OR Manager March 2022 - 29

AMBULATORY
SURGERY CENTERS
tors should be on the inside, reading
multiple parameters including pressure
and time. Type 5 or type 6 are the preferred
chemical indicators for the inside
of the package, but type 3 or 4 can be
used as well. Be sure to check that the
chemical indicators are placed correctly.
A recent study on the effectiveness
of chemical indicators showed that
13.5% of chemical indicators did not
change. Further research was needed to
see if there was an autoclave malfunction
or operator error that caused that
13.5%; however, if everyone is consistent
on placement, monitoring, and documenting
all elements in central sterile,
it will be easy to discern when something
is not working correctly.
The type 2 chemical indicator, also
known as a Bowie-Dick test, should be
used daily for any gravity displacement
steam sterilizers. According to AORN
guidelines, running the test before the
first load each day and after the warmup
cycle is complete is suggested. The
Bowie-Dick test does not replace any
biological indicator testing. When using
biological indicator testing, use the correct
spore test with the type of autoclave
and follow the manufacturer's IFU
on how to load, run, and read the test.
AORN suggests running a spore test
daily, but at minimum once a week on
every autoclave in central sterile.
Sterilize instruments
After the cleaning and packaging is complete,
the last step in central sterile is
sterilization. The facility must always
clean and sterilize any reusable semicritical
and critical instruments. Like
the other machines and items used
throughout central sterile, always follow
the IFUs on how to load, run, monitor,
unload, and clean the autoclaves.
Cycle and drying times must be done
correctly. If anything is taken out before
the complete cycle, there is no guarantee
that the instruments are completely
sterilized before being used on another
patient. Many pathogens can live on a
surface for long periods. For instance,
www.ormanager.com
Hepatitis B and Hepatitis C are a few
of the pathogens that can remain on a
surface for days and transmit easily if
not killed correctly. Another indication
that sterilization was not completed for
steam sterilizers is if packages come
out wet after the full cycle is complete.
If this happens, a series of investigations
must be done to find the error in
the sterilization process.
Determine how loaded the autoclave
is and if the packages stayed in the full
cycle; then, run biological tests to confirm
if the autoclave is working or not and
see if there are any mechanical errors
such as clogged drains. If the error is
found, run a series of biological tests to
confirm that the autoclave is fixed and
rerun packages that were running before
the error occurred. If it is not fixed, remove
the autoclave and packages from
rotation and seek service. To maintain
the safety of the patients that the instruments
are being used on, as well as the
staff using the instruments, it is important
to monitor and document every load.
If there is any doubt that something is
not properly working, pull all instruments
from the failed cycle out of rotation and
begin tests to diagnose the problem.
Lastly, other solutions can help maintain
the sterility of instruments in an
ASC. One solution is the reprocessing
of single-use devices. Facilities cannot
reprocess single-use devices. However,
using an FDA-cleared third-party reprocessing
manufacturer, a facility can
guarantee the proper sterilization and
inspection of single-use devices. Reprocessing
can help limit costs in the
central sterile department, as well as
return the devices to a state as if they
were new from the manufacturer. Finding
ways to mainstream central sterile
while keeping proper infection control
can help keep processes and procedures
consistent.
ASCs must always remember to follow
the IFU, monitor and document materials,
run tests to make sure all equipment
is working, and follow the steps
laid out by guidelines from the appropriate
regulatory bodies. By practicing all
these steps and prioritizing having a
sterile environment, the safety of both
patients and staff can be achieved. ORM
-Erica Smith, MBA, is a
surgical solutions specialist
at Henry Schein, Inc.
In her role, Smith helps
guide healthcare professionals
in conducting
proper infection prevention
protocols throughout ASCs.
References
$68,000 proposed OSHA fine for ASC
raises concerns: Is the field complying?
Relias Media: Same-Day Surgery.
May 2013.
Comprehensive guide to steam sterilization
and sterility assurance in
health care facilities. Association
for the Advancement of Medical Instrumentation.
2017.
Function of Central Sterile Service Department.
Philadelphia Technician
Training Institute EDU. December
20, 2021.
Guidelines for perioperative practice.
AORN Inc. 2021.
Mathias J. New scoring process lowers
infection control findings. OR Manager.
2020:36(1):1, 6-11.
Panta G, Richardson A K, Shaw I C, et
al. Effectiveness of steam sterilization
of reusable medical devices in
primary and secondary care public
hospitals in Nepal and factors associated
with ineffective sterilization:
A nation-wide cross-sectional study.
PLOS ONE, 14(11). 2019.
Salmon N. Danger in the OR: Dirty surgical
instruments. RN.com. 2015.
Seavey R. Education & training packaging
for sterilization. Managing Infection
Control. 2008.
Zhou W, Ye C, Huang X, et al. Efficacy
of cleaning methods for ophthalmic
microscopic instruments: A comparison
study. AORN Journal, 112(2),
112-121. 2020.
OR Manager | March 2022 29

https://www.reliasmedia.com/articles/63155-68-000-proposed-osha-fine-for-asc-raises-concerns-is-the-field-complying https://www.aami.org/detail-pages/press-release/updated-steam-sterilization-standard-for-healthcare-facilities-st79-now-available https://www.ptt.edu/blog/function-of-central-sterile-service-department/ https://www.aorn.org/guidelines/about-aorn-guidelines https://www.ormanager.com/cms-expects-greater-scrutiny-joint-commission-surveyors/ https://www.doi.org/10.1371/journal.pone.0225595 https://www.rn.com/nursing-news/dirty-surgical-instruments/ https://multimedia.3m.com/mws/media/504696O/packaging-for-sterilization-mic-jan08.pdf https://www.doi.org/10.1002/aorn.13105 http://www.ormanager.com

OR Manager March 2022

Table of Contents for the Digital Edition of OR Manager March 2022