How you transport flash-sterilized items from the autoclave to the OR has come under scrutiny as of late. Walking uncovered baskets or trays of instruments across an unsterile corridor is a no-no, forbidden by Medicare inspectors and accreditation surveyors and frowned upon by AORN standards and infection preventionists. Their concern: The trip from the chamber to the sterile point of use could expose just-sterilized items to airborne contaminants in the environment.

Enter flash sterilization containers: sealed, metal vessels specially designed for immediate-use sterilization cycles (a euphemism for flashing) to protect instruments during transport to the point of use. Instruments remain in these containers while they're flashed and transported. You remove the sealed container from the sterilizer and walk or wheel it to the OR. If you flash, you can only transport flashed items to the sterile field in a flash container, says Jan Davidson, MSN, RN, the new AORN perioperative education specialist. The container that you use for full-cycle terminal sterilization may not be interchangeable with the one that you use for flash sterilization. AORN's 2011 Standards of Practice specifically say to use a container that is designed and intended for flash-sterilization cycles.

Selecting the right container
Ramona L. Conner, MSN, RN, CNOR, AORN's manager of standards and recommended practices, says flash containers address some of the challenges associated with flash sterilization. "They're a wonderful invention, a great creation to minimize the possibility of human error during flashing."

In addition to noting the frequency with which you flash — and scolding you if it's too often — Medicare inspectors and accreditation surveyors are examining all aspects of flashing, including whether you're running the proper cycle and using the proper flash container, says Ms. Conner.

When shopping, pay close attention to the sterilization cycles for which the manufacturer has validated the container. "Not all sterilization containers have been validated for typical flash sterilization cycles," says Ms. Conner. "Unless the manufacturer has tested the container under the conditions under which you're going to use them, you can't be absolutely certain that you're going to have a sterile product." The manufacturer should provide data that demonstrates that sterilization can be achieved when a sealed container is used for immediate-use sterilization, adds Ms. Davidson.

How many containers will you need? Robyn North, RN, BSN, the OR manager at Oroville (Calif.) Hospital, which paid close to $10,000 for 7 flash containers in 3 different sizes, says flashing is necessary when the schedule and her instrument inventory conspire against her, as when several vaginal hysterectomy and cataract cases are stacked consecutively on the schedule and she has neither enough instrument trays nor time to wrap and sterilize.

Remember to decontaminate the containers after every use. "Don't assume that just because the container itself has gone through the sterilization process that it hasn't come in contact with contaminants on surfaces," says Ms. Conner. Be sure your reprocessing techs follow manufacturers' instructions for cleaning and maintaining containers between uses.

Hallway safety
Jeanne Fanoni, RN, director of nursing at Cook Children's Pediatric Surgery Center in Plano, Texas, was in search of a safe way to transport sterile instruments from the autoclaves to the ORs for those "4 to 8 times a month when we need to do immediate-use sterilization."

Before Ms. Fanoni bought 2 flash sterilization containers, her reprocessing techs would don mitts and walk flash-sterilized items to the OR in open baskets. Now they're wheeling unwrapped instruments over in sealed containers. Techs pull the containers right out of the autoclave onto a waiting adjustable table with wheels. "It's easier to push something on wheels," she says.

It's only a few footsteps to cross the corridor that separates the 2 autoclaves from the 5 ORs, but the goal is safe transport of the instrument to the point of use while maintaining the sterility of the item until it's needed. "We were running the risk of [instruments] becoming contaminated in the hallway," says Ms. Fanoni. "We wanted something we could use to take us across the hallway safely."