CS QUESTIONS • CS ANSWERS
Absorbing moisture in orthopedic trays, mysterious washer test results
by Ray Taurasi
I am the sterile processing clinical resource nurse and quality control manager in an orthopedic specialty hospital. We run 10 operating rooms (ORs) with a very high, daily case load. The demand for timely turnaround on many of our specialty sets is great. As you know, orthopedic trays are
Q
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large and consist of large metal mass, which makes moisture and tear management a major challenge that we confront on a daily basis. We have been utilizing a combination of various foam and silicone products to reduce our sterile packaging tear ratio and while we’ve had some good results in this regard, we’re encountering a rise in moisture problems. I have increased the use of OR towels to help facilitate wicking of the moisture with some success but the combined cost of all foam products and towels has adversely affected the SPD budget. The OR is also opposed to the use of towels as tray liners as they feel the towels can shed lint and fi bers as well as leach deter- gent residuals onto the instruments. Can you suggest any alternatives to the use of foam, silicone or OR towels?
The OR’s objective and concern regard- ing the use of OR towels as packaging accessories is a legitimate one and, for the reasons noted, should not be used as tray liners or packaging aids. Silicone and foam products used as tray liners, corners, or other packaging aids can affectively protect instru- ments and reduce tearing; however such materials have no moisture absorption or wicking capabilities and thus are more prone to moisture retention. Further, due to a lower thermal capacity, they may also contribute to the creation of condensate. A more economical and effective alternative you might want to consider is the use of medical grade cellulose (paper) products, as pictured in Figures 1 through 3 at right.
A
We have been following AAMI guide- lines, which recommend weekly, prefer- ably daily, monitoring of automated washers. We fi rmly believe that daily monitoring of all washers is critical and is the best practice. Thus, we test all six of our washers daily. For the fi rst several weeks that we implemented the daily monitoring of all our automated washers, all of the test results were A+, indi- cating that the washers were performing as they should. Over the past couple of weeks, I have been getting puzzling and confl icting re- sults. One day all of the washers will pass then one will fail for no apparent reason the next day and then the next day after that the same washer passes the test but another one will fail. I started conducting additional testing on all of the washers and kept getting confl icting
Q Figure 1: Tray liners are used to protect instruments,
provide wicking and prevent instruments from protruding through mesh baskets.
I am a strong advocate and supporter of the AAMI and AORN recommendations relative to cleaning verifi cation and moni- toring the performance of your automated washers. I do strongly recommend that you continue your testing and monitoring of all automated washers. A failed cleaning verifi cation test is a serious matter indicating that your equipment and cleaning process is not at optimum performance and, as a result, your instruments may not be effectively cleaned. A faulty washer rack used between the various washers often causes confl icting results, such as those that you have described. You must recognize that a washer rack is actually, in and of itself, a piece of processing equipment and must function properly. Washer racks must be carefully inspected before use for problems or defects which could affect their proper performance, some things you should observe and check include: • Ensure that spray arms are free of debris and occlusions.
A
• Be certain that spray arms are all present, in good condition, and spin freely.
• The rack condition must be free of any damage, bends, etc.
• Make sure rack and spray arm bushing are present and free of crack or breaks.
• Confi rm that all rack wheels are present, sitting properly on the washer track and functioning.
Figure 2: An under guard liner placed under an
instrument tray or loaner case is used to absorb and wick moisture and provide padding to reduce tearing.
• Check to see that the rack properly aligns to the coupler and water source feed. When you have multiple washers sharing or using racks interchangeably, I would suggest that you identify and label each rack so that when you conduct your clean- ing verifi cation testing, you can include the rack identifi cation on the record sheet. Now, when attempting to determine the cause, you have the ability to identify whether or not the confl icting results might be a defective rack circulating between washer s. HPN
Figure 3: Protective corners used on instrument trays,
baskets or cases will prevent tears and punctures while the cellulose material delivers excellent wicking action.
50 September 2015 • HEALTHCARE PURCHASING NEWS •
www.hpnonline.com
Ray Taurasi is Eastern Regional Director of Clini- cal Sales and Services for Healthmark Industries. His healthcare career spans over three decades as an Administrator, Educator, Technologist and Consultant.
results amongst them. On consecutive testing days, a washer may pass one test but then fail the very next test. It may sound crazy, but it’s like the machines are taking turns failing. All of my printouts look fi ne, the instruments look clean, and the maintenance team claims the washers seem to be functioning fi ne. I am
really baffl ed and at wit’s end here. What are your thoughts on this? Should I continue testing?
CS SOLUTIONS
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