Tips for Effective Flash Sterilization

Different outpatient surgery facilities employ flash sterilization, which is simply steam sterilization with no drying or packaging, quite differently. Some facilities flash sterilize single instruments that have become contaminated; others routinely flash anything and everything. Most follow protocols that are somewhere between these two extremes.

When you flash sterilize, you do need to take extra care to make sure the items are properly decontaminated, that the steam reaches all surfaces of the instruments, and that the items are not re-contaminated upon removal from the sterilizer. In this article, I'll explore the theory and practice of flash sterilization and present some guidelines to help you address these three important concerns. One note: This article will not attempt to define the circumstances under which flash sterilization is appropriate. There really is no good answer to that question that would apply to every facility.

Decontaminate Thoroughly
As with all types of sterilization, cleaning is the most important step-you cannot sterilize a dirty instrument. In Central Service departments, the decontamination activity appropriately takes place in a negative pressure area physically separated from the prep, pack, and sterilization areas. But too often, flash sterilization takes place in a busy, patient-care area, by staff that is not trained in proper cleaning techniques.

If you are routinely flash sterilizing complete sets between cases (which I do not recommend; it's better and safer to take the time to sterilize wrapped packs), you must dedicate a secured place and trained staff for the all-important job of decontamination. Make sure your staff understands the basics of how to separate clean instruments from dirty, disassemble and reassemble complex instruments, and properly use washer/decontaminators and ultrasonic equipment. Make sure the decontamination function is supervised by someone who has the time and training for the job.

Don't Overload
If you can sterilize a single surgical instrument in three minutes, you may think, why not sterilize two? Or three? Or perhaps an entire set?

The kinetics of effective steam sterilization require the steam to condense on the surfaces of the items being sterilized, where it gives up its latent heat to the object and then evaporates. It's this condensation and the associated heat transfer that allow items to be heated much more rapidly in steam than in dry heat. This evaporation creates a temporary vacuum that pulls fresh steam to the surface where more heat is transferred until a stable condition is reached (when the steam and the object being sterilized are the same temperature). This is called the conditioning phase.

The length of the conditioning phase will vary depending upon the amount of metal mass in the load, the source and quality of steam, and the type of cycle used (gravity, pre-vacuum, or steam-flush pressure pulse [s-fpp]).

If you load the sterilizer with too many instruments, or instruments that are too heavy, you will prevent this transfer of energy from occurring in the short amount of time that a typical flash cycle usually takes. Therefore, keep sets simple and the instruments spaced so that steam reaches all surfaces uniformly.

Do not attempt to flash sterilize power tools-there are too many hidden crevices and places to trap air. You can flash lumened instruments in gravity cycles for 10 minutes, pre-vacuum cycles in four minutes, and s-fpp cycles in three minutes. Make sure you open all hinged instruments and ratchets, disassemble all complex instruments, and place instruments with concave surfaces so that the surface does not pool water or trap air.

Never flash sterilize implantables. Implantables need to be quarantined until you obtain the results from the biological monitoring of the sterilization cycle.

Recommended Steam Sterilization Parameters for 270oF/1320C