|
Orthopedic set containers; OR towels; PA sterilization
by Ray Taurasi
Q Do
you have any information on container systems for orthopedics? I was
told that the orthopedic loaner companies are being forced to look at
putting their items into sterilization containers.
A Due
to the weight of loaner sets and the design of many of the cases in
which they come; tearing of the sterile wrap has become a major
concern and problem for most Central Processing Departments. To my
knowledge there is no mandate or source forcing the manufacturers to
place their instrumentation in sterilization containers. Back a couple
of years ago AAMI published a manufacturers document ST77 which
addressed design considerations for cases and other containment
devices used to hold and organize instrumentation. While this document
did not call for the requirement to use sterilization containers it
did recommend a weight limit which should not exceed 25lbs. The
recommended weight limit was to address ergonomic issues and it
recognized that excessive weight of such devices contributes to
tearing and wetness commonly associated with weight and metal mass.
I do know that many hospitals have purchased
sterilization containers that are large enough to accommodate loaner
cases and or the internal trays inside of the cases. It is however
important to check with the container manufacturer to be certain that
the sterilization containers have been validated for such use along
with obtaining instructions and sterilization parameters. Many of the
sterilization container manufacturers have coordinated efforts with
the orthopedic device manufacturers to work jointly with customers to
address concerns relative to care, handling, processing and
sterilization of loaner sets. Most of the sterilization container
manufacturers can provide users with clinical and technical
consultation and assistance in the organization of complicated
orthopedic sets, which often involves breaking them down into smaller
sets which are less likely to cause tears and wetness. Some orthopedic
manufacturers have provided customers with resources to purchase
sterilization containers for use with their loaner sets. This often is
related to volume and annual usage requirements. I would suggest that
you discuss your concerns with the manufacturers that provide your
loaner sets and your sterilization container manufacturer.
Q We
used to use OR towels under our instrument sets to protect the wrap
from tearing which seemed to work very well. However the OR hired a
new nurse coordinator for education and quality assurance and she did
not want towels to be used in any sets as a packaging aid or for
padding. She said that towels posed a potential risk for lint and
other fibers to be deposited in the sets and onto the instruments; she
also said there was a risk of laundering detergent residual getting on
and damaging instruments. We have tried a number of different foam,
paper and plastic corners on trays but they are quite costly and labor
intensive and they were difficult to use. They frequently fall off and
the reusable ones seldom get returned to us. Since we stopped using
the OR towels and the corners haven’t been working out the incidents
of tears have significantly increased. Can you suggest any other
options?
A The
previous question addresses some of your issues. You may want to
explore the use of sterilization containers for some of your most
challenging and heavier sets. If you are using a disposable wrap you
might want to discuss the tearing issues with your wrap manufacturer.
There are various strengths of disposable wrap available for use and
you might want to try a heavier grade of wrap as your manufacture
recommends. You should also assess all the storage conditions and
assure that all material handling protocols are appropriate and are
being followed. Consider the use of shelf liners on your storage racks
and sterilizer carts. Kimberly-Clark also provides customers with
plastic transport trays which are used under trays during
sterilization and remain with the set until the time of use. Users
report that these transport trays have significantly reduced the tear
rate occurrences. An option to using OR towels under your trays to
reduce tearing and facilitate drying would be the use of a paper under
guard product (see figure one). The under guard product is a medical
grade super strength highly absorbent paper designed expressly for
such use and it eliminates the concerns of linting and detergent
residuals associated with the use of OR towels.
Q
I know that there are new low
temperature sterilization processes being introduced all the time. I
recently heard of a PA sterilization system. What is that?
A
PA is an abbreviation some people
use for Peracetic Acid. You probably are familiar with the STERIS
System 1 sterilizer which is used for the processing of various
endoscopes. Peracetic Acid (PA) is the liquid chemical sterilant that
is used in this process. This method of sterilization has been
utilized for many years now. It was cleared by FDA as a Just In Time (JIT)
process, which means that the items sterilized are intended for
immediate use. This sterilization process requires the total immersion
of devices to allow the complete contact of the sterilant to all
surfaces and internal components of the scope, e.g., lumen channels
and the like. Devices sterilized by this process must be able to be
completely immersed in a liquid – some older scopes, cameras, etc.,
may not be able to be processed in this manner. Always consult with
the scope manufacturer for processing instructions.
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. |
