3 4 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E M A Y 2 0 1 6
should be applied to the out-
side of every package unless
an internal indicator is visi-
ble.
• Type 2 (also called Bowie-
Dick tests) detect air leaks,
ineffective air removal and
the presence of non-condens-
able gases. Intended for daily
use in dynamic-air-removal
sterilizers, they should be run
through a cycle in an empty
chamber before the first load
of the day to test the system.
Internal indicators include:
• Type 3 are designed to
react to a single parameter of
the sterilization process, such
as time, temperature or
steam saturation.
• Type 4 are designed to
react to multiple parameters
of the sterilization process.
• Type 5 are integrating indicators, which react to all critical parameters over a
specified range of sterilization cycles. These indicators include a spore strip, in
which changing color signals the cycle's ability to eliminate microbes.
• Type 6 are emulating indicators, which react to all of the critical parameters of
a specific cycle.
You need to have established procedures in place for sterile processing and
surgical team members to follow in the event that the results of physical,
chemical or biological monitoring indicate that sterilization cycles are inef-
fective. Start by following these response protocols.
• Terminate a sterilization cycle that doesn't meet the required parameters.
• Remove malfunctioning equipment from service for inspection, mainte-
nance and testing.
• Reject the instruments or trays with indicators that show a failed result.
• Return incorrectly sterilized items to the sterile processing department
for another round of processing.
• Root out the reasons for a sterilization assurance indicator failure.
— Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC
When Sterilization Cycles Fail
• TRAY ADDITION Chemical and biological indicators report the adequacy of sterili-
zation conditions inside of instrument containers.
Pamela
Bevelhymer,
RN,
BSN
PLAN IN PLACE
