Super heated steam; shoes for SPD;
proper use of containers
for IUSS
by Ray Taurasi
Q
I have often heard the phrase
"super heated steam" but to be honest, I really don’t understand what
it is. Could you please explain this and how it can affect
sterilization?
A
Super heated steam refers to
steam quality issues where the steam does not consist of the proper
moisture ratio; as a result the steam becomes too hot and dry. A
sterilization load can become superheated, which is a condition in
which dehydrated textiles are subjected to steam sterilization. The
package or product becomes too dry and causes destructive effects on
the strength of the cloth fibers. In addition, the dehydrated textiles
absorb moisture that may compromise the efficacy of the sterilization
process by not delivering the required steam contact to the packaged
goods. In some situations packaging materials may actually show
charred marks from the excessive heat.
Q
I am in the process of revising
the dress code policy for our Sterile Processing Department and was
wondering if there were specific type of shoes that should be worn.
Are shoe covers required to be worn in all SPD work areas?
A
Wearing proper shoes may
reduce the risk of injury from slips and falls and decrease the
possibility of foot injuries in the Sterile Processing Department. To
provide adequate protection shoes should have enclosed toes and backs,
low heels and non skid soles. Occupational Safety and Health
Administration (OSHA) regulations address all aspects of employee
safety in the workplace which includes the potential for foot
injuries. Employers are responsible for conducting a workplace hazard
risk assessment and determining dress code requirements that would
afford the appropriate protection thus minimizing the risk of injury
in the work environment. A risk assessment should identify all
potential hazards such as needle sticks, scalpel cuts, and exposure to
blood or other potentially infectious bio hazards, as well as whether
there is a danger of foot injury from falling or rolling objects or
objects that might pierce footwear.
Professional studies
have been conducted in the past which demonstrated that the following
shoe types and materials offered the best protection from punctures
and cuts:
• suede sneaker,
• suede with an inner
mesh lining,
• leather with an inner
canvas lining,
• non-pliable leather,
• rubber with an inner
lining, and
• rubber.
The use of shoe covers
minimizes exposure to bloodborne pathogens and other potentially
infectious material. The OSHA regulations state that shoe covers or
boots shall be worn in instances when gross contamination can
reasonably be anticipated. Certain work activities in the
Decontamination area may present the potential for exposure to
contaminated body fluids and or other moisture that could penetrate
shoes. In such conditions protective impervious shoe covers and or
boots should be worn. The protective foot gear should extend and cover
portions of the legs that may be at risk of exposure as well. All
footwear worn in the SPD area should be capable of being cleaned and
be maintained in a clean state. The decision to wear shoe covers in
other areas of SPD is a matter of hospital policy.
Q
The use of closed sterilization
containers is now the recommended practice for immediate use steam
sterilization, aka FLASH. We are currently using sterilization
containers with the lid slid open for our flashing and we slide the
lid closed prior to removing the container from the sterilizer. Is
this an acceptable practice? Couldn’t the instruments be contaminated
once the sterilizer door is opened before the lid is shut?
A
You want to be certain that
any containment device you are using for IUSS (immediate use steam
sterilization) has been validated by the manufacturer for this
application and for the sterilization parameters of the cycle you are
using. Be certain that the appropriate FDA clearances and 510k
requirements have been secured. It is also imperative that you follow
the manufacturer’s IFUs (instructions for use). There are
sterilization containers that have been validated and cleared by FDA
for IUSS in which the lid is left slightly opened during the
sterilization process and slid shut prior to removing the container
from the sterilizer. The sterile field is maintained once the door is
opened because the inside temperature of the sterilizer and the
container is hotter than the outside air and any ambient airflow would
be from inside the container to the outside. Proper protocols and
technique in accordance with the IFUs must be followed when closing
the lid to prevent any contact contamination.
References:
1. Barr J, Siegel D. Dangers of
dermatologic surgery: protect your feet. Dermotol Surg. 2004;30(12 Pt
1):1495-1497.
2. Watt AM, Patkin M, Sinnott MJ, Black
RJ, Madern GJ. Scalpel safety in the operative setting: a systematic
review. Surgery. 2010;147(1):98-106.
3.Occupational Safety and Health
Standards 1910.136.
4. Occupational exposure to bloodborne
pathogens—OSHA. Final rule. Fed Regist. 1991;56(235):64004-64182.