Cleaning and care procedures for sterilizers; moving SPD under the OR; mixed load sterilizing

Healthcare Purchasing News, May, 2004 by Ray Taurasi

Editor's Note: To ask a question, e-mail it to jakridge @hpnonline.com, or call it in to Jeannie Akridge at HPN, (941)927-9345 ext.202, or mail to: HPN CS Questions, 7650 So. Tamiami, Ste. 10, Sarasota, FL 34231. Names and hospital identification will be withheld upon request.

CS Question: What is the recommended cleaning and care procedure for sterilizers and how frequently should the inner chamber be cleaned? My staff tells me that my predecessor used a vinegar mixture for cleaning the sterilizer walls; is this a good idea?

CS Answer: The sterilizer manufacturer's instruction manual should be consulted for the exact procedures to be used on its sterilizer equipment. Sterilizer make and models differ and therefore processes may vary somewhat. In general, the following is common protocol:

* Sterilizer chamber should be cool prior to performing any maintenance or cleaning process

* The chamber screen strainer should be removed at least daily and cleaned thoroughly. All lint or other debris deposits must be removed from the screen. The use of a soft brush and mild detergent will help facilitate the cleaning process and the strainer may be flushed by holding under running water. The screen strainer may need to be cleaned more than once a day depending on volume and load contents. For example, if you are processing a lot of linen or textile loads, a significant amount of lint may clog the drain and affect the sterilizer's proper functioning.

* The chamber walls should be cleaned at least weekly utilizing a mild detergent and a long handled sterilizer cleaning brush or mop. Abrasives or steel wool pads should never be used when cleaning an inner chamber, as they may damage the corrosive resistant surface that protects the chamber walls from corrosion caused by steam boiler water treatment chemicals.

* Chamber drain lines may be flushed weekly with a mixture of tri sodium phosphate or hot water and a mild detergent solution. Household drain cleaning agent should not be used.

* The door gasket should be carefully inspected daily for any cracks or defects and wiped clean with a lint free cloth.

* Loading racks, carriages and baskets should be cleaned at least daily with a mild cleaning agent and wiped dry with a soft lint-free towel.

* There are many cleaning products, agents and accessories on the market specifically designed for the proper care, cleaning and maintenance of sterilizers. It is not recommended or advisable to create your own cleaning mixtures without the expressed instructions of the sterilizer manufacturer.

CS Question: I am responsible for the Sterile Processing Department and currently report to Materials Management, but there is some reorganization underway at my hospital and there is discussion about moving the Sterile Processing Department under the OR. I am against this reorganization and am very happy with the current arrangement because I feel I am in a better position to challenge the OR when they suggest we cut corners. Do you have information on reporting relationships that would assist me in my goal to keep SPD from becoming under the control of the OR?

CS Answer: Unfortunately, I cannot state one proven method or organizational structure that can support your "goal" or serve that of every hospital. Reporting relationships run the full gamut and there are examples of successes and failures to every scenario. Institution working mechanisms are as varied as the many individual personalities which occupy them. Key factors to success include appropriate alignment of human and material resources to get a job done. The appropriate application and utilization of resources is paramount. There must be a fit of skills and people, in other words, the right person in the right job armed with the knowledge, accountability and professionalism to carry out the job tasks at hand. A balance of authority and responsibility is essential. Organizational restructuring alone will not necessarily assure smooth operations or cure the ills existing between combatting departments. Superior interpersonal relations, mutual respect, open communications, integrity and teamwork, are the driving forces to success.

CS Question: What is the appropriate loading of a Sterilizer when there is a combination of textile, disposable wrap, and peel pouches mixed with sterilization containers? Is it appropriate to mix loads such as this?

CS Answer: Mixing of load contents is acceptable. When sterilizing mixed loads consisting of peel pouches, wrapped goods and containerized instruments, the containers should be placed on the lower shelves below the wrapped and peel pouched items. Remember that peel pouches are to be placed standing on their side or edge with paper to plastic. Placing the peel pouches in a wire basket or peel pouch rack will facilitate keeping them positioned properly during the sterilization process. In order to better facilitate permeation of the sterilant and drying, the load contents must not be compressed or packed too tightly on the sterilizer racks or cart. Be mindful that many containers can not be stacked during sterilization. Therefore be certain to get written validation documentation from your sterilization container manufacturer prior to stacking containers during the sterilization process.