CS Questions & CS Answers
Handling wrapped packages; lost instruments; chemical risks & pregnancy

with Ray Taurasi

Editor’s Note:
Questions can be emailed to:jakridge@hpnonline.com, called in to Jeannie Akridge at HPN, (941)927-9345 ext.202, or mailed to: HPN CS Questions, 7650 So. Tamiami, Ste.10, Sarasota, FL 34231. Names and hospital identification will be withheld upon request.

CS Question:
 Are the contents of a package considered un-sterile if the package is handled while it is still warm?

CS Answer:
 Handling wrapped packages that are still warm can possibly compromise the barrier properties of the sterile wrapper, and the potential for contamination is increased. Current standards and recommended practices found in AAMI and AORN documents advise that the thorough cooling of wrapped sterile packages is essential before handling or moving from the sterilizer cart. At the end of the sterilization drying cycle, the packages may still be warm and steam may be trapped inside. If the warm packages are handled with un-sterile hands or placed on cold surfaces where condensation may form, the sterile integrity of the package may be com-promised. After removing the sterilization cart from the sterilizer, cart containing warm sterile goods should be left in a cool, dry secure location for 1 – 2 hours to allow for complete cooling prior to further handling and distribution. Be certain the cart is not placed by or under any HVAC vents while cooling. Sealed sterilization containers which have solid bottoms and/or offset filter plate perforations (which create a torturous path) may be handled and transported while still warm if absolutely necessary.

CS Question:
 Lost instruments continue to be a major problem at our hospital. We utilize an outside hospital laundry service and the return of instruments from them is not very good since they currently do not identify soiled linen by facility. Their policy states that they will dispose of all "sharps" and will not be responsible for any lost or damaged instruments. Do you have any recommendations for metal detectors or metal scanning equipment to identify instruments and other devices erroneously included in soiled linen bags before they are sent down the chute or off to the laundry? I would also appreciate any other recommendations you may have to help minimize our losses?

CS Answer:
 Many large hospitals have reported that their costs for the replacement of lost and damaged surgical instruments ranges from $150,000 to an excess of $200,000 a year. Needless to say that is a sizeable amount of money to virtually throw away due to careless behaviors. Retrieving items from trash and laundry bags can substantially reduce this expense. Metal detectors can be useful tools to scan laundry and trash bags prior to disposal or sending to the laundry. There are many different styles and models of scanners available, from hand held devices to various types of pass through units. One particularly popular device is Mediscan. Losses are pre-vented by simply dropping bio-hazardous trash bags and surgi-cal suite laundry bags through Mediscan’s sensor. The screen-ing procedure is fast and easy; Mediscan alarms when surgical instruments or metal devices pass through it. For more information on Mediscan go to http://www.eMediscan.com. You can also do a web search for "metal detectors" and you will find an array of options and price ranges. Detectors of the caliber of Mediscan cost approximately $3,900.


Mediscan metal detector

Loss prevention is the responsibility of everyone who uses surgical instruments or who is involved in the reprocessing and distribution function. Individuals must be held accountable for their actions. I would suggest that you set up an interdisci-plinary taskforce consisting of members from the O.R. and CPD team to assess the seriousness of the loss you are exper-iencing and to share in the development of a plan to curtail this unnecessary expense. There are also many compu-terized instrument management and tracking systems available, which can assist in controlling instrument loss. The establishment and enforcement of policies and procedures such as surgical case breakdown, instrument counts, and the care and handling of surgical instruments can reduce losses and decrease the associ-ated costs. Continuous education, surveillance, tracking, reporting and open communications are also critical to preventing loss and misuse of valuable resources.

CS Question:
 I recently learned that I am pregnant; my job requires assignment rotations to all work stations and jobs in CPD including the scope processing room. We soak all our scopes in Cidex and I was wondering if there were any risks or special handling procedures during pregnancy?

CS Answer:
 Cidex is the ASP (Advanced Sterilization Products’s) brand name for the chemical glutaraldehyde. According to the material safety data sheet for Cidex solution, "toxicity studies have been conducted and demonstrated that at maternally non toxic doses glutaraldehyde does not produce fetotoxic, embryotoxic or teratogenic effects." So by following the appropriate work related procedures and safety pre-cautions that normally apply for the use of and working with Cidex (glutaraldehyde) you need not be concerned. There is no evidence of adverse affects on pregnant women or the unborn child. You should obtain a copy of the MSDS from your supervisor and discuss any concerns you may have with your personal physician.

CS Question:
 We have a new manager in our CS department who has changed our dress code and personal hygiene policy which now states we are not allowed to wear any type of nail treatments including polish, false nails, acrylic wraps, etc. We don’t have any direct contact with patients and I don’t understand her logic for instituting this change. I have worked in this department for over 10 years and have always had sculptured, polished and manicured nails and no one seemed to object. I am very meticulous about my appearance and personal hygiene.

CS Answer:
 CS technicians are preparing surgical instruments sets and handling sterile products all the time. There have been many studies conducted that have shown that long nails, false nails, wraps and other treatments can harbor bacteria and fungi. It is extremely important for infection control reasons that the sterile processing work area be as clean as possible. Bacteria or other microorganisms that might be found under nails could possibly be transferred on to instruments placed in sets increasing the bio burden, which could challenge and adversely affect the efficacy of the sterilization process. Nail polish can chip or flake off, false nails, acrylic wraps, etc. can also break and/or fall off ending up in an instrument set. I have actually witnessed such things found in sterilized sets opened in the O.R. The functions of sterile processing are very critical to patient care and we must do everything possible to ensure the quality of the sterilization process is in no way compromised. HPN

About the Author:
Ray Taurasi is Director of Professional Services for Case Medical Inc. Ridgefield, NJ. His healthcare career spans over three decades as an administrator, educator, technologist and consultant. He is a past president of IAHCSMM and has served on and contributed to many national committees with a myriad of professional organizations, manufacturers, corporations and prestigious healthcare networks. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration and health sciences. In addition to this column he has authored several articles and has been a featured speaker on the international scene.

May
2006