Related Links
Perioperative Standards and Recommended Practices,
2009 Edition
ANSI/AAMI's ST-79 2006/AI:2008 Comprehensive Guide to Steam Sterilization
ANSI/AAMI's ST-79 2006/AI:2008 Comprehensive Guide to Steam Sterilization
IN FOCUS
Practicing the complete sterilization process
By Sheila Mitchell, RN, BSN, MS, CNOR
AORN Perioperative Nursing Specialist
It is critical to follow the complete sterilization process when cleaning all surgical instruments to achieve the greatest level of infection prevention. Cleaning, decontaminating, sterilizing and transporting are essential steps in the sterilization process-steps that are recommended by AORN, the Association for the Advancement of Medical Instrumentation (AAMI) and other organizations.
*Recommended Practices are applicable to all practice settings where surgical procedures are performed (ie, hospital, ambulatory, office-based, dental, interventional radiology and GI labs).
AORN and AAMI recommend practicing the complete sterilization process for sterilizing all surgical instruments in all practice.
Maintaining a strong stand on proper flash sterilization
Sterilization practices directly affect patient safety. These practices include flash sterilization, also known as the abbreviated cycle. Some facilities may take an abbreviated approach when flash sterilizing surgical instruments . If this approach to flash sterilization does not include the proper practice of each step of the sterilization process recommended by AORN, patients may be at risk.
Not adhering to all steps in the complete sterilization process for flashing and other types of sterilization may result in patients acquiring a surgical site infection or other poor outcomes. For example, improperly cleaned instruments used in ophthalmic surgeries, such as cataract instruments, may result in patients acquiring Toxic Anterior Segment Syndrome (TASS).
In addition to recommending proper cleaning and decontamination prior to flash sterilization, AORN recommends transporting the sterilized items to the point of use in a manner that prevents contamination. The best way to achieve this is by using closed containers that are specifically designed for sterilization (see AORN Recommended Practices for Sterilization in the Perioperative Practice Setting, Perioperative Standards and Recommended Practices, 2009 ed., pages 650-653).
Focusing on the complete sterilization process
Rather than continuing to refine the definition of flash sterilization, The Joint Commission is focusing on the process necessary for optimal patient outcomes, according to an April 7 article in Outpatient Surgery titled "Joint Commission Softens Stance on Flashing Cataract Instruments." In the article, Robert Wise, MD, vice president of standards at The Joint Commission, says "We will move away from focusing simply on the method of steam sterilization to looking at the process in a broader and more rigorous way-from the time the instruments leave the OR to their return to the OR."
This proposed process is consistent with ANSI/AAMI's ST-79 2006/AI:2008 Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities (2008 ed., pages 43-79 and 116), AORN's Recommended Practices for Sterilization in the Perioperative Practice Setting (Perioperative Standards and Recommended Practices, 2009 ed., pages 650-653) and AORN's Recommended Practices for Cleaning and Care of Surgical Instruments and Powered Equipment (Perioperative Standards and Recommended Practices, 2009 ed., pages 611-634), which continue to support the idea that flashing or abbreviated cycles should not be performed for convenience as an alternative to purchasing additional instrument sets or to save time.
Definitions of the multistep sterilization process
Cleaning: A process using friction, detergent and water to remove organic debris; the process by which any type of soil, including organic debris, is removed. Cleaning removes rather than kills microorganisms.
Decontamination: A process that removes contaminating infectious agents and renders reusable medical products safe for handling.
Sterilization: Processes by which all microbial life, including pathogenic and nonpathogenic microorganisms and spores, are killed.
Flash sterilization: A process designed for the steam sterilization of patient care items for immediate use.
Transporting sterilized flash items: A process of removing flash sterilized items from the autoclave in a rigid flash sterilization container to point of use.
Source: AORN Recommended Practices on Sterilization in the Perioperative Practice Setting, Perioperative Standards and Recommended Practices, 2009 ed., pages 650-653.
Read more news in AORN Connections.
*Recommended Practices are applicable to all practice settings where surgical procedures are performed (ie, hospital, ambulatory, office-based, dental, interventional radiology and GI labs).
AORN and AAMI recommend practicing the complete sterilization process for sterilizing all surgical instruments in all practice.
Maintaining a strong stand on proper flash sterilization
Sterilization practices directly affect patient safety. These practices include flash sterilization, also known as the abbreviated cycle. Some facilities may take an abbreviated approach when flash sterilizing surgical instruments . If this approach to flash sterilization does not include the proper practice of each step of the sterilization process recommended by AORN, patients may be at risk.
Not adhering to all steps in the complete sterilization process for flashing and other types of sterilization may result in patients acquiring a surgical site infection or other poor outcomes. For example, improperly cleaned instruments used in ophthalmic surgeries, such as cataract instruments, may result in patients acquiring Toxic Anterior Segment Syndrome (TASS).
In addition to recommending proper cleaning and decontamination prior to flash sterilization, AORN recommends transporting the sterilized items to the point of use in a manner that prevents contamination. The best way to achieve this is by using closed containers that are specifically designed for sterilization (see AORN Recommended Practices for Sterilization in the Perioperative Practice Setting, Perioperative Standards and Recommended Practices, 2009 ed., pages 650-653).
Focusing on the complete sterilization process
Rather than continuing to refine the definition of flash sterilization, The Joint Commission is focusing on the process necessary for optimal patient outcomes, according to an April 7 article in Outpatient Surgery titled "Joint Commission Softens Stance on Flashing Cataract Instruments." In the article, Robert Wise, MD, vice president of standards at The Joint Commission, says "We will move away from focusing simply on the method of steam sterilization to looking at the process in a broader and more rigorous way-from the time the instruments leave the OR to their return to the OR."
This proposed process is consistent with ANSI/AAMI's ST-79 2006/AI:2008 Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities (2008 ed., pages 43-79 and 116), AORN's Recommended Practices for Sterilization in the Perioperative Practice Setting (Perioperative Standards and Recommended Practices, 2009 ed., pages 650-653) and AORN's Recommended Practices for Cleaning and Care of Surgical Instruments and Powered Equipment (Perioperative Standards and Recommended Practices, 2009 ed., pages 611-634), which continue to support the idea that flashing or abbreviated cycles should not be performed for convenience as an alternative to purchasing additional instrument sets or to save time.
Definitions of the multistep sterilization process
Cleaning: A process using friction, detergent and water to remove organic debris; the process by which any type of soil, including organic debris, is removed. Cleaning removes rather than kills microorganisms.
Decontamination: A process that removes contaminating infectious agents and renders reusable medical products safe for handling.
Sterilization: Processes by which all microbial life, including pathogenic and nonpathogenic microorganisms and spores, are killed.
Flash sterilization: A process designed for the steam sterilization of patient care items for immediate use.
Transporting sterilized flash items: A process of removing flash sterilized items from the autoclave in a rigid flash sterilization container to point of use.
Source: AORN Recommended Practices on Sterilization in the Perioperative Practice Setting, Perioperative Standards and Recommended Practices, 2009 ed., pages 650-653.
Read more news in AORN Connections.