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Questions can be sent
to:jakridge@hpnonline.com
called in to Jeannie Akridge at HPN:(941) 927-9345 ext.202
or mailed to:
HPN CS Questions, 2477 Stickney Point Road, Suite 315B,
Sarasota, FL 34231
Names and hospital identification will be withheld upon
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Security locks; degassing ultra sonic washers; containers for
pre vac flash
by Ray Taurasi
Q
At our staff meeting we were discussing an issue that came up at
a recent CS Forum regarding replacing damaged or missing security locks on
sterilization containers. We have always maintained a supply of sterilized locks
for this purpose. The practice is only allowed if the container has not been
opened and only if just one lock is broken or missing. We have done this for a
long time without any negative outcomes. Many of my staff claims they also did
this at other hospitals. I was surprised to hear several folks at the forum say
this is not an acceptable practice. How do you weigh in?
A I would have to agree that this is a
totally unacceptable and very dangerous practice. And here’s why:
1. These locks are called "tamper evident" locks for a reason:
When a lock is damaged or missing you cannot guarantee that the sterile
integrity of the container contents has not been compromised or violated.
2. A missing or damaged lock is a red flag that something is
faulty and that the container may have been tampered with.
3. You should never pre-sterilize open security locks for future
use…this may lead to inappropriate use and lead to a mix up of unsterile and
sterile goods.
4. You should immediately stop this practice and dispose of all
pre-sterilized security locks.
5. If you have frequent reoccurrences of damaged and/or missing
locks you need to find the cause and resolve the problem (whether it be a
product or staff performance issue).
6. This practice is a definite breech in technique and the
continuation will lead to other inferior practices and complacency on behalf of
your staff.
I observed this practice at a hospital where I was consulting
once – the practice evolved into techs actually opening sterilized containers
and adding missing instruments back into sets and then placing a pre-sterilized
lock back onto the container. My point here is that one bad practice can lead to
others. The business of sterile processing is a serious and exacting practice.
There are absolutely no short cuts to doing things right! If a container is
missing a lock or a lock is damaged following sterilization, you must breakdown
and reprocess the set. Doing things right may not always be the fastest or
easiest thing to do, however as CS practitioners we have an obligation to
protect the patient’s safety and welfare and that requires a commitment to
service excellence and doing the right thing at the right time – ALL THE TIME!
To quote my mentor and good friend Dr. Bertha Litsky, "an unsterile item used in
surgery is as dangerous as a loaded gun." If you are in doubt about the sterile
integrity on a package and allow questionable products to be used in patient
care it’s like putting a loaded gun to a patient’s head.
Q I am embarrassed to admit that as a
seasoned CS manager I have just recently heard about degassing of the sonic
washer. I really don’t understand what this is, why it’s so important, how it is
accomplished and how frequently it must be done.
A First and foremost there is no need
to be embarrassed. You can be sure there are many others who, like you, have not
heard about degassing or understand the process. By asking the question, other
readers will also glean new information. Degassing the ultra sonic bath is an
essential step to be done before processing any instruments in the ultra sonic.
It should be done each time the ultra sonic is filled. Dissolved air bubbles are
present in water and cleaning solutions; this entrapped air can inhibit and
interfere with the efficiency and effectiveness of the cavitation energy and
action required for proper cleaning. Degassing will disperse and release these
dissolved air bubbles. The Degassing process is done after the cleaning agent
detergents or enzymatic solutions are added to the water bath. While the amount
of time required to complete the degassing process may vary depending on the
type of chemical agents used, water quality, tank capacity, and temperature,
generally the process can be completed by running one cycle without any
instruments in the water tank. For more specific detailed instructions you
should consult with the manufacturer of your particular equipment; they will
provide you written instructions which you in turn can incorporate into your
procedure manual.
Q
I work at an Ambulatory Surgery Center. We do several procedures
a day, our pace is quick and our scheduling is tight. All of our sets require a
fast turn around. We do not compromise the decontamination process at all –
every instrument goes through proper cleaning, automated washing, thermal
disinfection and inspection during set assembly. We do however run all sets
through pre vacuum flash sterilization utilizing standard sterilization
containers. Recently another container sales representative has gone to the OR
director stating we are improperly sterilizing sets by using these containers
and that we need to purchase Sealed Flash Sterilization container with valves
which his company sells. Why would I need a special container for flashing in a
pre vac sterilizer?
A
There has been lots of confusion on this topic – most flash
processes are done by using a gravity cycle; some OR flash sterilizers have the
capability of running either gravity or pre vac. In such cases some cycles might
be programmed for gravity and others for pre vac. By pressing a button a cycle
may be changed so it is critical that sterilizer operators be knowledgeable and
certain about the cycle they are using. Gravity cycles will require a
containment device that is designed and validated for use in gravity cycles.
That said, if a pre vac cycle is run the sterilization parameters in flash are
the same as they are in a terminal conventional pre vac cycle except that the
dry phase is eliminated or abridged. Therefore any containment device with FDA
510k clearance and validated for use in pre vac cycles are acceptable for use in
a pre vac flash cycle. It is important that you obtain and follow the
manufacturer’s instructions for use and that you verify the container’s
performance in your sterilizer and in each cycle.
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.
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