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No doubt about it, effective sterilization is among the most critical elements of patient and worker safety, and quality outcomes. In its absence, infection control challenges multiply and healthcare organizations open themselves up to citations and potential litigation – and a sea of other logistical complications that can mar the facility’s reputation for quality.

While safe and effective sterilization is essential, it isn’t always easy to achieve, particularly in light of the myriad challenges plaguing Central Service departments. Aside from increasingly intricate, delicate and difficult-to-clean devices, and mounting pressures from the operating room and other CS customers to turn instruments around more quickly, there’s the challenge of inexperienced, inadequately trained CS technicians managing the vital process – an all too common scenario for many healthcare facilities.

Looking for inspiration and success stories that can be applied within your own department? Read on.

Despite standards stating that flash sterilization should be limited to emergency situations — or instances where instruments have been dropped or otherwise contaminated and are required to continue a surgical procedure – routine flashing is still an all too common occurrence for many facilities.

It’s an ongoing trend that has been perpetuated by numerous circumstances, including over-scheduling and a lack of inventory and/or equipment to turn around the devices in time. Even so, the problem is one that some CS departments aren’t willing to tackle lying down.

To curb overuse of the practice, the sterile processing department at Hospital for Special Surgery, a specialty hospital for orthopedics and rheumatology located in New York City, gathers and tracks flash sterilization statistics to identify the most frequently flash sterilized trays.

"Under AAMI standards, you’re not supposed to flash sterilize because of lack of inventory, so if we’re seeing a trend where one tray is being flashed more frequently than others that sends a signal to us that there might be an inventory issue that needs to be addressed," said Don Gordon, MPS, CRCST, FCS, director of Central Sterile Processing for Hospital for Special Surgery. "Building inventory takes time and budgetary adjustments, but it’s [essential] for promoting quality and excellence, and our hospital understands that."

The same can be said for Mansfield, OH-based MedCentral Health System. Because the healthcare organization, like many others, sometimes schedules more cases than inventory allows, MedCentral’s manager of sterile reprocessing, David Narance, RN, BSN, CRCST, carefully logs and tracks the most frequently used and requested – and flashed — sets, and makes inventory recommendations based on his findings.

"I present monthly at infection meetings and I give a year-end summary that identifies the most heavily used and requested sets," he said. "If we have only five sets, but they’re typically scheduling nine cases, that sends a very clear message." Although his recommendations may involve an increase in inventory, such a recommendation does come with a qualifier.

"I point out that if scheduling would be more in line with our current inventory that would go a long way in alleviating the problem," he said, pointing out that the organization has been receptive to the SPD’s pleas for additional instrumentation, when needed.

That’s not to say that inventory shortages are the only reasons behind routine flash sterilization, however. Because other factors can contribute to compromised sterility and the need to subsequently flash sterilize devices, CS must remain privy to such problems and implement effective solutions. Both Hospital for Special Surgery and MedCentral Health System make a concerted effort to identify potential problems that can contribute to the overuse of flash sterilization.

"There might have been a hole in the wrapper, for example, which might indicate that a tray was too heavy or that there was a handling problem that took place somewhere along the way," noted Gordon. To reduce the risk for wrapper tears and holes – and the potential need for flash sterilization as a result — HSS is planning to convert a major portion of its inventory to a container system that will eliminate the need for wrapped trays. To address space challenges related to storing the containers, the Central Sterile Processing department – which manages instrumentation for 30 operating suites and processes 18,000 trays per month — is implementing a new track-based storage system that will boost available storage space by approximately 50 percent.

"Moving to a container system is a big shift and it created some space challenges we needed to address, but we believed it was a necessary part of eliminating flash sterilization as much as possible."

MedCentral has taken its own unique approach to managing instrumentation and keeping flash sterilization to a minimum. In the past, the SPD was inundated with requests from customers who needed certain sets turned around immediately. While the SPD did its best to meet those demands, it wasn’t always easy, explained Narance.

"As people were rolling the soiled cart into decontam, they’d say they needed it back right away. But by the time it got around to the clean side, we sometimes forgot which set it was and who needed it, which obviously created a problem," he said. To remedy the situation, the SPD implemented a carbonless paper work order protocol that visually alerted staff to the instruments that needed to move to the front of the line. Customers would indicate whether they had time for the SPD to process the instruments (marking the time the instruments would be needed), or whether flash sterilization was necessary.

"At the time we began implementing the carbonless work order [protocol] we were up around six or seven and sometimes eight percent of requests being for immediate turnaround. That was incredibly difficult because we had to stop what we were doing and shift gears, which wasn’t very efficient," Narance explained. The paper work order process helped pinpoint inventory shortcomings and also gave the department a much clearer picture of which instruments truly did require immediate turnaround and which could wait a while longer, thereby eliminating the need for unnecessary flash sterilization.

Today, MedCentral’s flash sterilization rate is an impressive half percent – a success story Narance attributes, in great part, to an increase in instrumentation, where needed, and the implementation of the work order process. His information gathering skills have also allowed him to present instrumentation-related data to the appropriate departments, which has helped them understand the importance of more appropriate procedure scheduling.

Having SPD staff play a greater role in the flash sterilization and customer education process is another strategy for success. The CS department at Centra Health Inc., Lynchburg, VA, for example, is in the process of taking over all testing and operating of flash sterilization cycles.

"I was glad to take over because we are the ones who are most knowledgeable about sterilization," acknowledged Erle Shepard, BA, CRCST, CHL, CHMM, FCS, CS manager for Central Health. "It’s a critical process and I believe we should be the ones to manage and monitor it."

MedCentral and HSS share that belief. At MedCentral, flash sterilization is undertaken by a mix of OR and sterile processing personnel, and the SPD provides ongoing training to ensure that the OR has a full understanding of the process, including how to use and read chemical indicators correctly. "Effective sterilization is critical and it can’t be taken lightly," Narance noted. "It can’t just be automatically assumed that everyone is [well-versed] on the process and is following appropriate protocol. All it takes is just one error or misstep for an adverse outcome to occur, which is why [the sterile processing department] needs to be actively involved."