Infection Prevention

Infection Prevention

By: Dan Mayworm

Published: 10/10/2007

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Wet Load or Wet Pack, Here's What to Do


Dan Mayworm Q What's the difference between moisture on the outside or inside of the packs, and what causes this to happen?

A Moisture on the outside of the surface of packages could be the result of condensate and means you have a wet load, which is the result of sterilizer malfunction and/or poor steam quality. Redo the entire load, which potentially is open to contamination. Moisture on the inside of a pack means you have a wet pack, which is the result of improper pack set-up, packaging and loading. You need only redo the affected package.

In either case, a wet load or a wet pack is the result of your sterilizer's producing more condensate during the heat-up and conditioning phase than can be evaporated during the drying phase. In a normal cycle with a properly prepared load, most of the condensate drains from the sterilizer before the exposure timing begins. Any remaining condensate should be re-vaporized at the end of the exposure period and evacuated from the sterilizer before the door is opened.

Q Occasionally we find moisture on the outside of one or two packs in the load. What can we do to fix the problem?

A A properly functioning sterilizer, properly loaded with properly put-up packages, and fed with the proper quality of steam, should never show water droplets on the outside of packages. Something is wrong, and you need to find out where the moisture is coming from.

Depending on your facility's staff structure, either you need to play detective to isolate the cause or you need to get the sterilizer-maintenance person to solve it for you. Do not relent until you have the answer.

There are several questions you can ask to uncover clues to the cause:

  • Does the moisture only occur on one type of pack or is it random?
  • Does it happen only in the first or last load of the day, or always at the same time of the day?
  • Does it only happen on the bottom rack, only on the top rack or can it happen anywhere in the load?
  • Are the sterilizer walls dripping with moisture when you open the door?
  • Does water pool in the bottom of the sterilizer?
  • What was above the affected package during the cycle?

Infection Prevention Notebook

' While most facilities prohibit OR personnel from flash sterilizing implantable devices, and guidelines from AAMI, the CDC and AORN frown upon the practice, an increasing number of facilities now permit it under emergency conditions. One such facility is Johns Hopkins University Hospital in Baltimore. Last year, the hospital adopted a revised policy to allow flash sterilization of implantables "in emergency situations when there is insufficient time to sterilize an item by the preferred pre-packaged method." Trish Perl, MD, of the university's school of infectious diseases says that staff must be educated to employ flash sterilization of implantables only as their last resort.

' The CDC has released new guidelines for infection control in oral and dental surgery. Topics include
? ?'' the application of standard precautions rather than universal precautions;
? ?'' management of occupational exposures to bloodborne pathogens, including post-exposure prophylaxis (PEP) for work exposures to hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV)
? ?'' hand-hygiene products and surgical hand antisepsis;
? ?'' dental water-quality concerns, such as delivery of water of acceptable biological quality for patient care and use of sterile irrigating solutions; and
? ?'' pre-procedural mouth rinsing for patients. Although the guidelines focus on outpatient, ambulatory dental health-care settings, the recommended infection-control practices are applicable to all settings in which dental treatment is provided.

' VHA, Inc., a healthcare cooperative including more than 2,200 facilities in 48 states, recently announced that its 450 members participating in a third-party device-reprocessing program have collectively saved nearly $25 million since April 2002. VHA says that reprocessing of single-use devices has saved it an average of 50 percent over the cost of purchasing a replacement device.

' On Feb. 12, JCAHO was expected to close out another round of input-gathering on newly proposed standards that address the management of antimicrobial-resistant pathogens and the role organizations play in limiting the emergence of these pathogens. The standards would extend the existing Emergency Preparedness Standards.

- Stephanie Wasek

Say, for example, that you put a heavy tray loaded with metal on the second shelf. It could pool water that could then drip on the package below. The package below could be perfectly safe to use - but the package above it that shows no sign of moisture on the pack's top would not be.

My advice would be to line the shelves with moisture-absorbent towels. If the problem persists, get the sterilizer manufacturer to solve the problem after you have answered all the above questions.

Q How can we prevent wet packs?

A You can solve wet-pack problems (moisture on the inside) by arranging the contents of the sterilizer so moisture is not allowed to pool and, if there is a lot of heavy metal, by arranging the contents so there is sufficient moisture-absorbent material in the pack.

Q Do we need to replace cracked, torn or worn-out table pads?

A Being able to clean and disinfect all surfaces that come in direct or indirect contact with a patient is a fundamental infection-control issue. Obviously, you can't effectively disinfect cracks in table pads, which harbor bacterial growth. If you don't replace the cracked covers, at least repair the cracks so that moisture can't penetrate the cracks. Taping over the cracks is not acceptable, as the tape edges are a great portal to the underside of the tape.

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