CS Solutions

PPE in decontam; seasoned O.R. nurse moves to CSP; when to run a biological test

with Ray Taurasi

Editor’s Note: 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, 7650 So. Tamiami, Ste.10, Sarasota, FL 34231. Names and hospital identification will be withheld upon request

CS Question:
Recently I had the opportunity to tour several different CPD departments with a manufac-turer’s represen-tative to view their equipment, steri-lizers and washers in use. I was very surprised to see the different level of control and lack of personal protective equipment (PPE) enforced by some of these hospitals. While touring the decontamination area of one hospital we were allowed to enter without wearing any PPE beyond a gown and hair covering. I observed staff working in this department not fully attired in protective gear e.g. water repellent gown, gloves, face shields, masks, boots, hair covering and the like. Some of the staff were fully garbed while others were wearing minimal PPE. Isn’t it an OSHA violation not to be wearing full PPE attire when in the decontamination area?

CS Answer: OSHA does indeed have very strict and enforceable regulations regarding worker protection from blood borne pathogens and other biohazards in the workplace. Many individuals and hospitals have misinterpreted these regulations or have chosen to require that anyone working in or entering the decontamination area be dressed in full PPE. This however is not necessary and is not what OSHA intended or mandated. OSHA regulations state that employees must be provided with and required to wear PPE, which is appropriate to the personal exposure risks associated with the task they are performing.

Hospital policies and procedures must clearly define and explain the appropriate use of PPE in relation to various work areas and activities. Employee orientation, training and continuing education must emphasize the workplace safety risks that are associated with biohazards and blood borne exposures. Employees must demonstrate knowledge and competence as it relates to OSHA regulations and the application of related hospital policies and procedures. CPD management should assess the various work functions in the decontamination area to determine the type and real potential for the risk of exposure related to each task and then develop a PPE dress code policy accordingly. There likely will be many functions in the decontamination area where it will not be necessary to wear full PPE e.g. hair covering, impervious gown / jump suits, gloves, masks, face shields, and boots. There are functions that present minimal or no exposure risks – in such cases an apron, hair covering, goggles, gloves and scrubs may suffice.

CS Question: I have worked in the O.R. as an R.N. for 20 years. About a year ago, I became the manager of the Central Sterile Processing department. I was amazed to find out how little I really knew about CSP. For the past year I have been like a sponge soaking up all the information I could find in print, through networking, and seminars. Currently I am enrolled in a CS course at a local college. Our hospital is expanding and the project will include a totally new CSP department. I have been given the responsibility to determine all the equipment and space needs for the new department in a relatively short time frame. To be honest, I am overwhelmed and have no resources to employ a consultant. Any suggestions?

CS Answer: Don’t fret – you are not the first seasoned O.R. professional who has felt a bit overwhelmed when they discover the many complexities and depth of technical expertise required to run a CSP department. Kudos to you for recognizing you have a need to acquire additional knowledge and skills and for actively doing something about it. Your vast clinical knowledge and O.R. expertise will serve you well. Surveys in the past have revealed that CS managers with a solid O.R. background are the most successful. What an exciting and great opportunity you have to be able to have an active role and voice in planning for a new CS department. There are many manufacturers that can assist you in this task with no consulting fees required. I suggest that you contact a few of the major sterilization manufacturers; you will find them very helpful in assisting you in determining your equipment and space needs. Most have a team of clinical consultants and technical experts, who can assess your production needs, case volume, and work activities to determine your space, equipment and even labor needs. They can also provide you with floor plans and design layouts. Most manufacturers will also provide you an opportunity to visit their manufacturing facilities to become more familiar and better informed with equipment options. You may also find it helpful to request visits to other facilities they have provided planning services to. This will provide you a first hand look at their equipment in use as well as provide an opportunity to network with other managers who have been through such a process.

CS Question: Our SPD serves three to four operating rooms. Because of our size, we run one large steam load a day. My question is, does it matter what time of day this load and the Biological is run? We run the Dart test in the A.M. Would it be acceptable to run the biological with our load in the afternoon? Or does the load and biological have to be run first thing in the A.M.?  

CS Answer: The Dart Test is used to ensure that dynamic air removal sterilizers (pre vacuum) are working adequately to remove residual air from the sterilizer chamber. Complete air removal from a sterilizer chamber is essential in order to allow for the direct and intimated contact of the steam sterilant to all surfaces of the sterilizer’s contents .The Dart test should be placed on the lowest shelf over the sterilizer drain in an otherwise empty sterilizer chamber. The sterilizer operating parameters for the Dart Test are 132 - 134° C (270 - 273° F) for a 3.5 – 4.0 minute cycle based on the temperature setting. The air removal tests are commonly run at the start of each day but it is not an absolute requirement to conduct this test at that time or at the same time each day. Biological indicators are a challenge test which utilizes live spores and are run through a sterilization cycle to ensure that the sterilization conditions, parameters and performance were adequate to destroy all forms of living organisms. Biological tests should be run in a full load at standard cycle parameters. The biological test pack should be placed in the most challenging spot in the sterilizer, which is generally the bottom front over the drain or in the center of the load. It is not essential to run your daily biological test at the same time each day. Since the air removal (Dart) and biological tests are for monitoring different functions and the parameters for their use is different they cannot be run together. By choice many hospitals do run these tests at set times each day in order to establish a routine and to assign the responsibility to a specific shift, individual or job assignment. It is imperative that you consult and incorporate the sterilizer; biological and air removal tests manufacturers’ instructions for use into your policies and procedures. HPN

About the Author:

Ray Taurasi is director of business development for Case Medical Inc., Ridgefield, NJ. His healthcare career spans more than 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.