SPECIALTY
ASSEMBLIES
Strategies for reducing flashing
Cost-effective ways to reduce flashing are possible, according to members of the Ophthalmology SA.
By Carina Stanton
Senior News Editor/Writer
Following an increased focus to reduce flashing in the wake of pressure from The Joint Commission and recommendations from AORN, members of the Ophthalmology SA recently discussed how they are finding cost-effective strategies to reduce flash sterilization in operating room suites.
"Reducing flash sterilization requires a paradigm shift," said Linda Timmons, RN, CNOR, past chair of AORN's Ophthalmology SA and director of surgery at Bascom Palmer Eye Institute in Miami. "We must all recognize that every patient deserves the same level of care, whether they are the first surgical case of the day or the last, and that requires standardized sterilization practices."
Donna Starkey, RN, CNOR, agreed that reducing flashing directly connects to providing standardized patient care. Starkey is a perioperative nurse and ophthalmic specialist who serves as communication chair for the Ophthalmology SA. Since last April, Starkey and her colleagues at Samaritan Hospital in Ashland, Ohio, have reduced flash sterilization in the OR by 40%.
Developing tailored alternatives
Starkey stressed that there is no one-size-fits-all strategy to reducing flashing, even in one facility, because different surgical specialties require varied instruments and varied time in the OR. Recognizing the varied sterilization needs required by different specialties at her facility, Starkey's director tasked each surgical specialty with devising its own plan to reduce flashing.
Like most specialties, Starkey and her ophthalmic surgery colleagues decided to purchase more surgical instruments, which her hospital administration approved. However, the ophthalmic instruments were delayed from the manufacturer, so Starkey and her team had to come up with an alternative solution to reducing flash sterilization.
"The key, we found, is close coordination with sterile processing technicians to ensure sterilized instruments are always available for the next case," Starkey said.
Working closely with sterile processing technician Kim Price, CSP-DT, Starkey and her ophthalmic perioperative colleagues established a daily process to sterilize instruments sets after every two ophthalmic surgeries (the facility averages 15 ophthalmic surgeries daily.) The sets are sterilized in a steam sterilizer located in the OR workroom. The sterilizer parameters are set exactly as those in the facility's sterile processing department are set. The instruments are sterilized in a covered flash pan. So, two complete and sterilized instrument sets are available prior to every ophthalmic surgery. Price also properly cleans instruments before they are sterilized, following manufacturer and sterile processing guidelines.
"Being able to have a qualified sterile processing staff member work with us in the OR is wonderful quality control for us," Starkey acknowledged.
Working in the OR at Samaritan Hospital in
Ashland, Ohio, Sterile Processing Technician Kim Price
sterilizes an instrument set as it would be in the facility's
sterile processing department.
On the first day of implementing these new sterilization processes, Starkey's facility received a surprise visit from The Joint Commission. "Because we had all discussed our new process and were adequately prepared prior to implementation, every staff member was able to articulate to surveyors what we were doing and why, and that made all of the difference," she said.
The facility passed the survey and received praise from the surveyors who commended the process to reduce flashing.
"While we are still working to get more instrument sets, we are also pleased to have established a cost-effective way to reduce flashing, just by streamlining our processes and collaborating with our sterile processing colleagues," Starkey added. "None of this would have been possible without support from our high-level administration."
Getting buy-in
Purchasing additional instrument sets to reduce the need for flashing requires administrative support because these instruments can be very costly, explained Timmons. For example, just one piece of a standard ophthalmic instrument set costs $8,000. Multiply that by the number of instrument sets that may need to be purchased, and your facility is looking at a significant financial investment, particularly for larger facilities that handle more surgical cases on a daily basis.
However, when you look at the bigger picture and think about what can happen if your facility is cited for flashing too often, the costs in lost revenue may be even greater than purchasing the instrument sets, Timmons added. "You have to look at the big picture and make sure you articulate that bigger picture when you ask administration to support reduced flashing."
Flash sterilization has been reduced by 24% over the past five months at Bascom Palmer Eye Institute in Miami, following strategies the facility implemented to reduce flashing, including:
1. Centralized processing in one geographic area to maintain standarized cleaning and sterilization procedures.
2. Outsourced instrumentation sterilization for ENT and Ortho specialties.
3. During FY 2008, equipment in the amount of $225,640 was purchased to reduce flashing frequency: $163,536 for instrumentation, $47,104 for trays, and $15,000 for phaco handpieces.
4. Changed procedure 4 min prevac with 1 minute dry to 4 minute prevac with 10 minute dry in covered pans.
5. Cultured the water in the bottom of the flash pans on vitrectomy trays and cataract tray. The microbiology results negative growth in a week.
In addition to administration buy-in, both Timmons and Starkey stressed that reducing flashing requires buy-in from all perioperative staff.
"As a specialty nurse clinician, it is my job to bring knowledge and information to my colleagues so we can stay current on practice and accreditation requirements, such as the move to reduce flashing. Sharing this knowledge empowers each of us and gives us the power to practice with the confidence that we all understand why we are altering our processes," Starkey said.
Networking for knowledge
Earlier this year Starkey, Timmons and other members of their Ophthalmology SA learned about the need to address flashing from a facility cited by The Joint Commission for using flashing too often. The perioperative nurses then attended a session given at AORN's 2008 Congress on updates to AORN's Recommended Practices for Sterilization in the Perioperative Setting. At this session the nurses learned that AORN recommends "use of flash sterilization be kept to a minimum ... and used only in selected clinical situations and in a controlled manner."
Following the session, Starkey and Timmons discussed this stricter stand against flashing with other members of their SA and made a commitment to share this information with colleagues at their facilities.
"Attending Congress and sharing concerns and practices with our SA colleagues is what has helped us to understand and communicate the need to reduce flash sterilization. We are all working toward the same goal, to provide safe patient care, and sharing knowledge and resources with our AORN colleagues helps us to do this," Starkey acknowledged.
Timmons encourages AORN members working to reduce flashing in their facilities to contact the Ophthalmology SA and share their challenges and strategies. She is particularly interested to learn how ambulatory surgery centers are working to reduce flashing. To speak with Timmons directly, send her an e-mail to ltimmons@miami.med.edu or access the Ophthalmology SA Online Community of Practice by visiting communities.aorn.org/COP and selecting Ophthalmology SA.
Additional Resources
"AORN Recommended Practices for Sterilization in the Perioperative Setting," pgs. 575-598 in
Perioperative Standards and Recommended Practices, 2008 Edition.
"Understanding Current Steam Sterilization Recommendations and Guidelines," by Cynthia Spry, RN, MA, MSN, CNOR, in the October 2008 issue of AORN Journal.
Read more news in AORN Connections.