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Protocols

These are our proven recovery protocols designed to quickly adapt to the everyday operating room routine. While these are the procedures developed for the active pilot program in the Operating Room of Yale-New Haven Hospital (YNHH), they can (and should) be modified to adapt to the demands and resources of each healthcare facility. YNHH uses a "case cart" system, that is, a case-by-case preparation of materials.

Step 1 Recovery paper bags are stored in the surgical-supply room and are placed on "case carts" (optional) by the supply room staff, as these carts are "built" for the following day's surgical procedures.

Step 2 Following a procedure, or upon cancellation of a case, nurses are requested to place in these bags (or directly on the cart) those items, which were opened for a procedure but not used, or items which may have fallen to the floor (and are no longer considered sterile). "Sharps" (e.g. needles, scalpels), damaged, or grossly contaminated materials are not recovered. From this point, until decontamination is complete, the bags are treated as "contaminated."

Step 3 Bags are returned to the Decontamination Area, along with all other items from the operating rooms (e.g. surgical instruments), and are placed in large, dedicated bins.

Step 4 The volunteer staff (trained in Standard Precautions) empties these bags into baskets and visibly inspect for mistakenly recovered unusable, contaminated or "sharp" items. Until decontamination is complete, physical contact with the recovered material is kept to a minimum. The staff person must "over-dress" for this job (i.e., wear a cover gown, gloves, masks and booties, all of which needs to be shed before leaving the Decontamination Room). Items, which will not tolerate ethylene oxide sterilization, are removed (e.g. sutures and solutions). Many hospitals, based upon their in house protocols, choose not to place the items through a decontamination process. Yale New Haven Hospital stopped decontaminating recovered supplies in 2008.

Step 5 The staff places material ready for decontamination in a designated "hold" area proximal to the ethylene oxide apparatus.

Step 6 When surplus space is available on a planned ethylene oxide load, the decontamination personnel include the recovered items. (Items which are not gas sterilized are cleaned with alcohol bath as further detailed in the REMEDY policies and procedures for contaminated material handling).
Note: All hospital decontamination/sterile supply facilities are not alike. REMEDY has encountered facilities which do not easily lend themselves to the above procedures. Thus far, REMEDY has been able to adapt the procedures to fit all facilities. In every implementation, REMEDY has approached the problems with the primary goal of non-violation of the hospitals' sterile and Standard Precaution policies. In situations where the ethylene oxide capacity of the hospital is insufficient or non-existent, the protocols suggest concentrating the program on the highest cost and space efficient items, i.e. sutures.

Step 7 The decontaminated materials are sorted by volunteer staff and placed in Shipping Boxes.

Step 8 Boxes are then individually labeled (one type of item per box).

Step 9 Boxes are inventoried by item type and weight and are either:
  • Picked up by or shipped to a receiving charity, and noted in the shipping log, or
  • Stored for later donation to charity or volunteer medical trip.

 
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