November 2007

Q I find it very frustrating that groups like AAMI and AORN come out with all these regulations without getting the people involved who will be required to implement the protocols. I think many of their regulations are not warranted and result in excessive, labor, cost and waste of resources.

A Both AAMI and AORN are professional membership associations – healthcare professionals, manufacturers, consultants and others interested parties may become participating members. These associations do publish recommended practices and guidelines – since neither of these associations are governmental entities their published documents are not regulatory and users are not obligated by law to implement all recommendations or guidelines. That said it should be noted that the published works of both of these associations are based on sound clinical and technical rationale and have gone through a stringent review process prior to publication.

Q In the last issue there was a question regarding the requirements for ventilation where disinfectants are being used. I was wondering what the specific recommendations are for the disposal of Cidex after use and ventilation requirements in the room where it is used.

A CIDEX Activated Dialdehyde Solution can be discarded down hospital and office drains in accordance with local regulations. Immediately dispose of any glutaraldehyde-soiled rags or towels by rinsing with water and discarding in a closed plastic bag. It is recommended that you check with your state and municipal agency to ascertain that they do not have any additional or more stringent requirements.

Q We are having a debate between OR, CPD and Infection Control, which perhaps you could clarify for us. I was always taught that disinfection was a prerequisite to the sterilization process and that all items to be sterilized had to first go through disinfection. Our CPD director claims that disinfection is not a requirement.

A Items do not have to be disinfected prior to sterilization. The prerequisite to sterilization is thorough decontamination / cleaning to reduce the bio burden and microbial load. Items that go through an automated washer are generally disinfected by thermal process but the disinfection is to render the items safe for further handling during preparation and packaging. The thermal disinfection process done via the automated process is relatively quick and does provide an added margin to worker safety but it is not an absolute required prerequisite to sterilization. Remember, unlike sterilization, there are various levels of disinfection. The cleaning processes in of itself can achieve some level of disinfection depending on water temperatures and agents utilized.

Q Is it recommended to crack the sterilizer door when muslin wrap is used? Also what about when sterilizing batteries for power equipment? We have found that our batteries have been ruined because we were not cracking the door following sterilization.

A The topic of cracking the sterilizer door post sterilization allowing the load temperature to balance prior to removal has been addressed and discussed in recent issues of Healthcare Purchasing News. You can access previous issues and articles on HPN’s website www.hpnonline.com. There was an interesting article in the May’07 issue entitled "Cracking the Steam Sterilizer Door: Dispelling the Myth", and the "CS Solutions" column in the June ’07 and August ’07 issues also addressed the topic.

However I am not clear on exactly what your issue is but based on the concerns you noted I will assume that you might be leaving sterilized items in the chamber for a prolonged period of time following the completion of the cycle. If items are left in a hot chamber for extended periods the heat could lead to product degradation, damage and even burn and char linens and non woven wraps. Regarding the damage to your batteries you need to get the instruction for care and sterilization from the manufacturer. Some batteries can be damaged if temperature and exposure times are too long and high.

Ray Taurasi is Eastern Regional Director of Clinical Sales and Services for Healthmark Industries. His healthcare career spans over three decades as an administrator, educator, technologist and consultant. He is a member of AORN, ASHCSP, AAMI and 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.