transportation isues

[SHIRLEEN VANOCKER]

We are in the process of designing a new SPD department. SPD will be on the floor below the O.R. We will have a cart lift to transport soiled items from the O.R. and then later, transport sterile items back. (we will never transport these at the same time) Soiled items will be transported via closed case carts; these carts will be manually cleaned between uses with a disinfectant wipe. These carts may or may not be used to transport sterile items back to the O.R. Our infection control department believes that the same cart lift should not be used to transport soiled and sterile (even separately) nor should the same closed carts be used to transport soiled and sterile items.
( even separately, and even if carts have been properly disinfected and cleaned.) Are there thoughts or suggestions on this? Does anyone know of any infection control standards that would be violated if we proceed in this direction? Are there ANY standards or guidelines that indicate that we should not do this? We have the AAMI guidelines and according to what we have, this practice should be acceptable with proper cleaning of lift(daily) and proper cleaning of closed carts between uses. thank you Shirleen V.

[Harvey Johnson]

In our department we have up to a few weeks ago used only clean and decontam dumb waiters for transport to/from OR.
Now we are transporting to a new ASC attached by a non public access sky bridge to the main hospital. We will be transporting in separate closed, covered containers and dust covers through public access areas.
So we will be using the same elevators for clean and decontam, not much difference from your situation.
I wanted to assure compliance, so checked with IC and other hospitals in the area who are transporting outside SP/OR to gather info on policy and procedures.
We have ordered dedicated decontam carts powder coated a bright red for easy identification from the case carts. As long as we keep the carts closed and separate from each other, our IC sees no problem.
Of course the case carts will be cleaned and disinfected before re entry into the clean area, as will all carts with each turn around at SP.

Hope this helps!

[SHIRLEEN VANOCKER]

Thank you for the information. It sounds like you are using separate "dirty" carts for soiled items. Am I reading this incorrectly? We will be using the same closed case cart to transport both soiled and clean, but not at the same time ( of course) what do you think? thanks

[Harvey Johnson]

Yes, the red carts will be used only for decontam.
Knowing the chances all carts may not be completely disinfecteded 100% of the time, two dedicated carts for decontam to us seemed worth the investment, when compared to the risk.

[djw]

We have always used the same carts. They go to the OR with a clean case set-up, the SAME cart comes back to us with the used, soiled items. The soiled items are in the cart, but in a biohazard bucket with soak and a lid. The cart goes through a cart wash each time it comes back, then is put back into "clean" for another case to be set up on it. I doubt anyone has room or funding for 2 carts for each surgery? Am I understanding your dilemma correctly? :confused:

[Harvey Johnson]

djw is correct,
purchasing two carts for each procedure would be somewhat cost prohibitive......we also use the same cart each case in our main OR's and transport to decontam on dedicated dumbwaiters.
For transporting to the remote ASC we plan to shuttle our 4 decontam carts (one for each room) empty to the ASC decontam and return to the main SPD filled with used instruments to process continuously during the day. Trash and linen will be handled at the ASC, so our situation may not be the same as Shirleen's.
Shirleen, you would think if AAMI addresses the elevator issue in a guideline, it would be sufficient to satisfy the Infection Control Department's concerns.

[SHIRLEEN VANOCKER]

Thank you for your input. I guess our problem with infection control is the fact that we will not have a cart washer and IC does not believe there will be consistency or completeness in cleaning these carts manually. My issue with IC's concerns is that the contaminated instruments will be contained in an impervious covered biohazard container, so there won't be a huge potential for gross contamination of the cart itself. I believe that with a policy addressing the cleaning of the carts and employee education, IC should not have these concerns. Am I dreaming?

[sonny1388]

I am trying to find something in AAMI that directly addresses this issue, so I may update what I find. However, my understanding is that there should always be one entrance (whether it is an elevator, door, or whatever) designated solely for decontam, and one designated for Sterile area. We do not allow street clothes or cardboard or anything pass through a sterile area, so it doesn't make much sense to me to allow a contaminated cart go through either. Sure it is contained, but wasn't the cart exposed to anything airborne coming out of the room? All of the cutting, sawing, aspirating, etc. that can aerosolize BBP would make me nervous.

[Harvey Johnson]

What if the new department design included a "neutral area" lobby for the elevator to arrive with separate entry doors on opposite sides leading to decontam and to clean?
Shirleen, I'm curious, how does your O.R. plan to address the issue of separate clean/dirty - arrival/departure upstairs?
The concept of a "neutral" area is basicly what we are practicing now that the department is required to transport to/from a remote ASC through public areas to CSPD and a receiving area, then through dedicated doors into either clean or decontam.
We don't have a cart washer either (on my capital equip wish list now for five years running!!!), just good 'ol disinfectant, long handled brush and a steam gun. We average about 35 cases per day, so your requirements might be different.

[barrhelv]

We set up a new SPD dept. with a clean only elevator and dirty only elevator. This way no chance of contamination. Better to be on the safe side. Also how would you stop the inevitable splatters from carts being pushed on with to full of fluid.

[sonny1388]

I think a neutral area would be an okay solution. While not optimal, it would sure be better than direct exposure. I assume, of course, that there is only sterile or dirty in the neutral area at one time? I would think that a daily disinfection of the room would also be necessary, but that is just my opinion.

[autoclave1]

Check with your engineer for local codes and standrds. JCAHO EOC may also say something about seperate dedicated elevators. You also need to expect the worst case scenario for external disasters (nuclear, biological, terroristic). Your state health dept. may also have some requirements on this issue. AIA may also have some specific requirements.

[cpdguy]

Please contact me off line.
I have samples policeis and a study to share with you on this topic.