Sterilization practices

AORN Journal, Sept, 2004 by Brenda Whitworth, Dorothy Fogg

I am writing about the answer to a question in the "Clinical Issues" column in the AORN Journal (vol 80, July 2004). As a member of AORN for more than 25 years, I am one of your strongest advocates. I am very proud of our professional organization and have always considered AORN as the "gatekeeper" of recommended practices and standards. This is the first time I have interpreted one of AORN's recommendations for perioperative practice as a compromise to patient safety.

The answer to the sterilization question, in my opinion, does not represent the standard of practice that the AORN standards recommend and support. It was recommended in the article that the scrub person in the OR leave the sterile field and retrieve flash sterilized instruments directly from the sterilizer in a substerile room. It is not accepted practice to leave the sterile field at any time, and I believe that going from a sterile field to a substerile field and then back to the sterile field is a compromise of practice and patient safety. A scrub person would contaminate the substerile room when he or she retrieved the instruments, compromising the environment and staff member safety. The practice outlined in the article is a compromise, in my opinion, of the basic standards of perioperative practice and a contradiction of AORN's standard of practice.

BRENDA WHITWORTH

RN, CNOR

EDUCATION/COMPLIANCE COORDINATOR

TOPS SURGICAL SPECIALTY HOSPITAL

HOUSTON

Author's response. According to AORN's "Recommended practices for maintaining a sterile field," scrubbed persons should not leave the immediate area of the sterile field. AORN considers the substerile area to be within the immediate area of the sterile field. AORN does not consider movement from the sterile field to the substerile area and back to the sterile field to be a breach of technique or a compromise of practice and patient safety.

The substerile area is a restricted area with environ mental controls similar to those found in the OR. Access is through the OR only and is limited to people in appropriate surgical attire. When a scrubbed person enters the substerile area, he or she touches nothing except the item(s) to be removed from the sterilizer. No people from adjoining rooms are to be in the substerile area at that time. Of course, if a contaminating event occurs at any time, regardless of where the scrubbed person or other members of the sterile team are, the break in technique must be corrected before the surgical procedure continues.

Even though it is possible to place more than one tray in the sterilizer for a single sterilization cycle, the sterilizer should be used for instruments for only one room at a time. The sterilizer must be run again if items from an adjoining room are included in the load. Whenever anyone (eg, scrub person or circulating nurse) reaches into the sterilizer, items in the sterilizer are considered dedicated to that room or patient, and any items belonging to an adjoining room will require resterilization before use.

DOROTHY FOGG

RN, MA

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE

NOTE

(1.) "Recommended practices for maintaining a sterile field," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2004) 367-371.