CONTAINMENT PANS Transport flashed instruments from the sterilizer to the point of use in a sealed container that's approved for flashing.

Immediate-use steam sterilization (née flashing) is about as rare as a lunar eclipse at some outpatient surgical centers. Take the Sharp Chula Vista (Calif.) Outpatient Surgery Center, for example. This year, they've flashed 6 times — or once every 333 or so procedures. That was high compared to last year, when they flashed all of 4 times. "And those times when we had to do it, everybody felt bad about it," says Manager Mindy Hoffman, RN, CNOR. "If we flashed, you can bet it was a true emergency" — like an odd drill bit that came in from a loaner ortho set or a retractor wing nut that fell to the floor while someone was trying to tighten it.

Such infrequent flashing wasn't always the case at the 12-year-old surgery center. In the early years, routine flashing was the norm. Each eye surgeon had a single set of instruments — that's right, there weren't any backup sets — that techs flashed after each case. "We were flashing all day long," says Ms. Hoffman.

Soon after an infection prevention consultant advised the center that it's neither safe nor wise to run rapid cycles to cover up for an inadequate instrument inventory, Ms. Hoffman went to her superiors with a plan of action. From now on, she told them, every time we have to flash a set of instruments, we'll invest in a backup set for it. They agreed. "It was a chunk of change, but they said do what you need to do to get to where you need to be." And so before long, the facility had invested in 6 new sets of eye instruments for its cataract surgeons. "Now that we have enough backup instruments, we hardly ever flash," says Ms. Hoffman.

Ms. Hoffman's simple flash-avoidance policy: Have enough instrument sets for your daily caseload or schedule cases to allow for enough time between cases for full-cycle reprocessing. "We as a staff pride ourselves on not flashing," she says.

Only in an emergency
AORN guidelines say you should only flash when time prohibits all other options. While it's best to avoid flash-sterilizing surgical instruments in non-emergency situations, there are times when you have no other choice but to run instruments through an immediate-use cycle. Trish Stoutzenberger, ST, CRCST, CHL, manager of central sterile supply at Lancaster (Pa.) General Hospital, summed it up neatly when she said, "Immediate-use sterilization is an effective way to quickly get instruments back into the hands of physicians when — and only when — emergent situations prevent the possibility of full reprocessing cycles."

Fifteen of the 18 facility managers we questioned last month say they only flash-sterilize in an emergency. "We flash only for instruments that are dropped," says Maureen Lamson, RN, nurse administrator at the Annapolis (Md.) ENT Surgery Center. "Only if surgeons bring equipment with them," says a hospital OR manager. For Karen Tyre, RN, CNOR, perioperative educator at the Southeast Georgia Health System in Brunswick, Ga., flashing is an administrative burden. "If we flash, we have to fill out an event report explaining why," she says.

Sometimes flashing is unavoidable, such as when several of the same types of cases are stacked consecutively on the schedule and you don't have enough instrument trays. Then there are times when an instrument literally can't take the heat of a full cycle. Take, for example, the tonometer ophthalmologists use to measure intraocular pressure before they take an intraoperative measurement with an ORA (Optiwave Refractive Analysis) system to determine the precise IOL implant power they'll need. The heat of a long cycle would destroy the tonometer, "so we flash it in a closed container and carry it into the room," says Imelda Kelly, RN, the director of regulatory compliance at the Barnet Dulaney Perkins Eye Center in Phoenix, Ariz.

Flashing done right
As the saying goes, if you're going to flash, do so safely. Here are 4 pieces of advice for doing so.

1. Use a closed container approved for flashing. When you do flash, recommended practices say that you should use closed rigid sterilization containers designed for flash sterilization cycles, as opposed to open trays. The containers can reduce the risk of contamination when staff brings the instruments to the point of use by keeping them protected and sealed. "If you have to flash sterilize, use a sterilization container," says Connie Cecil, RN, BSN, CNOR, surgical services director at Dearborn County Hospital in Lawrenceburg, Ind. Ms. Cecil is not alone: 16 of the 18 facility leaders we surveyed transport flash-sterilized items from the autoclave to the OR in flash sterilization containers. Only 2 walk uncovered baskets or trays of instruments to the OR. Be sure that the manufacturer has validated the container for typical flash sterilization cycles.

2. Validate cycles. "If the need to flash arises, make sure you add a biological and read it to prove the contents are sterile prior to use," says Ms. Tyre. The recommended practices say that you should use Class 5 chemical integrating indicators in each container or tray you flash. These are relatively inexpensive, so taking this extra step means spending a couple more dollars on each flash to ensure the instruments are effectively sterilized.

3. Maintain a log of all flash cycles. We heard from one SPD manager who each day would collect the flash logs from each flash sterilizer and record each item flashed, the parameters that were met and the reason for the flash process for that item. By reviewing these logs, he was able to identify the most commonly flashed items — and make purchases to reduce these incidents. "Logging this information is time consuming, but it gives a great picture of what is actually going on daily with flash sterilization," he says. Logging also lets you track the tray to a patient in the case of a surgical site infection.

4. Clean before you sterilize. Finally, don't shortcut the cleaning process. Be sure to properly clean, rinse and decontaminate before you sterilize a rapid-cycle load. "You can't produce a sterile product when bioburden remains," says Andy Beck, RN, BSN, CAPA, director of surgical services at Providence Surgery Center in Missoula, Mont.