SP: Every stage of OR steril-
ization is important, but what
step is the most crucial?
Matt Smith, Marketing Manager, Healthmark
Industries: One of the most important factors
is cleaning and disinfecting prior to sterilization.
If the instruments are not properly cleaned,
bioburden, the number of bacteria living on a
surface before sterilization, will be higher. This
means bacteria and other microorganisms may
still exist after sterilization is completed. This
can potentially cause serious harm to the patient.
To know that instruments are being cleaned
properly every time, it is important to regularly test
washers and cleaning equipment.
Chuck Hughes, Vice President of Infection
Prevention Consulting Services, Crosstex
International/SPSmedical Supply Corporation,
Cantel Medical Corporation: When sterilization
is done in the OR, it is most often immediate-use
steam sterilization (IUSS), formerly referred to as
flash or emergency sterilization. This steam sterilization method is not recommended for routine
use, as items may be vulnerable to contamination
by exposure to the environment and handling by personnel while transporting to point of use. The most crucial step is knowing that the manufacturer’s
instructions for use (IFU) have been followed for cleaning prior to sterilization. Complex instruments may require detailed cleaning procedures that
differ greatly from the healthcare facility’s standardized cleaning procedures.
Sterilization 101 states, you cannot sterilize if you do not first clean.
Rosie D. Lyles, MD, Head of Clinical Affairs for Clorox Healthcare:
Often times in healthcare settings, there’s a rush to clean the OR in between
procedures, and some surfaces may not get the attention they need. However,
cleaning and disinfecting in between patients is extremely important to ensure
infection-causing pathogens do not spread from patient to patient or to staff.
According to industry guidelines from the Association of periOperative
Registered Nurses (AORN), the Association for Professionals in Infection
Control and Epidemiology (APIC), and the Association for the Healthcare
Environment (AHE), between procedures the OR should be disinfected
from high to low and from clean to dirty areas while wearing clean gloves
and using a clean, lint-free or microfiber cloth moistened with an Environmental Protection Agency (EPA)-registered disinfectant. Items such as
tables, furniture, receptacles, pneumatic tourniquet cuffs, mattress covers
and blood pressure cuffs should be disinfected following manufacturer instructions for product use. Floors surrounding the patient area also should
be disinfected between patients.
In addition to environmental surface disinfection, another crucial OR
infection prevention step to keep in mind is reducing bacteria on a patient’s skin prior to a procedure. When it comes to surgical site infections
(SSIs), the primary source of contamination is the patient’s skin. That is
why the “Compendium of Strategies to Prevent Surgical Site Infections
in Acute Care Hospitals: 2014 Update,” led by the Society for Healthcare
Epidemiology of America (SHEA) and the Infectious Diseases Society of
America (IDSA), recommends the use of an appropriate antiseptic agent to
perform preoperative surgical scrub and suggests providing patients with
instructions and information on reducing infection risk prior to surgery.
SP: When it comes to OR sterilization, what
is a practice or technique that hospital staff
should be more educated on?
Smith: Healthcare workers need to be educated on the particular requirements and manufacturer’s IFU. This education is crucial for healthcare
providers to know before reprocessing, because equipment can vary on the
types and settings for proper reprocessing. It is important to know which
steps are specific to the instruments a hospital is reprocessing to prevent
error and inefficient sterilization.
Stephan Kovach, Director of Education, Healthmark Industries: Of
course the IFU is first and foremost, but after that it is still IUSS. Hospitals
need to be aware of the proper use of IUSS of the sterilization process,
because some instruments require special cleaning.
Lyles: It’s essential for OR staff to comply with all sterilization and disinfection protocols at all times. Even the best products can’t stop the spread
of infection if they are not used properly. Environmental services (EVS)
and clinical staff need to be well-educated on infection prevention protocols, and their compliance should be regularly observed and monitored
to ensure timely feedback. Healthcare professionals need to understand
how critical their role is in preventing the spread of infections and why it’s
critical that they perform these tasks correctly.
SP: How has OR sterilization technology ad-
vanced in the past five years? Where will we
be 5 years from now?
Hughes: OR sterilization has advanced in recent years in two ways. First, by
recognizing that not all devices can be processed in gravity displacement and
therefore, the word flash should be changed to immediate-use steam sterilization.
Many OR sterilizers have cycles that are still labeled flash which usually refers to
gravity displacement. Now that staff understand that IUSS can be accomplished
by gravity displacement or dynamic air removal, OR sterilizers should be relabeled to say which method they are set to. This is particularly important when
device manufacturer’s IFUs state gravity or dynamic air removal as the validated
method of sterilization. The second advancement has been AORN’s recommendation to use approved sealed containers in place of open trays. This change en-
Keeping It Clean, Safe &
Industry experts recently offered their input regarding OR sterilization efforts, strategies and new
technologies for combatting infections that can inhibit recovery times and procedural success.
Rosie D. Lyles