7 steps to reducing flash sterilization rate
7 steps to reducing flash sterilization rate
Nationwide Children's Hospital in Columbus, OH, has reduced its rate of flash sterilization from 17% to 1.85%.
The project was featured at this year's poster presentation at the annual meeting of the Association of periOperative Registered Nurses (AORN). Earlier this year, AORN's Standards, Recommended Practices and Guidelines were amended to say that "flash sterilization should not be used as a substitute for sufficient instrument inventory. . . . The process may be associated with increased risk of infection to patients. This increased risk of infection may be caused by pressure on personnel to eliminate one or more steps in the cleaning and sterilization process." Surgery centers might particularly struggle with the issue of flash sterilization because of less equipment to substitute and limitations in central processing staff.
Flash sterilization is no longer used as a routine substitute for insufficient inventory at Nationwide Children's, according to Roberta R. Timmerman, RN, CPN, MSN, perioperative services education nurse specialist. Specialty and general instruments are decontaminated and sterilized in the controlled environment of the Central Processing Department, she says. Vendor-owned instruments arrive 24 hours in advance of care. Vendor-owned instruments are cleaned, packaged, and sterilized in a consistent manner by central processing.
Data were collected from 2002 to 2007 to identify overall rate of flash sterilization, rate of flash sterilization for each surgical services, items being flash sterilized, unit practices that contributed to the use of flash sterilization, and type of surgical cases that used flash-sterilized instruments (nonemergent vs. emergency/urgent surgical cases). Most cases of flash sterilization were for scheduled surgical cases, Timmerman says. (See types of instruments being flash sterilized and reasons, below.)
Here were the steps taken:
- Action plans were developed by specialty leaders of each surgical service that increased inventory and led to custom manufacture of one-of-a-kind instruments, such as a rongeur and scissors.
- Case scheduling practices were adjusted and relieved the demand for one-of-a-kind instruments in back-to-back scheduled cases.
- More general instruments, such as hemostats, scissors, and forceps, were kept up sterile. Central processing increased the quantity of these on the master instrument cart.
- Awareness of staff members increased so that when an instrument was needed, they would open other sufficiently inventoried sets to obtain the instruments rather than flash sterilizing.
"We increased staff's awareness when we communicated to them the quarterly results of the monitors," Timmerman says. "We showed them what was being flash sterilized and talked through our other sources of those instruments."
- Vendor agreements were established that ensured vendor-owned instrument sets arrived in-house 24 hours prior to scheduled surgery.
- Nationwide Children's discontinued the practice of decontaminating and sterilizing instruments in the OR. They transferred FTEs and responsibility for all instrument decontamination and sterilization to central processing.
- They bought a computerized instrument tracking system [Sterile Processing Microsystem (SPM)] from Materials Management Microsystems, which facilitated timely location of instruments. The cost was approximately $80,000, including hardware.
Annual competency assessment is needed for newer staff members who have had limited experience running the sterilizer.
The project was featured at this year's poster presentation at the annual meeting of the Association of periOperative Registered Nurses (AORN).Subscribe Now for Access
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