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Industry: Email Alert RSS FeedA process for improving flash sterilization - Statistical Data Included
AORN Journal, Jan, 2002 by Karen A. Huggins, Robert Mood, Fran Koch
In health care facilities, monitoring sterilization processes for quality assurance is accomplished by using biological indicators. The standard indicates that sterilizers used for flash sterilization should be monitored daily. (1) In reviewing the sterilization monitoring practices in the OR at Presbyterian Hospital of Dallas, staff members identified a process improvement opportunity. This led to a joint venture between the OR and sterile processing departments, because both departments rely on the results of biological monitoring for process validation.
It was discovered that staff members who performed daily biological monitoring were taking a shortcut. They were placing biological indicators and air-removal tests in a single load. Staff members in the OR and sterile processing departments began questioning the current flash sterilization and biological monitoring practices and performed a literature search on biological monitoring. They found only a few references to biological indicator studies for flash sterilization. The occurrences of inconsistent positive results from biological monitoring challenged staff members to reevaluate the current process. As a result, they learned more about biological indicators, container systems, and flash sterilization, as well as their correlation and interdependent relationship.
FLASH STERILIZATION METHODS
Knowledge of sterilizer operating instructions is essential in identifying and understanding the basics of sterilization. There are three main methods of sterilizing via steam:
* gravity displacement--incoming steam displaces residual air through a port or drain in or near the bottom of the sterilizer's chamber;
* prevacuum steam--one or more pressure and vacuum excursions at the beginning of the cycle remove air; and
* steam-flush/pressure pulse--a repeated sequence consisting of a steam flush and a pressure pulse that remove air from the sterilizing chamber and process materials using steam at above atmospheric pressure but without requiring a vacuum. (2)
Most of the sterilizers manufactured today offer a combination of choices for gravity and prevacuum methods. Flash sterilization most often is accomplished by the gravity method. (3) Prevacuum methods were designed for sterilization of wrapped items because the vacuum allows for faster air removal and decreases the sterilization cycle time. Following the manufacturer's instructions and using critical thinking skills will help determine the most appropriate cycle to use.
FLASH STERILIZATION RECOMMENDATIONS
The Association for the Advancement of Medical Instrumentation (AAMI) and AORN have published recommendations for sterilization practices, and specific criteria for flash sterilization have been developed. (4) A few points regarding sterilization methods, however, need to be emphasized. Any sterilization cycle may be used if the manufacturer's instructions are followed. Flash sterilization provides for the sterilization of unwrapped items, (5) and this method must not be used to sterilize wrapped instruments. (6) An exception to this recommendation is when a single wrapper is used to confine the instrument or when a sterilizer is designed and labeled specifically for this use. (7)
AORN's "Recommended practices for sterilization in perioperative practice settings" state, "Flash sterilization should be used only in carefully selected clinical situations when certain parameters are met." (8) These parameters include
* that instruments are properly cleaned, decontaminated, inspected, and arranged in the sterilizing tray or container;
* that instruments are delivered directly to the point of use; and
* that defined procedures for aseptic handling and personnel safety are followed during transfer. (9)
The type (eg, porous versus nonporous, lumen versus nonlumen) and quality of instrument to be sterilized should be considered. The most rigorous exposure times should be used when more than one type of item is sterilized. (10)
BIOLOGICAL MONITORING
For perioperative nurses, biological monitoring is correlated indirectly to patient care. Perioperative nurses should be able to answer the following questions related to biological monitoring.
* Why is biological monitoring performed?
* How is testing performed?
* What is the correct microbial spore used for the biological monitor?
* When should testing be performed?
* How are results interpreted?
* What does one do if there is a positive result?.
The purpose of biological monitoring is to document the sterilization process' efficacy to kill pathogenic organisms. (11) Biological monitoring does not verify that an item is sterile, instead it helps detect procedural errors and equipment malfunctions. Biological indicators used to monitor sterilization processes represent a worst case microbial load or challenge to the sterilization process. (12)
A variety of biological monitoring tests or indicator strips are available through manufacturers. The product information provides directions for use and should be used as a resource by all staff members who perform biological monitoring. Perioperative nurses also should review their facility's biological monitoring policies and procedures. For accurate results, a biological indicator should be placed strategically in the load. In a steam sterilizer, this means placing the indicator at the point of suspected lowest steam or heat penetration. (13)
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