Question.
Anyone out there see the new CAP requirement regarding cross contamination at gross bench and cleaning of forceps. How are other people planning to comply. My supervisor has instructed me to use a Germinator 500 at gross bench and at Embedding center. I have no experience using these sterilizers but my initial thought is that I will need to be really careful not to inadvertently apply too much heat to the tissue. Any thoughts appreciated
Answer 1.
The "Germinator 500" Sounds like something from Phineas and Ferb. Hahaha.
Anyway - The mandate from CAP is designed to clean the instruments, not sterilize them. If the instruments aren't cleaned before stuffing them into a 250 C trough of glass beads (the Germinator), you will just have burnt on fragments of other tissue stuck on forceps. The thought of what molten paraffin at the embedding unit would do to those glass beads is downright scary. I would certainly check with the manufacturer of both the unit, and the paraffin before attempting. Also, the Germinator manual states that instruments be allowed to cool for 30 seconds before reuse. Can you imagine how that might slow everything down. It just doesn't sound appropriate for what CAP is trying to accomplish.
Our policy calls for wiping of forceps with gauze between cases at gross and at embedding. At gross, we use a disposable absorbant lined pad on the cutting board for each larger case, and just a fresh c-fold paper towel between small biopsy cases. We do not allow double-dipping of swabs into ink, but instead, pour out small amounts into a large plastic weigh boat which is also discarded after the case. We use disposable safety scapels, with a 70 blade (love 'em) for each case. For excessively bloody/fatty cases, we put the dirty forceps into an enzyme pre-soak (Aseptizyme) to remove all tissue debris. Then they are scrubbed with a brush, then rinsed in a disinfectant before being re-used.
I sure hope this helps
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
Answer 2.
I've never seen a pathology service (and I've worked in 80 of them) do any of these things, all of them good ideas. I'm glad to see the CAP taking the issue up. Carry-overs from case to case are common, particularly when the grosser is overworked and working too fast. I've never seen a serious error made as a result of such contamination, but I've seen a few close calls.
Terri Braud, could you copy us the actual text in the CAP inspection form?
Bob Richmond
Samurai Pathologist
Maryville TN
Answer 3.
In response to the request to post the new phase II CAP requirement on cross contamination:
ANP.11680 Cross Contamination Phase II
There is a written procedure to prevent cross-contamination of specimens during grossing.
NOTE: At a minimum, cleaning (e.g. wiping or rinsing) of forceps and scalpel blades between cases is required. In addition, if a laboratory processes both small specimens (e.g. biopsies) and large specimens (e.g. surgical resections), cleaning of instruments and cutting surfaces must be performed between cases. Avoid re-using cotton swabs/applicator sticks on multiple specimens or "double-dipping" the cotton swab/applicator in the ink. Some laboratories may choose to use disposable surfaces (e.g. formalin absorbent pads, butcher paper, etc.) for large cases. Grossing of similar types of specimens sequentially should be avoided, if feasible.
REFERENCES
1) Lott R, et al. Practical Guide to Specimen Handling in Surgical Pathology. College of American Pathologists, November 2015.
2) Gephardt GN, Zarbo RJ. Extraneous tissue in surgical pathology: A College of American Pathologists study of 275 laboratories. Arch Pathol Lab Med. 1996;120:1009-14
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046