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Instrument organizers; ceiling leaks; basin/utensil sets; replacing
gaskets
by Ray Taurasi
Q We recently
started to use green foam
instrument organizers; we sterilize them in the trays and dispose of
them after each use. Is it acceptable practice to include the
organizers inside of our sterilization containers and wrapped
instrument sets?
A Disposable
instrument organizers come in many different styles and are made of
different types and colors of foam, paper and polypropylene. Some are
designed for and appropriate for multiple sterilization processes such
as, gas and steam while others are limited for use in one method of
sterilization such as, gas plasma. You must obtain technical data,
sterilization validation documentation and instructions for use from
the product manufacturer. This information will guide you in the
appropriate use and application of the instrument organizers. The
validation data will include documentation of the product’s use and
performance in various sterilization methods as well as the
appropriateness of use inside of sterilization containers and or
wrapped sets. You are responsible to use the product in accordance
with the manufacturer’s instructions and technical data. Foam and
paper products are designed as single use devices and in such must not
be reused.
Q
Last spring we had a long period
of torrential rain and there were leaks in the ceiling of our sterile
storage area. For several days we had absorbent mats and buckets all
over the place to capture the drips. We did move all of the sterile
goods to their areas of the department to prevent contamination. Once
the rain subsided and the walls and ceiling dried all items were moved
back to the sterile storage area. There were large brownish water
stains on the ceiling and walls and I requested that the ceiling tiles
be replaced. The hospital did experience lots of water damage so it
took several weeks before Facilities could get to CPD. When they
finally did come to repair the damage all that they did was put a
fresh coat of paint over the stained ceiling and walls. When I
questioned this they said there was no need to replace the tiles. Do
you think just repainting over the stains was the appropriate course
of action?
A
Entrapped moisture within ceiling tiles and walls can
create a very dangerous situation. Ceiling and wall materials are
absorbent and can retain moisture for prolonged periods. Other
building materials found behind the walls and ceiling such as
insulation, support beams and the like also retain moisture. Moisture
can damage and weaken these materials causing structural damage which
could pose a real risk to staff safety if the walls or ceiling should
collapse. It is critical that all structures be inspected for damage
and that the necessary repairs are made. Further it is essential that
the source of the problem that failed and allowed leakage to enter the
building be repaired to obviate any reoccurrence during future storms.
There could also be very significant microbiological and environmental
concerns, as entrapped moisture could cause the formation of molds and
fungi which can quickly multiply and spread within structures. These
organisms are also spore formers. Generally aspergillus fungi are
harmless to healthy individuals but it could be lethal to immune
deficient patients. Spores could become airborne and could be
circulated throughout the environment via the ventilation system
infecting patients who inhale the airborne contaminants. While
painting over the stained walls and ceiling tiles may have addressed
the aesthetics of the environment it was not the appropriate action to
be taken. The damaged tiles, wall board and insulation should have
been removed and replaced and the area should have been thoroughly
cleaned and decontaminated to prevent the growth and spread of
dangerous molds and fungi.
Q
Is there a limit to how many basins, metal cups and
trays can be included in a sterile utensil set?
A
Basin / utensil sets should be carefully assembled to
allow for the permeation of the sterilant and contact to all surfaces.
Graduated nested basins should differ in diameter by a minimum of one
inch and each tier should be separated by an appropriate wicking
material to allow the flow and contact of steam to all surfaces and to
facilitate thorough drying. Sponge type gauze should not be used as a
wicking material in these sets as the gauze material could become
confused with the surgical sponges used in surgery that must be
counted and accounted for. All basins, cups and other concave utensils
in the set should be positioned upward and out in the same direction.
As a general rule the set weight should not exceed 7 lbs. Excessive
metal mass can result in wet loads, therefore your careful evaluation
and assessment of your practice will determine the appropriateness of
set size and design as well as the number of basin sets to be
sterilized per load.
Q
How often do I need to replace
the gaskets in my sterilization container?
A
There is no one set answer to
your question. Your sterilization container manufacturer can provide
you with basic guidelines relative to gasket replacement. Most
container manufacturers do have a warranty on the life expectancy of
gaskets based on normal and appropriate use in accordance with their
instructions. It is important that the container gaskets be inspected
prior to each use. Gaskets should be present, securely in place and
free of any cracks, breaks or cuts. Any defects in a gasket,
regardless of age, must be repaired and or replaced.
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, AHA, SGNA, 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. |
