Aseptic technique; transporting sterilized items; washing instruments in the scrub sink; airway fires - Clinical Issues

AORN Journal, August, 2002 by Ramona Conner

When the circulating nurse is removing sterilized items from the flash sterilizer that are not in a closed container, he or she should

* place items in a perforated tray for sterilization,

* avoid reaching over the top of the item while pulling the tray out of the sterilizer, and

* not allow the bottom of the perforated tray to come in contact with unsterile surfaces.

If the scrub person is removing sterilized items from the sterilizer, he or she should remember the following guidelines.

* The scrub nurse should avoid leaving the sterile field when the procedure is in progress--attention should be on the field and assisting with the procedure, not on retrieving items from the sterilizer.

* The circulating nurse should accompany the scrub person to the sterilizer to help monitor possible contamination of the sterile gown's sleeves.

* The scrub person retrieving the tray should avoid accidental contact with doorways, edges of the sterilizer doors, and other miscellaneous equipment that often is in the pathway to the substerile room.

There is no one correct way to transfer items from the sterilizer to the point of use. The application of sound aseptic principles and disciplined surgical conscience are the essential ingredients required for safely transporting flash sterilized items to the point of use.

Question: Our OR recently was renovated, and 10 new ORs were added. In the new part of the OR suite, there are no substerile areas between rooms; instead there are only soiled utility rooms off each core. With this design, it often is inconvenient to get to the soiled utility room to wash instruments that have fallen from the sterile field before flash sterilization. Some staff members have begun washing these instruments in the scrub sink. After reviewing AORN's "Recommended practices for care and cleaning of instruments" and "Recommended practices for sterilization In perioperative practice settings," I cannot find anything that specifically addresses where Instruments should be washed before flash sterilization in emergency situations. I can only find that manually decontaminated instruments should be submerged in warm water and washed with a detergent under water to prevent splashing and aerosolization. Is it an acceptable practice to hand wash contaminated instruments in the scrub sink before flash sterilization?

Answer: Instruments may be hand washed, but they should not be washed in the scrub sink or any sink used for hand washing. Instruments should be taken to the soiled utility or decontamination room for proper cleaning before resterilization. Scrub sinks should not be contaminated with bloodborne pathogens from contaminated instruments. Microorganisms left behind from cleaning contaminated instruments in the scrub sink can pose a risk to patients, as well as personnel. (5)

The scrub sink area is not designed for decontamination of surgical instruments, and the necessary supplies (eg, detergents, brushes, protective attire) are not readily available. Instruments should be cleaned and decontaminated carefully, and appropriate personal protective equipment should be worn to protect personnel from exposure to bloodborne pathogens. (6)