June 2007

Bulk unsterile items;
Cleaning sterilizers; Dry times

by Ray Taurasi

QI have a new director of surgical services who states that at his last facility he was told to get rid of all bulk unsterile items, (ace, cloth towels, cotton balls) that were sterilized by CS and buy these products sterile from the manufacturer. It was stated to him that this was a JCAHO violation. I cannot see in the AAMI guidelines that this practice has been changed in CS departments as long as you can validate your sterilization process with administrative, chemical and biological quality assurances. Do I remove all these items?

AThere is no JCAHO or AAMI guideline or recommendation that states ace bandages, towels and cotton balls can- not be sterilized by a hospital CS department. Likewise neither of these agencies suggests that such products should be purchased sterile from a manufacturer. It would be interesting to know the source and reasoning your surgical services director was told to stop sterilizing these items at his last facility. Considering the costs associated with the procurement of the bulk unsterilized products and the cost of labor and packaging materials it sometimes may be more economical to purchase these products sterile. From a scientific and technical perspective there is no reason such items could not be effectively processed and sterilized by a hospital sterile processing department. As with all items processed and sterilized by a hospital it is essential to obtain product information and sterilization instructions from the manufacturer and to follow their recommendations and instructions. As you noted hospital quality control and quality assurance policies must be enforced.

QOur sterilizers are old and the walls are coated with a dark soil. Recently we have instituted a weekly cleaning procedure but the soil continues to build up. I have tried many different chemicals and cleaning agents but the problem persists. Are there any specific chemicals that you could recommend that might be more effective in permanently removing the debris? Can the condition of the chamber walls affect the sterilizer’s performance?

AProper maintenance, care and cleaning of a sterilizer is imperative to ensure longevity and proper functioning. AAMI document ST79 2006 addresses the Routine Care of Sterilizers in section 9 - ST79 9.4 page 77. The AAMI guidelines state that sterilizers should be cleaned daily in accordance with manufacturer’s instructions. You should refer to your manufacturer’s user manual; it will contain specific instructions relative to the cleaning and maintenance of sterilizers including the frequency. If you do not have a manual you may obtain one from the sterilizer manufacturer. Older sterilizers are often more challenging to clean as the chamber walls are constructed from a thin nickel clad material coating over steel. Newer technology chamber walls are constructed of stainless steel which is easier to clean. Use of a non caustic cleaning agent is very important as the use of improper agents could be harmful and damaging to the sterilizer surfaces and walls. Manufacturers will provide you with information on the type of cleaning agents to use on their equipment. Clean chamber walls facilitate thorough and a more even transfer and distribution of heat within the chamber. Poor water and steam quality can also attribute to soil accumulation on chamber walls. If it is determined that you have inferior water and or steam quality you might consider installing a steam filtering system on your sterilizer. There are also service companies that specialize in cleaning and refurbishing sterilizer chamber walls. I would suggest that you consult your sterilizer manufacturer and have them assess and evaluate the condition of your sterilizer walls and the quality of your steam. The description of your situation suggests you may have steam quality issues, or excessive build up that might require professional attention and services. I am also concerned that you may have used some caustic or abrasive cleaning agents that might have affected the condition of the chamber walls. In addition to the daily cleaning of the surfaces and inner chamber walls it is important to clean the door gaskets and carefully check them for any cracks or cuts which could result in door leaks. The chamber drain strainer must be removed and cleaned at least daily and more often depending on the number of loads run and materials sterilized. Lint, paper, particulate or other debris which accumulates in the drain can adversely affect the sterilizer’s performance.

QOur manager recently changed the dry time on all our sterilizer loads to 30 minutes. He claims this ensures that all contents are completely dry. As a result we immediately remove the cart of sterilized goods from the sterilizer when the cycle is completes. The manager says since the contents are dry it is no longer necessary to crack the door and leave the contents in the sterilizer for 30 minutes before removing them from the sterilizer. Do you think this is an acceptable practice?

AIt is not a good idea to remove hot items from the sterilizer immediately after the cycle ends. Cracking the door and leaving the contents in the sterilizer for at least 15 minutes allows for some stabilization and balance of temperatures. Even if the contents are completely dry removing the hot items from the sterilizer into a radically cooler environment is likely to produce condensate which could become a source of contamination and or a conduit for microbial penetration. Certain porous packaging materials and package contents can greatly affect the probability of condensate contamination.

Ray Taurasi is Eastern Regional Director of Clinical Sales and Services for Healthmark Industries.