CS QUESTIONS • CS ANSWERS
Sterilization times for wrapped vs. unwrapped items; cracking the sterilizer door revisited; face mask protocol
by Ray Taurasi
I have a question for you that I hope you can put to rest for us. When the manufacturer gives you the parameters for sterilization times and they do not specify whether they are for wrapped or unwrapped items, should you just assume that the times are for wrapped items? The OR was asking if I had any information on a particular item so that they could “fl ash” the item for immediate use. The information I had did not say “un- wrapped,” so I told them they could not fl ash it in the OR and that the item would have to go through the entire process. They were not too happy that they had to use something else for the surgery.
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requirements and sterilization parameters for wrapped or unwrapped items. Current guidelines for IUSS (Immediate Use Steam Sterilization, formerly “fl ash”) sterilization call for utilizing closed systems which basically are like wrapped packages. That said, when using a containment device or other enclosed system for IUSS/fl ash sterilization you want to be certain that the packaging device is validated for fl ash (IUSS); obtain and follow the manufacturer’s IFUs (which will include specifi c sterilization parameters). You will also want to be sure that all users of the sterilizer are trained on the appropriate use and that they understand the various cycles that may be run e.g. prevac and gravity. Most sterilizers in today’s operating rooms are prevac units that may also have gravity cycle options. Often I fi nd that OR staff have little knowl- edge about operation of the sterilizer other than that for one item they press button “1” and for another item or kit they press button “2”, etc. They may not realize that one button might be for a gravity cycle and the other for prevac. As a result, the wrong containment devices, biological indicator, etc. may be used. Some sterilization containers are universal, meaning they may be used in various cycles in gravity or prevac, while others may only be appropriate for prevac and specifi c steriliza- tion parameters.
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allow the contents to cool slightly prior to removing them into the cooler room environ-
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We have always cracked the door of the sterilizer after the cycle is completed to
It is always best to have detailed information including packaging
Questions can be e-mailed to:
jakridge@hpnonline.com Called in to Jeannie Akridge at HPN: (941) 927-9345 ext.202 Or mailed to:
HPN CS Questions 2477 Stickney Point Road, Suite 315B Sarasota, FL 34231
ment. My nurse manager recently attended a seminar and claims the speaker stated that there is no need to crack the door any longer, “that this step is not needed nor is it helpful.” She said that items should be removed from the sterilizer immediately following the cycle’s completion. I feel it was wrong for the speaker to make such a “general” statement. Shouldn’t each department be considered individually since equipment, staff and other conditions may vary? Have you heard of many hospitals doing this? If so, how is it working for them? I haven’t heard of this until now. Is it still correct to crack the door?
All three major steam sterilizer manu- facturers, Steris, Getinge, and Belimed, claim it is not necessary to crack the door after a cycle to allow for temperature stabilization. As a matter of physical science, they state, heat vapors move outward from the hottest point which would minimize the likelihood of outside contaminants from entering a steril- ized package while cooling. All agree that one should never leave items in a sterilizer to dry following the sterilization cycle. Any moisture, visible or not, following the sterilization cycle is unacceptable and is an indication of some malfunction or poor steam quality. Leaving items in the sterilizer to dry is merely masking a problem that should be corrected and dealt with. All newer sterilizers have self activating gaskets which actually advance outward pro- ducing a tight seal once the door is engaged. Older models relied on muscle power when cranking the door shut. Once the cycle is com- pleted the action gaskets actually disengage and retract prior to opening the door, which in essence is like cracking the door, and this does allow for some heat stabilization. One manufacturer and engineer I consulted said there would be no harm in cracking the door to allow for further stabilization of temperatures,
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other than unnecessarily tying up the sterilizer which could affect productivity. Does all this mean that we do not have to be concerned with the possibility of temperature changes contributing to the possible formation of condensate and the contamination of sterile packages? Absolutely not! Depending on the pack contents, packaging materials, metal mass and the like, hot items placed in or on extremely cooler surfaces, or in environments adjacent to air conditioning vents could create condensate. In the ideal situation, depending on variables such as — packaging methods; contents and materials used; adherence to technique; enforcement of policies and pro- cedures; proper sterilizer functioning; appro- priate environmental controls; and adequate secure space and equipment to segregate sterilized items while cooling — it is probably fi ne to remove sterile items from a sterilizer immediately following the cycle. In the real world and in many CS depart- ments this is not the case. The responsibility lies with each CSSD manager to assess their particular environment and situation and to then implement protocols that are most appropriate for their unique situation to en- sure sterility maintenance. Because there are many factors to consider about each facility’s unique sterilization environment and every sterilizer and situation may be different, it is advisable to contact your sterilizer manu- facturer directly for their advice on handling the removal of items from the sterilizer and whether or not to leave the door cracked.
Each day a CS tech is assigned to work in the sterile core of the OR to handle any intra operative requirements for instruments or other supplies and to manage case carts. We are required to wear a face mask but are not allowed to let the face mask hang from our neck when not covering our face. Why is this?
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Masks should not be worn hanging down from the neck because the fi lter portion of a surgical mask may harbor bacteria from your nose and mouth. The contaminated mask may become a source of cross-contamination to your attire, sterile items and the environ- ment. HPN
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Ray Taurasi is Eastern Regional Director of Clin- ical Sales and Services for Healthmark Industries.
www.hpnonline.com • HEALTHCARE PURCHASING NEWS • January 2013 41
CS SOLUTIONS
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