AORN addresses issue of sterilization
AORN addresses issue of sterilization
Steam vs. flash: How do you decide?
[Editor’s note: To help our readers, Same-Day Surgery is printing advice in the top 10 areas that receive the most questions at the Center for Nursing Practice, Research, and Health Policy at the Association of Operating Room Nurses (AORN) in Denver. The eighth topic, addressed in this month’s issue, focuses on sterilization.]
In concert with the Centers for Disease Control and Prevention in Atlanta, AORN recommends sterilization for items classified as critical items. Critical items are defined as items that enter sterile tissue or the vascular system. Examples include surgical instruments, cardiac and urinary catheters, implants, and endoscopes entering sterile tissue or cavities. All items to be sterilized should be precleaned.
Steam sterilization is recommended for heat and moisture-stable items. Sterilization may be accomplished by a gravity-displacement sterilizer or a prevacuum sterilizer. Wrapped or containerized items should be sterilized for a full steam cycle followed by a drying cycle. Weight of containerized items for sterilization should not exceed that recommended by the manufacturer of the container system.
Sterilization of instruments for immediate use is known as flash sterilization. Items to be flash sterilized should be unwrapped or placed in containers or wrappers designed specifically for flash sterilization. Flash sterilization should be used only when there is insufficient time to sterilize by the preferred wrapped or containerized method. Flash sterilization loads contain-ing porous items such as fabric, plastic, or instrument marking tape should be sterilized a minimum of 10 minutes at 270 degrees in a gravity- displacement sterilizer or four min- utes at 270 degrees in an prevacuum sterilizer. The 10-minute gravity displacement cycle or four-minute prevacuum cycle also is required for items having lumens. Examples include hollow-bore needles or metal suction tips.
AORN recommends maintenance of a flash sterilization log. This log documents patient care delivery. It also can be used to validate practice should there be a legal inquiry at a later date. At a minimum, the flash sterilization log should include these items:
• identification number of the sterilizer;
• date and time of the cycle;
• general contents of the load;
• length and temperature of the exposure;
• portion of the cycle;
• identification of the sterilizer operator.
The patient’s name and operating room location also may be included in the log.
The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, has been particularly interested in flash sterilization documentation recently. Maintenance of the flash sterilization log will be helpful as you explain your practices to the surveyor during your next accreditation visit.
Sterilizer function should be monitored with mechanical, chemical, and biological indicators. Mechanical indicators include graphs and/or computer printouts indicating sterilizer function. A chemical indicator or integrator should be used with each flash sterilization load. Flash sterilizers should be monitored with a biological indicator daily. Biological indicators intended specifically for flash sterilization should be selected and used according to manufacturers’ instructions.
Implants should not be flash sterilized. Implants are defined as tissue or material placed within the body with the intent of permanent or long-term retention. Examples of implants include cardiac valves, orthopedic joints, and internal fixation devices such as screws, wires, and/or staples. Implants should be sterilized for a full steam cycle. A biological indicator should be run with each cycle containing an implant. Following a negative reading of the biological indicator, the item may be implanted into the patient.
Items that are heat and/or moisture sensitive may be sterilized by ethylene oxide. Items that are heat sensitive but moisture stable may be sterilized by low temperature hydrogen peroxide plasma sterilization. Items that may be immersed can be sterilized using peracetic acid as a liquid sterilant. Manufacturers of devices providing these means of sterilization should provide written instructions for use of these sterilization systems.
[Editor’s note: Reprinted with permission from AORN Online (http://www.aorn.org/), 1997. AORN Inc., 2170 S. Parker Road, Suite 300, Denver, CO 80231.]
• Gastroenterology, Managed Care, Endos-copic ASCs Creating Success April 2-4, Knoxville, TN. Sponsored by American Society for Gastrointestinal Endoscopy and The Endoscopy Center. Contact: Marilyn Bartling, GI Practice/ EASC Course, P.O. Box 59002, Knoxville, TN 37950-9002. Phone: (423) 558-0634.
• Same-Day Surgery Conference June 14-16, The Ritz-Carlton, Palm Beach, FL. Sponsored by American Health Consultants, publisher of Same-Day Surgery. For more information, contact Customer Service, American Health Consultants, P.O. Box 740056, Atlanta, GA 30374. Telephone: (800) 688-2421. E-mail: [email protected].
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.