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Evidence Guide: HLTSTE308B - Care for surgical instruments

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

HLTSTE308B - Care for surgical instruments

What evidence can you provide to prove your understanding of each of the following citeria?

Identify cleaning requirements of a range of surgical instruments

  1. Select cleaning process appropriate to each surgical instrument in line with relevant legislative requirements and following manufacturer's recommendations
  2. Take into account the composition and manufacturing process of surgical instruments
  3. Take into account the risk of galvanic corrosion, factors that cause pitting and corrosion and the effect of treatment for the various metal surfaces
  4. Identify surfaces requiring remedial processes
  5. Identify faulty medical devices and report in line with relevant requirements, policies and procedures
  6. Work with an understanding of the risk to clients and corrosion risk of debris retained on instruments with textured surfaces
  7. Identify items requiring insulation testing
Select cleaning process appropriate to each surgical instrument in line with relevant legislative requirements and following manufacturer's recommendations

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Take into account the composition and manufacturing process of surgical instruments

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Take into account the risk of galvanic corrosion, factors that cause pitting and corrosion and the effect of treatment for the various metal surfaces

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify surfaces requiring remedial processes

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify faulty medical devices and report in line with relevant requirements, policies and procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Work with an understanding of the risk to clients and corrosion risk of debris retained on instruments with textured surfaces

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify items requiring insulation testing

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Prepare for cleaning of a range of surgical instruments

  1. Prepare general surgical instruments for cleaning in line with current Australian/New Zealand Standards and associated guidelines
  2. Disassemble instruments for cleaning as required in line with manufacturer's and organisation guidelines and using correct dismantling techniques
  3. Select enzymatic detergents to soak instruments as required in line with manufacturer's instructions
  4. Follow safe work practices to conduct insulation testing as required
  5. Follow organisation guidelines, Australia/New Zealand Standards and manufacturer's instructions when receiving, disassembling and cleaning instruments on loan
  6. Identify and differentiate between re-usable and single use items such as diathermy loops in order to process only reusables
Prepare general surgical instruments for cleaning in line with current Australian/New Zealand Standards and associated guidelines

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Disassemble instruments for cleaning as required in line with manufacturer's and organisation guidelines and using correct dismantling techniques

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Select enzymatic detergents to soak instruments as required in line with manufacturer's instructions

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Follow safe work practices to conduct insulation testing as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Follow organisation guidelines, Australia/New Zealand Standards and manufacturer's instructions when receiving, disassembling and cleaning instruments on loan

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify and differentiate between re-usable and single use items such as diathermy loops in order to process only reusables

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Apply cleaning processes to a range of surgical instruments

  1. Address particular requirements of a range of general surgical instruments
  2. Soak instruments as required and rinse off gross debris in line with manufacturer's instructions for effective and safe use of enzymatic detergents
  3. Brush instruments with textured surfaces in the direction against the design to remove the debris effectively and in line with safety requirements
  4. Address requirements of instruments with tightly coiled structures such as flexible reamers
  5. Flush instruments with tightly coiled structures with high pressured water and brush the cannulations, attaching to the ultrasonic's flushing mechanism ensuring that flexion opens the coil as much as possible
  6. Check for retained debris by safely flushing with high pressure water and high pressure air
  7. Safely process fine, delicate items, brushing gently with a suitable brush to remove adherent soil
  8. Follow guidelines for safe and correct processing of instruments with specific processing requirements
Address particular requirements of a range of general surgical instruments

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Soak instruments as required and rinse off gross debris in line with manufacturer's instructions for effective and safe use of enzymatic detergents

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Brush instruments with textured surfaces in the direction against the design to remove the debris effectively and in line with safety requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Address requirements of instruments with tightly coiled structures such as flexible reamers

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Flush instruments with tightly coiled structures with high pressured water and brush the cannulations, attaching to the ultrasonic's flushing mechanism ensuring that flexion opens the coil as much as possible

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check for retained debris by safely flushing with high pressure water and high pressure air

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Safely process fine, delicate items, brushing gently with a suitable brush to remove adherent soil

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Follow guidelines for safe and correct processing of instruments with specific processing requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check quality of cleaning of surgical instruments

  1. Inspect instruments during and after processing in line with identified requirements
  2. Inspect instruments with textured surfaces for retained debris under lighted magnification
  3. Inspect instruments for completeness and working function
  4. Identify faults in the cleaning process and address in line with scope of own work role
Inspect instruments during and after processing in line with identified requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Inspect instruments with textured surfaces for retained debris under lighted magnification

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Inspect instruments for completeness and working function

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify faults in the cleaning process and address in line with scope of own work role

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this competency unit:

The individual being assessed must provide evidence of specified essential knowledge as well as skills

Where, for reasons of safety, space, or access to equipment and resources, assessment takes place away from the workplace, the assessment environment should represent workplace conditions as closely as possible

Consistency of performance should be demonstrated over the required range of situations relevant to the workplace

Context of and specific resources for assessment:

Assessment should replicate workplace conditions as far as possible

Simulations may be used to represent workplace conditions as closely as possible

Resources essential for assessment include access to:

relevant workplace or appropriately simulated environment where assessment can take place

Australian Standards, government and organisation policies and procedures

Access and equity considerations:

All workers in the health industry should be aware of access and equity issues in relation to their own area of work

All workers should develop their ability to work in a culturally diverse environment

In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people

Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities

Required Skills and Knowledge

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge:

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

Composition and manufacturing process of surgical instruments and how these impact on the correct use and selection of cleaning process eg various grades of stainless steel and properties of martensitic steel

Detergency action and standard precautions procedures

Enterprise code of practice

General categories of instruments and associated cleaning requirements

Impact on client care of defective insulation being used on surgical equipment

Relevant legislation for selection and reprocessing of reusable medical devices

Reporting requirements and mechanisms for faulty medical devices

Standards, including AS/NZS 4187, AS/NZS 4815, Therapeutic Goods Amendment (Medical Devices) Bill 2002 and the Therapeutic Goods (Medical Devices) Regulations 2002 Relevant state/territory guidelines for sterilising services, NCCTG (2004) Reducing Public Health Risks Associated With Reusable Medical Devices

The importance of cleaning and inspection as a contribution to client safety

Essential skills:

It is critical that the candidate demonstrate the ability to:

Accurately complete all documentation

Address relevant OHS, infection control and risk management requirements

Comply with relevant Australian /New Zealand standards and associated guidelines

Demonstrate consistency of performance over a number of trials

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

Apply cleaning processes

Apply problem solving skills - to use available resources

Follow manufacturer's recommendations, the Therapeutic Goods Amendment (Medical Devices) Bill 2002 and the Therapeutic Goods (Medical Devices) Regulations 2002 for care of surgical instruments

Follow manufacturer's, professional and organisation policies and procedures

Identify general and specialist surgical instruments

Identify items requiring insulation testing

Select and use personal protection equipment

Take into account opportunities to address waste minimisation, environmental responsibility and sustainable practice issues, including appropriate practices to ensure efficient use of resources

Use literacy, numeracy and oral communication skills required to fulfil the position in a safe manner as specified by the health care facility

Range Statement

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Surgical and medical instrumentation and equipment may include:

General instruments

Flexible and rigid endoscopic equipment

Insulated instruments

Laparoscopic instruments

Microscopic instruments

Power tools

Fibre optic equipment

Cleaning may involve:

Disassembly

Solutions including:

soaking

enzymatic

lubrication

stainless steel stain remover

Brushing of lumen/cannulated items

Non-immersible items

Complex specialised instrumentation

Leak testing of flexible endoscope

Mechanical lubrication

Disassembling instruments for cleaning may include:

Opening ratcheted instruments for processing

Opening taps and valves

Disassembling and reassembling multipart instruments and stilettes to check for correct fit and function

Using correct dismantling technique for a variety of endoscopic instruments

Particular requirements for general surgical instruments may include:

Check scissors for correct set, sharpness and barbs

Correctly clean, inspect and check box-jointed forceps for stiffness or wear

Identify and correctly clean and inspect instruments with long shafts for example cup biopsy forceps, punches and rongeurs, checking the shaft for debris

Identify processes required for removal of dyes/ adhesives

Soak instruments used for Bonny's Blue to remove the dye

Identify and process blind-ended instruments such as spackmann's cannula by processes that may include soaking and flushing safely with high pressure water

Identify cannulated drills and process to remove impacted bone and other debris, inspecting for cleanliness prior to packaging

Identify very fine suckers and process to remove wax blood and other organic debris using a variety of stillettes and brushes that touch the sides of the cannulation

Identify difficult designs, follow manufacturer's instructions, dismantle for cleaning by brushing and flushing, and reassemble to check function for instruments such as Filshie clip applicators and Tonsil snares

Instruments with textured surfaces may include:

Acetabula graters

Reamers

ENT files

Requirements of instruments with tightly coiled structures include:

Soak appropriate enzymatic detergents

Rinse off gross debris

Follow the manufacturer's instructions for effective and safe use of enzymatic detergents

Importance of soaking as soon as possible as part of pre-cleaning in the operating theatre

Value of keeping the instrument moist prior to dispatch for cleaning

Selection and use of enzymatic detergents includes:

To soak instruments with soil impacted in textured surfaces

To soak instruments with tightly coiled structures

Follow manufacturer's instructions for effective and safe use

Instruments with specific processing requirements include:

Flexible illuminated instruments, for example:

cystoscopes

choledochoscope

brochoscope with channels

Power tools

Screw and implant caddies

Items requiring manual cleaning

Safe and correct processing of flexible endoscopes may include:

Wipe and suction with a solution immediately after the procedure, following the manufacturer's instructions

Follow instructions for leak testing, and soaking in enzymatic detergent solution

Follow instructions for disassembling, brushing, wiping and checking for cleanliness

Follow instructions for drying (eg. using alcohol to flush channels or dry under low pressure forced air)

Safe and correct processing of power tools may include:

Follow manufacturer's instructions to prevent water entering the motor

Identify and brush cannulation in power-tools

Remove debris between movable, close-fitting parts

Safe and correct processing of screw and implant caddies may include:

Identify instruments likely to contain organic soil, such as drill bits

Follow manufacturer's and organisation instructions to:

soak in mild detergent solution

rinse with flushing water

assist drying with low-pressure forced air
(eg. leave lid on to prevent dislodging fine items)

Safe practices for manual cleaning include:

Safe and effective brushing:

selecting a suitable brush

reducing the creation of aerosols

removing debris off brush before retracting it up into a cannula.

Follow standards such as AS/NZS 4187 for safe and effective methods of manual cleaning.

Select agents and equipment for manual cleaning following AS/NZS 4187

Safe work practices to conduct insulation testing includes:

Follow safety requirements when operating insulation porosity testers

Follow appliance manufacturer instructions in applying devices such as the brush to identify defects

Follow organisation processes for the removal and replacement of defective items

Instruments on loan may include:

Complex instruments with instructions from a loan set company

Borrowed instruments from other hospitals