Are You Making These Sterilization Mistakes?

Scrub devices well enough to loosen organic debris - any remaining film may prevent complete exposure of the device to the sterilant.

Whether you're in a large hospital or small ambulatory surgery facility, the pressure to rush through cleaning and sterilizing equipment can be intense. But forming strict sterilization protocols, and sticking to them, is crucial to maintain quality standards and provide excellent patient care. We've talked to a number of sterilization experts who've seen the gamut of sterilization mistakes, from not scrubbing instruments long enough to letting them sit too long. We hope their advice will help you catch these errors and take steps to fix them.

Mistake #1: Insufficient Cleaning
According to our experts, many staff members frequently don't scrub devices long enough and thoroughly enough before placing them in an automatic reprocessor. However, manual cleaning is critical. Scrubbing loosens organic debris that may shield underlying microorganisms from the chemical germicide during automatic reprocessing. Scrubbing is particularly overlooked with cannulated devices, such as endoscopes and other equipment that contain long, narrow channels that hinder scrub brush access, says New York medical sterilization consultant Charles O. Hancock, RAC. Mr. Hancock claims to have seen multiple occasions where personnel have just run water through an endoscope channel until it comes out without any change in color. "Just because the water is clear doesn't mean that the instrument is clean," he says.

Our experts recommend sponging and brushing your endoscopes inside and out, using a long, thin brush to scrub the channels. Be sure to remove and scrub all valves, and remember that certain channels on an endoscope may require special cleaning adapters. Also, when scrubbing any equipment, follow the manufacturer's recommendations when deciding what detergent to use. Our experts claim to have seen everything from hand soap to steel wool to Clorox used for scrubbing.

Mistake #2: Failing to Follow the Manufacturer's Cleaning Recommendations

New Jersey sterilization consultant Anne Cofiell states that "Many people still sterilize according to their preference, without any regard for the manufacturer's recommendations." Unfortunately, manufacturers do not always provide good information on how to clean a specific instrument.

While the FDA now requires that all manufacturers provide use and cleaning instructions with their equipment, older instruments frequently lack even cursory reprocessing recommendations.

"There are still ways to get good information," says Mr. Hancock. "The first thing you should do is go back to the manufacturer and press for the answers; you can also network with associations and other medical centers." Sue Kuhnert, Manager of Validation and Sterilization Programs for the New York-based Sterilization Technical Services, agrees. "Many manufacturers retroactively form recommendations for older products," she says. "If they haven't already done so, ask them to. If they can't comply, tell them that you will no longer be able to continue using their products. That usually does the trick."

Mistake #3: Failing to Keep Liquid Chemical Sterilant at an Effective Concentration
"Knowledge of the sterilant's concentration is usually poor, and people don't use test strips correctly or routinely," opines Mr. Hancock. Dennis Stephenson, Supervisor of Sterile Processing for the University of Kansas Medical Center, adds that staff members tend to use the same bath of liquid chemical sterilant over and over, causing it to dilute and lose effectiveness. Mr. Hancock believes that you should either test your solution each time an instrument is about to be reprocessed, or you should only use single-use sterilants.

Always sponge and brush your endoscope inside and out.

Mistake #4: Improper Loading
When loading items into an automatic reprocessor, rule No. 1 is do not overload, says Zoe Aler, RN, a member of the Association for the Advancement of Medical Instruments' sterilization standards committee. Placing too many items in a sterilizer will decrease the reprocessor's effectiveness, cautions Mr. Hancock. When items are tightly packed together with a rubber band or even touching one another, instead of stacked side by side without touching, the sterilant may be unable to reach all of the surfaces that need to be cleaned. If you need to keep items together, consider stringing them together rather than bundling with a rubber band, suggests Ms. Aler.

Another mistake that can interfere with sterilant contact is failing to disassemble equipment into all of its parts before reprocessor loading. "Surgical instrumentation is getting more and more sophisticated, with many moving parts," says Kansas-based healthcare sterilization consultant Neal Danielson. He emphasizes the importance of disassembling instruments before cleaning to allow the sterilant to penetrate to all areas.

Mistake #5: Improper Packaging
When sterilizing a packaged device, the air within the device needs to be removed and replaced with the sterilant. The way you package can facilitate or interfere with this process, warns Mr. Hancock.

The worst offense is to adopt a "one-wrap-fits-all" mentality.

While it's true that stocking wraps in only one large size instead of multiple sizes would probably help keep inventory costs low, this can lead to inefficient sterilization. If a smaller item needs to be wrapped and you only have one size, your staff will need to fold the wrap over many times. This is wasteful, and it prevents the sterilant from reaching the instrument completely. "Keep multiple size flat-wraps and multiple size pouches in inventory," advises Ms. Aler. "When double wrapping with paper-plastic pouches, use a smaller one inside of a larger one so that there is no need to fold one over."

Mistake #6: Allowing Soil to Dry
On a busy day when you're short-staffed, it may be tempting to let used equipment sit while you attend to other, more pressing duties. But according to Ms. Kuhnert, it is much more difficult to reprocess the item if it has sat for a while. "Soil such as blood can actually damage some instruments if it stays on for too long," adds Mr. Danielson. Our experts recommend trying to reprocess all equipment as soon after it is used as your duties permit.