Safe IV solutions; supply storage; indicator strips; recommended practices; latex; physicians' orders - Clinical Issues

AORN Journal, Oct, 2001 by Ramona Conner

Class two, Indicators used for specific test procedures. Air-removal tests for vacuum steam sterilizers assess only the efficiency of the vacuum pump and the presence of air leaks or gases in the steam. They indicate the efficiency of the air removal system, but not sterilization efficacy. (4)

Class three, single parameter Indicators that respond to one sterilization parameter, such as temperature. A common type of class three indicator is a glass temperature tube containing a chemical that melts and changes color when a minimum temperature is reached. These indicators do not indicate the total time at one temperature or whether the temperature was exceeded. They are used to determine whether the appropriate temperature was achieved at the center of large packs.

Class four, multiparameter indicators that respond to more than one sterilization parameter. These indicators contain an ink that changes color when exposed to the correct combination of sterilization parameters.

Class five, integrator indicators. These indicators respond to all sterilization parameters. If the chemical on the integrator wicks into the "accept" area of the indicator, all parameters of sterilization have been met. (5)

AORN recommends that chemical indicators be used as part of the routine sterility assurance process. (6) Internal and external chemical indicators are recommended for all sterilized packages and containers. Only an internal chemical indicator can identify loading and packaging errors. Indicators allow the user to determine immediately whether the package has been through a sterilization process and whether the parameters of the cycle were met. Other indicators, both mechanical and biological, will provide information about the cycle but not about individual items or packs. Many acceptable chemical indicator products are available. Integrators are only one type of indicator that can be used as part of a total sterility assurance program.

Question: We always have followed AORN's Standards, Recommended Practices, and Guidelines in our OR. Recently, a newly hired manager stated that these documents are guidelines and not gospel. If this is true, which standards should guide our practice?

Answer: Your new manager is correct. The Standards, Recommended Practices, and Guidelines are intended as achievable recommendations for what is believed to be an optimal level of practice. (7) The Recommended Practices are intended as guidelines adaptable to various practice settings and situations. Facilities' own policies and procedures will reflect variations in practice settings and clinical situations, which will determine the degree to which the Recommended Practices can be implemented.

Standards are authoritative statements that describe the responsibilities for which nurses are accountable. These professional standards guide nurses' professional practice. The "Standards of perioperative nursing" are found in AORN's Standards, Recommended Practices, and Guidelines.

Question: Product representatives recently have indicated that if their product contains latex, It will be noted on the product's label. Otherwise, by law, we are to assume the product does not contain latex. Is there a "latex law"?