Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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1 8 S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M AY 2 0 1 4 tective equipment and following the manufacturers' instructions for use. Instruments must be disassem- bled and reassembled for clean- ing as they would be for termi- nal sterilization. Streamlining the reprocessing process does not mean corners can be cut. Run immediate-use cycles according to instrument manu- facturers' written instructions. Running 4- or 10-minute cycles in the OR as "flash" cycles may no longer be adequate to sterilize the more complex instrumentation in use today. Follow whatever exposure time manu- facturers recommend — some suggest 8-,10- or 20-minute cycles, and some provide specific instructions for immediate-use sterilization. Still others, espe- cially orthopedic suppliers, note that devices cannot be run through IUSS cycles. Importantly, immediate use is defined as the shortest possible time between sterilization and aseptic transfer to the sterile field. There is no shelf life for these instruments; you can't hold them over for another case or store them for later use. 3. How do you validate cycles? Chemical indicators should be placed in the most challenging location of rigid containers or wrapped packages and checked at the end of cycles to ensure they've reached the proper endpoint. Also, check the physical indicators on ster- ilizer tapes to ensure cycles reach correct temperatures for the required amount of time. Unless instrument manufacturers direct otherwise, avoid using gravity sterili- zation for immediate-use cycles. Some companies recommend against gravity cycles because they're not sufficient to achieve sterilization; they instead sug- I N S T R U M E N T R E P R O C E S S I N G Researchers have identified risk fac- tors for immediate-use sterilization. The most commonly documented rea- sons for "flashing" during hip and knee arthroplasties were: • OR turnover; • unsterile instruments received in the OR; • instruments becoming contaminated during surgery; and • reprocessing of one-of-a-kind items. The researchers noticed that smaller ORs had a higher incidence of immediate-use steriliza- tion. They theorized that it was more likely for surgeons and staff to mishandle or drop instru- ments in smaller ORs. They also found that ORs closer to the autoclave were more likely to send instruments for immediate-use sterilization when it wasn't indicated. Flashing was higher on Monday morning at the researchers' facility, a finding they found somewhat surprising, because instrumentation should be abundant at the start of the operating week. They acknowledged poor planning for a busy week of surgery could have been to blame. Conversely, the study notes flashing rates were lower during morning procedures, which the authors say highlighted an important point: Flashing is more likely to occur as case volumes increase throughout the day and resources are stretched thin, highlighting the need to have enough instrumentation to handle the demands of a full operating schedule. Notably, the researchers point out that only 10% of flashing cycles involved instruments that were contaminated intraoperatively — an acceptable reason to fast-track — which means most cycles were performed against recommended guidelines. The 2012 study, "An evaluation of immediate- use steam sterilization practices in adult knee and hip arthroplasty procedures," was pub- lished in the American Journal of Infection Control ( tinyurl.com/kkv4aw7 ). — Daniel Cook RESEARCH REVIEW Common Causes of Immediate-Use Sterilization REPEAT OFFENDERS Some sur- geons or nurses might be more inclined to send instruments for immediate-use sterilization. Aesculap, Inc. | 800-282-9000 | www.aesculapusa.com Aesculap, Inc. - a B. Braun company E!ciency That Saves Aesculap SterilContainer ™ Systems—the preferred choice for cost savings versus single-use blue wrap Call 610-984-9287 to discuss a customized savings program for your facility, or visit www.AesculapUSA.com to order the Aesculap SterilContainer ™ Information Kit. *Data on !le. Q SAVE up to 80% on operating expenses * Q SAVE reprocessing time from tears in single-use blue wrap; up to $50,000 annual savings * Q SAVE the environment by decreasing your waste stream by up to 5,000 pounds per year * 1405_InfectionControl_Layout 1 5/2/14 11:05 AM Page 18