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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



December 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

Wash/rinse phase temperatures; bar codes explained; shelf liners on wire transport carts

by Ray Taurasi

Q We recently changed some of our detergents that are used in our washer disinfector. The rep came in to do implementation and she suggested we make some temperature adjustments to our wash phase to maximize the detergents’ performance. She also stated that she didn’t think our final rinse temperature was adequate for thermal disinfection. I told her I wasn’t that concerned because our drying temperature was well above the required 180 degree disinfection temperature which should be more than adequate to achieve thermal disinfection during the dry phase. She suggested I might want to look into the matter. Am I correct in my thinking?

A The final rinse phase in a washer disinfector is when thermal disinfection actually takes place. The hot water, at a minimum temperature of 180 degrees, acts as a conduit which delivers the required temperature to all of the surfaces and crevices of the instruments and other items in the washer. During the dry phase hot air is merely blown over the instrument’s outer surface. Although the dry phase temperatures may be at much higher temperatures, well above 200 degrees, it could take an excessive amount of time before the entire washer contents were heated to the required temperature to achieve thermal disinfection. This would be somewhat similar to the difference between saturated steam sterilization and dry heat sterilization. We know that steam sterilization is a faster process than dry heat sterilization because the saturated steam is capable of reaching external and internal surfaces of load contents. Steam is basically vaporized water which acts as the conduit to deliver the moist heat at the required high temperatures (250 ° - 270°) to achieve sterilization within minutes. On the other hand, dry heat sterilization utilizes temperatures ranging from 320° - 350° and beyond and depending on the load contents it could take several hours for all items to "heat up" and reach the required sterilization temperature. It is important that you consult your washer manufacturer’s instructions for use (IFU) and ensure that each phase of your washer cycle is in compliance with the manufacturer’s instructions and that the thermal disinfection (final rinse) phase meets the required temperature and time parameters.

Q This might sound like a silly question but I’ll ask anyway. We were chit chatting in the break room the other day and the subject of bar codes came up which led to the question, what exactly are they and how do they work? Can you explain?

A A bar code is a series of vertical bars and spaces of varying thicknesses arranged in a specific way representing numbers, letters or other symbols. (Figure 1) Bar codes are used to facilitate inventory management and procurement functions. Bar codes are scanable and translatable by computer or other technology. The use of bar codes has proven to be very cost effective and efficient. They allow the ability to trace or track supplies or equipment on an active and timely basis. Manual systems require a lot of visual translation, written documentation and other paper work consuming a great amount of human labor. Manual methods also are more prone to errors.

Figure 1 - USB MICROSCOPE 26700-206 Healthmark

Q We recently had a consultant come in to do a mock Joint Commission survey in preparation for the real survey that we anticipate will be within the next six months. In the surveyor’s report she noted that SPD utilized open wire rack shelving transport carts and that we had no cart washer. She stated that since the carts could not be put through a cart wash that we needed to put solid shelf liners on all the top shelves as this would be in accordance with recommended practices. My boss has now told me that I need to do this. I told my boss that I was unaware of any such recommendation and I felt that the liners would be more prone to holding dirt and dust than the open wire shelves. What are your thoughts? Do you know of any requirement or recommendation that top shelves need to be solid?

A I have never heard of this before and I do not believe there is any standard or recommendation to that effect in AAMI or AORN documents. Unless I am missing something in your question I frankly do not believe the rationale as stated is sound. In reality there are many benefits to using wire transport carts including ease in more effective cleaning. That said, it is recommended that transport carts be routinely cleaned between uses (either manually or through a washer). Recommendations also state that the bottom shelf on transport carts or storage racks should be solid. If wire rack shelving or transport carts are utilized a solid shelf liner may be used or items on the bottom shelf may be stored in tote boxes or other containerized bins. The solid bottom shelf or tote boxes will protect the clean or sterile items from contamination caused by dust and other particulate stirred up from the floor in transit. When transporting clean or sterile items via open transport carts, it is important that cart covers be utilized to protect the cleanliness and sterile integrity of the items. Reusable cart covers must be made of a cleanable material and be kept clean at all times.

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.