful space): 12 /2"W x 5"H 1 move it to maintain or drain the water. Load (900-4088) ...... 32/box x 7 /2"D; no. of trays: 2; weight: 17 lb (100-5400)...... ea it, set it, and forget it. Tartar and Stain Remover • Press “Start” and M9 fills with correct (900-4089) ...... 32/box #300 Unit 1 amount of water Dimensions: outside: 19"W x 14 /2"H x 1 • When cycle is complete, door opens 11"D; inside (useful space): 15"W x 7 /2" H automatically and quietly for fast x 9"D; no. of trays: 3; weight: 27 lb drying time (100-7250)...... ea M9 Ultra Clave (386-7984)...... ea ULTRASONIC CLEANER WITH TOUCH PAD SUPER One-touch, press-set CONCENTRATED digital pad timer in beige, ULTRASONIC vinyl-clad housing. Solid-state circuitry. CLEANING Stainless steel drain with reversible right or SOLUTIONS left hookup. 43 kHz of cleaning power. Fast-acting solutions M250 Soniclean® Includes an FCC-approved EMI filter and a clean quickly and Ultrasonic Cleaner 60-minute timer with infinity hold. effectively. Nontoxic 3 3 • Tank dimensions: 9 /8" x 5 /8" x 4" and noncorrosive. In small, easy-to-store, #M150, Tank Capacity: 3 1 /8 1 /2 gal; Tank Size: 12" x 6" x 6"* • Tank capacity: 3 qt 16-oz bottles, which are less expensive to 1/ (102-5893) ...... ea • 2 2-year warranty ship, handle, and stock. Metered-dose dispenser top ensures exact dose. To use: 1/ 110-V Unit 1 #M250, Tank Capacity: 2 2 gal; Tank Size: loosen cap /2 turn, squeeze to 1-oz mark, 1 1 (104-4057) ...... ea 11 /2" x 9 /2" x 6"* and remove cap and pour into glass beaker. (386-0250)...... ea Accessory Package Available in 3 formulas. 1 (100-7900)...... ea #M550, Tank Capacity: 5 /2 gal; Tank Size: Metered Dose Bottles ...... ea 1 1 19 /2" x 11 /2" x 6"* Contains: 1 stainless steel solid-side basket, Specify: (102-5896) ...... ea 1 bur tray, 1 positioning cover, 2–600-mL General Purpose Cleaner beakers, 2 beaker covers & 2 beaker bands. (Makes 16 gal) Used for very fast Accessory Kit with Half Basket Basket Only, Solid Side, Perforated Bottom cleaning of blood, mucus, and (386-2836)...... ea (101-1667)...... ea tissue...... (101-4412) *Required safety basket sold separately. Tartar and Stain Remover Cover (Makes 96 oz) Its citric acid (900-4354)...... ea formula is noncorrosive and cleans quickly...... (101-0827) Enzymatic Cleaning Solution (Makes 16 gal) Effective against blood, tissue, and mucus found Ritter M11 UltraClave® Crosszyme on instruments...... (102-6472) Automatic Sterilizer Ultrasonic Solutions Like the Ritter M9, this Neutral pH formula will unit also contains an not damage or harm automatic opening door. Unique chamber instruments. Contains EZ-Zyme™ size gives it the most sterilizing capacity of no harsh alkaline components— All-Purpose any standard countertop sterilizer on the Enzyme Cleaners market. Featuring a modern look, quiet door noncorrosive. Safe for use on plastics, operation, and pulse air-removal technology, stainless steel, glass and aluminum. Easy-to-use, neutral pH, this sterilizer couldn't be easier, more Contains rust inhibitors. Enhances the multienzyme concentrate efficient, or more reliable. You load it, set it, dissolving of organic materials. Balanced for use as a surgical and dental and forget it. detergent system for effective cleaning and instrument/apparatus presoak and as an easy rinsing over a wide range of ultrasonic and evacuation system cleaner. • Door opens automatically 3 concentrations and temperatures. Each /4-oz packet makes 1 gal; 1-gal refill • UL listed and CSA/ASME certified Powerfully chelated to improve performance makes 170 gal. Economical shipping and • Chamber size: 11" x 18" in hard water conditions. May be used as an convenient storage. • Weight: 99 lb Ultrasonic Cleaning Solution or an 3 /4-oz Unit Dose (386-8917) ...... ea Instrument Presoak. Door and Dam Gasket Kit, M11 (953-2961) ...... 32/box Call (386-7195) ...... ea Gallon 1-gal Bottle Refill with Dispenser Pump (107-0064) ...... ea (953-8528)...... ea Call 18 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:04 AM Page 19

Henry Schein Brand EZ-Zyme™ Our Henry Schein Brand is a perfect match for health care facilities looking for products that are cost-effective with exceptional value. Our instrument reprocessing product line will help reduce costs and promote better outcomes… Every Day, Every Patient, Every Time!

SURGICAL MILK MAXIMA® DUAL-PURPOSE Super Concentrated NyLON MULTIPARAMETER SELF-SEAL STERILIZATION Rust inhibitor and lubricant STERILIZATION with bacteriostatic action for TUBING POUCHES WITH ® surgical instruments. Dilute 100' Rolls SURE-CHECK TECHNOLOGy 3 1 part milk to 5 parts water. 2 /4" x 9" 1 Continuous Clear, 6" Makes 5 /2 gal of dip bath. (101-2227)...... ea (900-4602) ...... 200/box 64-fl-oz Bottle 1 1 Continuous Clear, 2" 3 /2" x 5 /4" (102-5539)...... ea (101-2224)...... ea (900-4604) ...... 200/box 1 Continuous with Indicator, 6" 3 /2" x 9" SELF-SEAL (101-2223)...... ea (900-4601) ...... 200/box STERILIZATION 1 Continuous Clear, 3" 5 /4" x 10" POUCHES (101-2225)...... ea (900-4603) ...... 200/box WITH DUAL INDICATORS 1/ Continuous Clear, 4" 7 2" x 13" Superior quality pouch with dual indicators (101-2226)...... ea (900-4782) ...... 200/box that comply with the recommendations of Continuous with Indicator, 3" 12" x 18" the CDC for effective sterilization. Preprinted (101-1110)...... ea (900-4783) ...... 100/box internal and external indicators change color when processed with steam and EtO. Continuous with Indicator, 2" 3 (101-1111)...... ea 2 /4" x 9" (112-4856) ...... 200 per Box Continuous with Indicator, 4" 1/ (101-2222)...... ea GERMICIDE 3 2" x 9" TRAyS (112-4853) ...... 200 per Box Dimensions: 1 3 5 /4" x 10" 10" x 4" x 2 /4" Stainless Cover...... ea (112-4854) ...... 200 per Box 1 Specify: 7 /2" x 13" Beige...... (100-8193) (112-4858) ...... 200 per Box Blue...... 1 (100-7778) 10 /2" x 17" White ...... (100-8485) MAXITEST® (112-4862) ...... 100 per Box Mauve ...... (101-8195) Biological Sterilization 13" x 20" Monitoring Service: Plastic Cover (112-4865) ...... 100 per Box MaxiTest includes test Opaque Smoke...... ea sets, culturing service, laboratory reports, Specify: all postage and handling, and any device White ...... (100-2937) MAXIZyME® Beige...... concerning sterilization procedures; the lab (100-6126) Dual Enzymatic Detergent cultures are completed in 7 days; however, Blue...... (100-7564) • Contains 2 gold-standard if any test strip cultures positive (spore Mauve ...... (101-8196) growth indicating sterilization failure), the proteolytic enzymes for more office will be telephoned immediately; if the effective cleaning test strips do not culture positive, the office • Dissolves and releases blood will receive a laboratory report in MAXICIDE® NS SOLUTION and tissue: minimizes approximately 2 weeks, indicating handling and scrubbing of 2.6% Alkaline contaminated items sterilization was achieved. Glutaraldehyde Solution 1-gal Bottle 12-Test Package Reusable sterilizing and high- (101-9031)...... ea (101-5830)...... ea level disinfecting 14-day solution. Contains: 12 packets, each containing 2 test Broad-spectrum kill of pathogenic microorganisms. Specifically strips & 1 control strip. MAXICIDE® PLUS 48-Test Package designed for scopes and ultrasound transducers. 3.4% Glutaraldehyde Solution (101-1253)...... ea Contains no surfactants. with Activator Contains: 48 packets, each containing 2 test strips & 1 control strip. 1-gal Bottle • Sterilization in 10 hours Not for export. (102-2866) ...... ea • 28-day reuse life after activation • Clear color before activation;

® turns blue after activation MAXITEST VALUE TEST PACK • Activated solution contains Biological Monitoring System anticorrosion and Used to test steam, dry heat, chemical vapor, and EtO antioxidant ingredients processes. Mail-in service with results reported quarterly. • Rapid and effective broad- Immediate and confidential notification of test failures. Test spectrum kill results available electronically. Postage not included. • Pleasant pine scent (101-4715)...... ea 1-qt Bottle (102-5796) ...... ea Contains: 52 test packets, each containing 1 test strip & 1 control strip. 1-gal Refill Bottle Not for export. (102-2865) ...... ea 19 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:05 AM Page 20

Guidelines & Recommendations

Understanding Proper 3M™ Attest™ 1291 Rapid Readout Instrument Storage Biological Indicators The correct storage of processed Self-contained biological indicator for instruments is important to protect them 270°F/132°C gravity steam cycles from environmental contamination. The consisting of a Geobacillus major source of environmental stearothermophilus spore strip; sealed contamination is airborne bacteria and glass ampule with growth medium and dual viruses that settle on instruments and indicator system; blue color-coded cap with equipment. Critical instruments that must holes for sterilant penetration and a hydrophobic filter as a bacterial barrier; and be sterile at the time of use must be stored ® a chemical indicator on the label that bagged/wrapped until use. However, an MAXITEST IN-OFFICE BIOLOGICAL changes from rose to brown when efficient way to protect all sterilization MONITORING SySTEM processed. After sterilization, the vial is In-office system for monitoring steam "crushed" to join the growth media with the critical instruments from environmental sterilizers. Easy to use and interpret. contamination is to bag them prior to processed spore strip. The BI is incubated Results in 24–48 hours. ™ ™ sterilization and store them in the for 1 hour in the 3M Attest 290 series Starter Kit auto-reader for a fluorescent reading. A red unopened bag/wrap. Critical instruments/ (102-6076) ...... ea light indicates a positive result or items must be stored in a way that Contains: 1 of each: box of 25 indicators, sterilization failure. maintains the integrity of packs and incubator, crusher & record keeper. (777-3276)...... 50/box prevents contamination from any source. Indicator Refill Items required to remain sterile must not (102-5804)...... 25/box be stored in ultraviolet cabinets or disinfectants as these processes will compromise sterility. It is important that critical wrapped instruments are stored in a clean dry area and are subjected to 3M™ Comply™ (SteriGage™) Chemical minimal handling before use. Integrator 1243A An ANSI/AAMI/ISO 11140-1:2005 Class 5 During storage, packs can Integrating Indicator for use in determining be contaminated by: whether the sterilization process conditions • over-handling – this can happen through were met inside each pack. Can be used in ProSure™ Mailers excessive transferring from one place to all 250°F-275°F sterilization cycles. Kits for Steam or Dry-Heat Sterilization another or during rotation of instrument (777-9032)...... 500/pkg (436-4128)...... 12/box packs from over-stocking storage areas or from bundling packs together using (991-3994)...... 26/box rubber bands; (331-2136)...... 52/box • moisture – if the pack is placed on a wet bench top, splashed with water, other liquids or aerosols; or • penetration – if instruments break through the surface of the pack.

A package is considered to be ProSpore2™ nonsterile when it: Indicator with Crusher • is damaged or open; (833-9786) ...... 50/box • comes out of the steam sterilizer wet Biological Test Pack and Culture or is placed on a wet surface; or Service Program • is dropped or placed on a dirty surface. Allows clinics and medical offices to monitor a steam, dry heat, or ethylene oxide gas sterilizer's performance on a regular basis. Storage areas must be dedicated for that purpose only and be free of dust, insects, • Tests are reproducible and and vermin. For open shelving, all items therefore reliable must be stored above floor level by at least Comply® SteriGage™ Integrator • Test packs are ready to use • Preaddressed envelopes are provided for 250 mm, from ceiling fixtures by at least Designed to monitor exposure to steam or 400 mm, and protected from direct culture service EO conditions in a pack. Provides a visual • Provides permanent record of test results sunlight. This will facilitate environmental accept/reject readout to determine that the • Provides for detection of a faulty sterilizer cleaning and allow unrestricted airflow and sterilant has penetrated to the point of • 2-day incubation prevent heating and degradation of the placement in the pack and confirms that (141-3829)...... 10/box packaging material. sufficient exposure conditions occurred. (220-1989) 2 x .75...... 100/box Not for export. 20 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:05 AM Page 21

To ensure that instruments and supplies are sterile when used, monitoring of the sterilization process is essential and requires administrative monitoring. Work practices must be supervised. Written policies and procedures must be strictly followed by all personnel responsible and accountable for sterilizing and disinfecting items, and for handling sterile supplies. If sterility cannot be achieved or maintained, the system has failed.

Source: University of Rochester University Medical Center

The Help Center:

Administrative Monitoring Work practices must be supervised. Written policies and procedures must be strictly followed by all personnel 3M™ Attest™ responsible and accountable for sterilizing Biological Indicators and disinfecting items, and for handling For use in steam sterilization. Will monitor sterile supplies. If sterility cannot be and indicate the effectiveness of steam achieved or maintained, the system has sterilization conditions. SporView® Self-Contained failed. Policies and procedures pertain to: #1261 Biological Indicators 1. Decontaminating, terminally sterilizing, (777-9599)...... 100/box An in-office biological indicator (BI) system and cleaning all reusable items; #1262 certified for use with all steam sterilization (777-5692)...... 100/box cycles. This system gives clear, easy-to- disposing of disposable items. #1262P interpret results for monitoring the 2. Packaging and labeling of items. effectiveness of the sterilization process. 3. Loading and unloading the sterilizer. (777-4656)...... 25/box Final results are known after only 24 hours #1261P of incubation in any compatible dry-block 4. Operating the sterilizer. (777-2331)...... 25/box incubator operating at 55–60°C. For user's 5. Monitoring and maintaining records convenience, SPSmedical offers a calibrated 60°C dry-block incubator that of each cycle. comes with 15 wells and a lifetime warranty. 6. Adhering to safety precautions and #SCS-025, SporView® BI System preventive maintenance protocol. (120-2516)...... 25/box 7. Storing of sterile items. #SCS-100 SporView® BI System 8. Handling sterile items ready for use. ® (120-1432)...... 100/box PassPort Plus 9. Making sterile transfer to a sterile field. Mail-in System #SK-116, SporView® Starter Kit Mail-In spore-test system, (896-3663) ...... ea Helpful Tips for Instrument certified for use with steam, #NDB-037, 37°C Dry Block Incubator, Processing Areas chemical vapor, EtO, and 11 mm • Every designated health care dry-heat sterilizers. Simply (120-6065) ...... ea place the spore strip and integrator together professional should have a personal set inside an instrument tray or peel pouch. of heavy-duty utility gloves, disinfected Steam customers receive immediate “peace and evaluated for cracks and integrity of mind” with our integrator, and their biological results after just 24 hours daily. This will help with compliance incubation time in the SPS lab. Prepaid 3M™ Comply™ Bowie-Dick Test Pack and guard against sharps injuries. mailers, educational CD-ROM in every box, 1233LF • To prevent having to change gloves, reports with every test, and access to your Consists of a chemical indicator sheet keep a spare set of clean cotton results on-line. positioned inside porous materials and forceps or a set of tongs to open and (613-4434)...... 12/box sealed inside a disposable outer wrap. The take things out of drawers and (120-5685) ...... 52/box 3M™ Comply™ Bowie-Dick Internal Steam Indicator Sheets are large-sized test sheets cupboards. used for health-care facility prepared, • Keep sterilization pouches in an open, reusable towel Bowie-Dick test packs. easy-to-access location to eliminate (777-0288) ...... ea the risk of cross contamination from opening drawers and cupboards. • Having the sterilizer divide the room between clean and dirty (one side is the dirty side, one side is the clean ProTest Steam BI side) is a simple way to help everyone • 24-hour results, instead of 48 hours • Intended for steam sterilization 121°C understand the concept. gravity displacement and 121°C–135°C • An instrument-management system prevacuum cycles that includes procedure tubs and • Not to be stored frozen or refrigerated cassettes is the most efficient and ProTest Starter Kit organized way to manage instruments (437-0028) ...... ea and consumable products, and INDICATOR STRIPS Contains: 1–25-pack of ProTest Biological saves time. Indicator Ampoules & 1–100-pack ProPack For steam and chemical sterilizers. Indicator Integrator. ink changes from white to black, indicating • Procedure tubs and cassettes (780-3685)...... 25 tests/box sterilization process has been completed. limit exposure to pathogens and (335-0392) ...... 100 tests/box (102-6332)...... 250/box sharps injuries.

21 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:05 AM Page 22

22 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:05 AM Page 23

USe pRoMo CoDe DAV To ReCeIVe fRee gooDS offeR VaLID UnTIL 9/28/2013 ThT e Fastest and Buy 3 OPA LLongest Lasting OPA ono the Market Today! Gallon Bottles ThT e RAPICIDE OPA/28 Advantage BY THE NUMBERS Get 1 FREE* MINUUTTE AER disinfection 5 time at 255ºC MINUUTTE MANUAL disinfectioon ttime 10 at 20ºC mminiimum Up to 10-24 addittionaal AER 84 reuse cycles† DAY reusee periood, twice as long as 28 other OPA brands 2 MEDIVATORSS® AER

manuaal appplications 337-7961337-7961 3 337-7962337-7962

WORKS FASTER LASTS LONGER Take quicker action Use for up to 28 days against microorganisms It's important for healthcare providers to manage budgets carefully while still delivering high-quality patient care. Rapicide OPA/28 has High-level disinfects devices manually in just 10 minutes at room been tested to provide 84 reuse cycles† along with a reuse period of

OPALIT - Rev. 0 - 2/13 ©2013 Crosstex temperature (20ºC minimum), to achieve bactericidal, fungicidal up to 28 days – twice the reuse period of other OPA brands. and tuberculocidal kills. Studies indicate Rapicide OPA/28 † Minimum recommended concentration

MRSA • VRE • TB Hepatitis Viruses • HIV

OPA's faster manual disinfection allows you to reprocess one extra scope for every disinfection cycle!

To Order or Contact your Sales Consultant for more information: Description Quantity HSI Code Phone: 1(800) P-SCHEIN / 1(800) 772-4346 8am-9pm (EST) Rapicide® 1-Gallon Bottle 337-7961 Fax: 1(800)329-9109 24 hours or OPA 28 Day HLD Visit: http://www.henryschein.com/opa28 Also Available: Please Mention Promotion Code DAV to Ensure Free Good; Rapicide® OPA 50 strips/bottle 337-7962 All o!ers expire: 09/28/2013 Test Strips

23 www.henryschein.com/infectioncontrol incontrol 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:05 AM Page 24

Call: 1-800-P-SCHEIN (1-800-772-4346) 8am–9pm (et) Fax: 1-800-329-9109 24 Hours

www.henryschein.com/infectioncontrol

Due to manufacturer price increases, prices are subject to change without notification. Offer valid on our full array of products. Upon any request by Medicare, Medicaid, Tricare or other payer, you must report the value of any benefit received from a discount program (e.g., points redemptions, gifts or other special awards). ©2013 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors. No adjustments from prior sales. Offer not to be combined with other promotions and/or special contract pricing. Void where prohibited. Local regulatory requirements may apply to use or installation of certain products. It is your responsibility to understand and comply with any such requirements prior to purchase, use or installation of products. †For informational purposes only. Source: ReimbursementCodes.com and/or www.cms.gov. Customer is responsible for verification of billing/coding in accordance with applicable specific circumstances.

13MS8747

The Perfect Handoff.

Together, a winning combination of cleaning and high-level disinfection. Start your cleaning process off with EmPower® dual enzymatic detergent then hand off the instrument to MetriCide® OPA Plus high-level disinfectant. This powerful combination has been engineered to work safely together to maximize instrument reprocessing performance. (640-8231) OPA Plus Solution Gallon (640-5822) EmPower Enzymatic Solution Gallon