A process for improving flash sterilization - Statistical Data Included

AORN Journal,  Jan, 2002  by Karen A. Huggins,  Robert Mood,  Fran Koch

• E-mail
• Print
• Link

A second report, published in 1997, documented a series of positive biological indicators in steam sterilizers in different departments in the same building. (24) The authors documented their search for the problem and included a suggested protocol for managing positive biological indicators.

IDENTIFYING THE PROBLEM

In April 1999, staff members in the main OR of Presbyterian Hospital of Dallas began to review and revise policies and procedures regarding flash sterilization, including the procedure for biological monitoring of steam sterilizers. The clinical specialist gathered information on current practices by investigating the process and spending time with staff members. Initially, there was no problem with biological monitoring, which was being performed daily with few positive biological indicator results occurring. The clinical specialist, however, found discrepancies in the procedures, and this led to multiple discoveries regarding flash sterilization and biological monitoring in the facility. The procedure was to run a one-hour biological indicator in a three-minute flash sterilization gravity cycle and a three-hour biological indicator pack in a three-minute prevacuum sterilizer cycle. To save time, staff members were running the three-hour biological indicator in the same sterilization cycle with the air-removal test. The manufacturer and AAMI recommend that the tests be performed separately for accurate air-removal test results and more meaningful biological indicator results. (25)

Performing these tests in separate loads was implemented immediately. Another change was using nonwrapped, three-hour biological indicators in the prevacuum cycles versus a biological indicator pack because the OR uses nonwrapped flash sterilization.

One-hour biological testing of the gravity cycle was being performed in an open weave basket or on a towel. Staff members contacted a manufacturer's representative to ask for assistance in reviewing the procedures. The representative suggested running biological indicators as a simulated instrument load, a true challenge for the indicator test method. At Presbyterian Hospital of Dallas, a container system is used for flash sterilization. For the test to simulate in-use conditions, biological indicators were placed in the containers being used to sterilize instruments.

Various types of sterilizers, as well as sterilizers made by various manufacturers, are used at Presbyterian Hospital of Dallas. Staff members could not isolate one specific sterilizer as a problem when biological indicator results were positive.

It was important to determine the level of staff member understanding of cycle options available for flash sterilization and their knowledge of how and when biological monitoring is performed. The knowledge base of staff members was assessed via interviews and observation of flash sterilization practices. Staff members were asked the following questions.

* How do you identify whether to use a gravity cycle or a prevacuum cycle?