Dr. Hudson Garrett is currently employed as the Senior Director, Clinical Affairs for PDI. He holds a Bachelor of Science degree in Biology/
Chemistry, a dual Masters in Nursing and Public
Health, and a PhD In Healthcare Administration. In
this interview he discusses methods of OR sterilization, their limiations, and how hospitals can get better results.
SP: Assess how some of the tried and
true methods of OR sterilization are in
terms of limiting and/or preventing the
spread of various healthcare-associated infections?
Garrett: Sterilization is a proven method for achieving total kill of microorganisms, however breaches frequently occur within the process. When immediate use sterilization is utilized, there is increased risk for potential breaches
in the process, and you also may not have the biological indicator prior to
closing the patient, which is of course problematic. When sterilization is used,
the process should be regularly validated, the equipment frequently inspected,
and the staff members involved in the process should receive ongoing continuing education. The use of immediate use sterilization should be limited to
emergency situations where traditional sterilization methods cannot be used.
SP: Obviously, these HAIs are a significant problem.
Is that a result of those aforementioned methods
not being effective? Are those methods being done
improperly or not done at all? Is it a little bit of
Garrett: Breaches in sterilization are certainly a risk factor for a patient contracting a healthcare-associated infection, but they are by no means the only
concern. HAIs are caused by a variety of breakdowns in the chain of infection
transmission, most notably failure of healthcare providers to properly sanitize
their hands when clinically indicated. Many infections are transmitted via the
hands as vehicles for transmission. Hand hygiene with either soap or water or
an alcohol based hand rub can dramatically reduce the risk for transmission
SP: What can be done to attack the problem of
HAIs in the OR? How can the results of sterilization
efforts be improved?
Garrett: Most infections are transmitted as a result of one or more of the fol-
lowing: contaminated hands of the healthcare worker, contaminated environ-
mental surfaces, and/or the patient’s own skin flora. Instruments
and other supplies can be sterilized, and this will reduce the
presence of bioburden, however it will not eliminate the risk for
infection transmission totally. Operating room clinicians should
practice rigorous hand hygiene, routinely clean and disinfect
contaminated environmental surfaces, and properly use pre-
operative skin antiseptics to reduce the presence of flora on the
patient’s skin. These basic infection prevention interventions will
further reduce the risk for transmission of HAIs.
Sterilization methods continue to improve thanks to continu-
ous innovation, but we still find breaches in policy and proce-
dure due to lack of staff training and other reasons. Staff mem-
bers involved in the sterilization process should receive extensive
ongoing training to ensure competence. Additionally, a robust
monitoring program is critical to success.
SP: Do you think this is an issue on the rise or
decline right now? Is this a problem that can be
fixed? If so, how?
Garrett: Thanks to the efforts of many key organizations such as the U.S.
Centers for Disease Control and Prevention (CDC) and the Association
for periOperative Registered Nurses (AORN), the incidence of HAIs has
drastically declined in many categories, however there is always room for
additional improvement. The sterilization and infection prevention technologies that exist today are important tools in the battle to reach zero,
however the most significant variable is the healthcare staff that use these
tools. Products and technologies may kill bugs, but people prevent infections.
Dr. Hudson Garrett,
Clinical Affairs, PDI