Nama : Samsul Maarif

Tgl Lahir : Gresik 06 Mei 1972

Status : Menikah, 1 orang Istri, 2 anak
Alamat : Jl Sampurna 74 Malang
Email : samsulmaarifmlg@yahoo.com

Pekerjaan : Staf Perawat IBS RS Islam Aisyiyah Malang

Ketua Komite Keperawatan RS Islam Aisyiyah Malang
Dosen Tamu pada FIKES Universitas Muhammadiyah Malang
Dosen Tamu pada D IV Kep Periop POLTEKKES Kemenkes Malang

Organisasi : Ketua Cabang HIPKABI Malang Raya 2017-2022

Bid Diklat & Pengembangan SDM PD HIPKABI JATIM 2016-2021

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SAFETY CULTURE
IN SURGICAL INSTRUMENTS REPROCESSING
Samsul Maarif

Seminar The 1st Sterilization Update.

Malang, November 4th 2017
Central Sterilization Association of Indonesia

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Which is More Danger ???

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We must give priority to the patients safety
But should not ignore to the self Health & safety

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 The CSSD is laden with potential hazard for the Patient & Staff,
therefore it should be made as safe as possible
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Potential Hazard for The Patients & Staff
In Surgical Instruments Reprocessing

Biological Hazards
Chemical Hazards
Phisical Hazard

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Biological Hazard

All contaminated surgical instruments are potential sources of

transmission of infectious disease for the next patients and staff
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How the Patient can be Exposed
to Biological Agent from the Surgical Instruments ?

The use of Contaminated Surgical Instruments

Caused by Failure of surgical Instrument Reprocessing

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Failure of surgical Instrument Reprocessing

Incomplete of Instruments Reprocessing cycle

The use of Inadequate Cleaning Agent
The Use of Inappropriate Lubricants
Inappropriate packing materials or technique
Sterilization process failure
Inadequate of sterile instruments storage

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Incomplete of Instruments Reprocessing cycle

The First & Most Important Step in Instruments

Reprocessing Cycle is Cleaning
If not done immediately, instruments should be
submerged in a neutral PH detergent or
Enzymatic Solution

A dirty instrument cannot be

effectively sterilized, because the
soil shields bacteria and viruses
from the sterilizing agent.

As a result, bacteria and viruses

may very well survive the
sterilization process and can cross
infect the next patient.
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The Use of Inadequate Cleaning Agent

Neutral detergents with a pH of seven

that are low-foaming should be used
for cleaning instruments

Neutral pH detergents work well, low- XXXX

foaming detergents are more easily
removed during rinsing
XXX

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The Use of Inappropriate Lubricants

Lubricants should be compatible with the

method of sterilization

Water soluble lubricants allow steam

penetration during sterilization, oil based xxxx
product cannot be penetrated and
prevent the sterilant from contacting the
instruments surfaces

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Inappropriate packing materials or technique

Packaging for sterilization should be

suitable for the sterilization method used to
ensure that the packaging material can be
penetrated by the sterilization agent.

The packaging also provides protection

from microbacterial recontamination
during transport and storage.

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 Packaging Material
Sterilization Method Requirements
Steam autoclave Should allow steam to
penetrate
Dry heat Should not insulate items from
heat
Should not be destroyed by
temperature used
Unsaturated chemical vapor Vapors should be allowed to
precipitate on contents
Vapors should not react with
packaging material
Plastics should not contact
sides of sterilizer
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Acceptable Materials
Paper
Plastic
Cloth
Paper/plastic peel packages
Wrapped perforated cassettes
Paper bags
Aluminum foil
Polyfilm plastic tubing
Wrapped perforated cassettes
Wrapped perforated cassettes
Paper
Paper/plastic peel packages
Sterilization process failure

Malfunctioning Sterilizer
User Errors
Sterilizer Loading Errors

All Staff must be trained (at least) Basic Sterilization Training

Chemical indicators (CI) should be used in combination

with mechanical monitors and biological indicators as part
of the quality assurance sterilization program.

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Inadequate of sterile instruments storage

Store sterile surgical instruments on carts or

shelving that is at least 8 to 10 inches from the
floor, 18 inches from the ceiling, and 2 inches
from outside walls.
Humidity should not exceed 70% and the
temperature should not exceed 24C (75F).
Minimize overhandling and unnecessary
traffic in the sterile storage area. Steril Instruments Storage

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Biological Hazard Prevention for the Patients

All Instruments Reprocessing cycle should be done

Adequate Cleaning Agent must be used
If Lubricant is needed, it should be compatible with the
method of sterilization
Use appropriate packing material or technique
Care & maintenance of sterilizer
Use sterilization process monitoring tools (physical
monitor, Chemical Indicator, Biological Iindicator)
Saff Training, at least Basic Sterilization Training
Adequate of sterile instruments storage

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How the Staff can be Exposed to Biological Agents ?

Exposure to blood-borne
biological agents through
- Nedle stick
- Eye Splash
- Cut from Sharp Object

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Biological Agents Expossure

samsul maarif Hawassa City, Southern Ethiopia, 2014

Risk of Transmission

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When does Sharp Injury Occur ?

mm

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Prevention of Biological Hazard
Expossure for the Staff

Brush all surfaces of the instruments while

they are submerged in a water bath

Apropriate personal protective equipment

All proper work procedures are taken
Safety devices are provided
Immunization for all high risk caregiver

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If exposure to bloodborne pathogen occurs, the
following procedur must be follow

Dont panic, Stop activity immediately

Dont Squeeze around the needle stick or cut to
expel blood and contaminant
Claen the puncture site or flush the eye with cool
water
Report the incident and seek medical attention
promptly
Follow the particular protocol established for follow
up

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 Blood sample from the patient and injured
Staff are drawn.
Staff who have been contaminated by a high
risk patient (hepatitis B or HIV) should be
treated with appropriate drug and followed by
the employee health departement
Periodic blood sample are drawn over a
period of months to make sure results remain
clear

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Chemical Hazard

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Potential Chemical Hazard

Low level Disinfectant : Chlorine

High level Disinfectant : Glutaraldehyde,
Orthoptalaldehyde
Sterilizing Agent : Ethylene Oxide

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Occupational Safety & Health Administration

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Chlorine

People may be exposed through skin

contact, eye contact and also may be
exposed by breathing air that contains
chlorine.
Peoples risk for exposure depends on
how close they are to the place where
the chlorine was released, the amount of
chlorine released, and the length of time
of exposure.
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Glutaraldehyde

Some disadvantageous including strongly

skin, eye and respiratory irritant.
May cause occupational asthma

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Ethylene Oxide

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Control of Chemical hazard

Substitution with less harmful product

Properly designed and maintained ventilation system
Purchase product in ready to use to minimize handling
Staff education for safe work procedure
Accommodation for workers who are
sensitized or may have health issues

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 personal protective equipment based on the
Air Purifying Respirator
risk assasment
use respiratory protective equipment (RPE)
when a hazard assessment indicates that a
worker may be exposed to airborne harmfull
substance
Emergency respon procedure for exposure

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Physical Hazard

Fire & Explossion

Ergonomic hazards
Slip & Fall
Noise from equipment and machinery
Exposure to environmental heat
Burns from handling recently heatsterilized equipment
Electrical hazards arising from use of electrical cords and
appliances

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References
Government of Alberta, Handbook of Occupational Hazard and
control for Staff in Central Processing, Canada, 2011.
AST. Standarts of Practice for the Decontamination of Surgical
Instruments, Association of Surgical Technologists, 2009
AORN. Guidelines for perioperative practice, guideline for selection
and use of packaging systems for sterilization. Denver, CO: AORN,
2015.
Pfidler Enterprises. The Role of Detergents and Disinfectants in
Instrument Cleaning and Reprocessing, Colorado, 2014.
L.Rebecca. Guideline Implementation for Surgical Instrument
Cleaning. AORN Journal, 2015

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