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Make an Impact With Small Moves
Improvements in both workflow and staff attitudes are part of a leader’s responsibilities, but your interventions in these areas don’t need to be major to make...
Question: Due to budgetary restraints we discontinued our in-house laundry service in our facility and now outsource it. Since then, I've been having a terrible time with stained linen. I've been told I am "old school" because I will not accept stained linen. I have not been able to find documentation from AORN or AAMI to support if it's okay or not okay. I'm having a very difficult time accepting that a stain is sterile when it can't be identified. What is your advice?
Answer: The only way to be absolutely confident that stained linens are safe to use is to have a representative sample cultured by a sterilization testing laboratory. However, you can be reasonably sure that the stain is not harmful by considering the source of the stain and the cleaning process. (The material has nothing to do with the toxicity of the stain)
We can assume that most stains are caused by bodily fluids. That is reason enough to handle the dirty linens gloved and with extreme care. In a washing machine, the linens are subjected to high temperatures and perhaps chlorine bleach. This combination will kill most harmful bacteria, but not all. They then are dried at very high temperatures that further reduce the bioburden.
Depending upon the source of the stain, this probably is enough to make the linen safe to handle. The stain then simply becomes an aesthetic issue. Work with your infection control committee to set a policy that would determine how to identify the types of stains that can safely go through this process and those that might not. In order to do this, they must have a thorough understanding of the temperatures, detergents, bleaches, etc. that the laundry is using, as well as the various causes for stains that typically occur at your facility.
On a related note, if you're using a laundry service, you should be especially vigilant about the damage that occurs to the fabric undergoing use and reuse. A contract laundry service may not inspect the linen carefully before returning it. The barrier properties of the linen are reduced with each successive use and laundering. Ask yourself, at what point does the barrier property cease to be effective? I would certainly not use 140TC linen as a CSR wrap and only use barrier linens by following the manufacturer's written instructions for laundering, counting uses, etc.
Question: In your August 2001 column on wet packs (see it on the web at http://www.outpatientsurgery.net/2001/os08/infection.shtml), you gave this advice: "Never crack the door after the cycle is finished and let the items ?cook' in the still-hot sterilizer. Sterile hot air will rush out and non-sterile cool air will rush in, carrying with it potential contamination for any packs inside that are wet." In our facility, we always crack the doors of the sterilizers to allow the items to cool down; otherwise they're too hot to be handled. Even if we could handle the hot items, nonsterile hot air would hit the items anyway when the door was opened. What do you propose that we do?
Answer: My reference to cracked doors specifically had to do with wet packs. Many facilities try to solve wet pack problems by extending the drying time and cracking the door to let the wet items cook longer. This is the worst thing you can do if the packs are wet, because incoming nonsterile air will use the wetness to gain access to the contents. This is not the way to solve wet pack problems.
It's okay to let items cool down in the sterilizer and even crack the door if you are sure that you don't have a wet pack problem. This is still not ideal procedure, however. Items will cool down faster if you remove them immediately-you can purchase gloves and/or tray/basket/cart handles that allow you to remove hot items from the sterilizer without burning your hands. Also, letting the items cool down in the sterilizer also ties up the sterilizer, taking it out of production.
Question: We use reusable OR linens in our facility. How do we quality check fluid-proof and fluid-resistant surgical gowns and drapes, and how should we track the number of uses (all the linens that I have seen have a specific life span)?
determined count. This is also a good inventory control tool (it is my experience that the two areas of a hospital that are the most in need of inventory control and management are surgical instruments and linens). Note that there are various testing methods for fabric fluid repellency (ASTM
Answer: The only way to be absolutely confident that stained linens are safe to use is to have a representative sample cultured by a sterilization testing laboratory. However, you can be reasonably sure that the stain is not harmful by considering the source of the stain and the cleaning process. (The material has nothing to do with the toxicity of the stain)
We can assume that most stains are caused by bodily fluids. That is reason enough to handle the dirty linens gloved and with extreme care. In a washing machine, the linens are subjected to high temperatures and perhaps chlorine bleach. This combination will kill most harmful bacteria, but not all. They then are dried at very high temperatures that further reduce the bioburden.
Depending upon the source of the stain, this probably is enough to make the linen safe to handle. The stain then simply becomes an aesthetic issue. Work with your infection control committee to set a policy that would determine how to identify the types of stains that can safely go through this process and those that might not. In order to do this, they must have a thorough understanding of the temperatures, detergents, bleaches, etc. that the laundry is using, as well as the various causes for stains that typically occur at your facility.
On a related note, if you're using a laundry service, you should be especially vigilant about the damage that occurs to the fabric undergoing use and reuse. A contract laundry service may not inspect the linen carefully before returning it. The barrier properties of the linen are reduced with each successive use and laundering. Ask yourself, at what point does the barrier property cease to be effective? I would certainly not use 140TC linen as a CSR wrap and only use barrier linens by following the manufacturer's written instructions for laundering, counting uses, etc.
Question: In your August 2001 column on wet packs (see it on the web at http://www.outpatientsurgery.net/2001/os08/infection.shtml), you gave this advice: "Never crack the door after the cycle is finished and let the items ?cook' in the still-hot sterilizer. Sterile hot air will rush out and non-sterile cool air will rush in, carrying with it potential contamination for any packs inside that are wet." In our facility, we always crack the doors of the sterilizers to allow the items to cool down; otherwise they're too hot to be handled. Even if we could handle the hot items, nonsterile hot air would hit the items anyway when the door was opened. What do you propose that we do?
Answer: My reference to cracked doors specifically had to do with wet packs. Many facilities try to solve wet pack problems by extending the drying time and cracking the door to let the wet items cook longer. This is the worst thing you can do if the packs are wet, because incoming nonsterile air will use the wetness to gain access to the contents. This is not the way to solve wet pack problems.
It's okay to let items cool down in the sterilizer and even crack the door if you are sure that you don't have a wet pack problem. This is still not ideal procedure, however. Items will cool down faster if you remove them immediately-you can purchase gloves and/or tray/basket/cart handles that allow you to remove hot items from the sterilizer without burning your hands. Also, letting the items cool down in the sterilizer also ties up the sterilizer, taking it out of production.
Question: We use reusable OR linens in our facility. How do we quality check fluid-proof and fluid-resistant surgical gowns and drapes, and how should we track the number of uses (all the linens that I have seen have a specific life span)?
| Answer: Some manufacturers of reusable gowns and drapes print a checkered box in one corner of the fabric as a way to keep track of how many times the fabric was used. Each time you use the fabric, you color in one of the boxes with an indelible, moisture-proof ink. Another way is to bar-code the gown or drape and have a computer program that will count and warn when the fabric has reached a pre- |
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determined count. This is also a good inventory control tool (it is my experience that the two areas of a hospital that are the most in need of inventory control and management are surgical instruments and linens). Note that there are various testing methods for fabric fluid repellency (ASTM
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