INSIDE THE CURRENT ISSUE

February 2012

CS Solutions


 

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 request.

Ray Taurasi

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.

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.