Felicia Krizman BSN, CRCST  Infection control/ Patient Safety specialist/ Central supply supervisor

Objectives  Basic CS education  What’s newer.  What’s up with that?  Kudos to CS staff

CENTRAL SUPPLY Sterile processing department Central Sterile Sterile Supply Central Sterile Supply Sterile Distribution AKA the place that makes reusables reusable. AKA the place that makes reusables reusable.

Organizations  CSAI- Central Service Association of Iowa  AAMI – Association of Medical Instrumentation  IAHCSMM- International Association of Healthcare Central Service Material Management  AORN-Association of Operating Room Nurses  OSHA  CDC  FDA

THE RULE  ANSI/AAMI ST79:2010 & A1:2010. Comprehensive guide to steam sterilization and sterility assurance in health care facilities Publication of standards by AAMI in regards to steam sterilization.  Periopertative Standards and Recommended Practices-Publication by AORN.  ANSI/AAMI ST55:2005/(R)2010. Chemical sterilization and high-level disinfection in healthcare facilities.

Different types of Sterilization  Sterrad= Hydrogen peroxide gas plasma  Sterris= Peracetic acid  Steam= Time, temperature and pressure  Ozone  Ethylene Oxide  Cidex OPA/ Metracide (high level disinfectant)  Dry Heat  Radiation

Definitions BI (biologic indicator)- also referred to as Attest which is brand name. PCD- sterilization pack Ran weekly and preferably every day, and with every implant load for steam. Or daily preferably with every load for chemical sterilization sterilization Vial containing Geobacillus stearothermophilus or Bacillus atrophaeus A control BI is incubated to insure a living specimen was used in the test vial.

Chemical Indicator  6 Class types  Class 1=An indicators used to demonstrate that an item has been exposed to sterilization  Class 2=The Bowie Dick test or other indicators used for evaluating the cycle vacuum on a prevac autoclave.  Class 3=Indicates a single parameter for sterilization has been met.  Class 4=Multi parameters of sterilization have been met.  Class 5=Indicates all critical parameters for sterilization have been met and most comparable to a BI.  Class 6=Very new indicator and claims to go beyond the class 5 in that it monitors specific variations of cycle. specific variations of cycle.

What do you need to say it is sterile?  “More tools in the tool box”  You will never be 100% sure.  Sterile means a sterility assurance level of  Each tool has a reason for being..

Different steam cycles  Gravity – Steam is pushed in from the top while cold air sinks down a drain in the bottom.  Prevacuum- Steam is pushed in during a series of pulses and between each pulse cold air is vacuumed out of a drain in the bottom  Extended load vs. Normal prevacuume is considered 4 minutes at around 273^ at a specific pressure. Manufactures recommend sterilizations times as much as 10 and 20 minutes or at Temps of 250^. Temps of 250^.

Why every load?  How many know if their CS runs a BI with every load? There is no right or wrong to this but you should be aware in the event of a recall.  The latest AMMI ST79 includes some specific info on recall of a load.

Immediate use  What is in a name? Flash vs. immediate use. How to stop this from happening? GOOD QUESTION!

Cleaning 101 Multi steps to hand washing Correct automated Washer cycle Correct type of water Correct water temps for appropriate cleaning agent What to do about TASS

How do you know you did it correct  Test for residual material on instruments  Test for automated washer- AMMI recommends once a week preferably once a day Many items on the market to help in verification.

What’s the deal with Manufacture  Joint commissions or CMS main question is how do you know you are doing it the right way? Manufacture’s give clear instructions on use, cleaning and sterilizing called instructions for use or IFU Soooo, why is it so hard? Different chemicals Different times Different temps Different cycles Non specific instructions

And while I’m complaining  How many sales reps show up with instructions in hand???  Did you know that a study was done that showed a large portion of loaner instruments delivered to a hospital contained biologic material?? Yucky Yucky

What is your facilities process? 1. Check in insturments > 10 min 2. Wash instruments > 30 min 3. Dry assemble and wrap > 15 min 3. Run in autoclave > 30 min 4. Cool > 30 min 5. Deliver to back table > 5 min = 2 hours

Variables  Washers are full  Multiple pans of instruments  Extended cycle times  Large multilayered heavy trays  Sterilizers in use  Staffing  Implants requiring 3 hour BI

KUDOS to Technicians One good technician is worth a million in labor and healthcare costs preventing SSI Where to look What to look for How to look There are over 10,000 Different surgical instruments

CRCST=certified registered central sterile technician  Technology advanced instruments are very difficult to clean  Experienced techs know what and where to look (unfortunately it is often learned from mistakes)  Certified techs know not only where to look but why and what they might have missed.

Challenge the system Why is it done this way? What can we do to change it? The squeaky and the greasy get fixed.

How can you benefit from CS  Do you keep them locked in a basement…? Bring them out and dust them off.  Use them for your handwashing audits in the OR  Use them to trade tips with environmental service.  Have them walk you through their steps  Ask them what they find most challenging

Link to national news story on clean surgical instruments.  news/2012/02/21/ today- investigates-dirty-surgical-instruments news/2012/02/21/ today- investigates-dirty-surgical-instruments news/2012/02/21/ today- investigates-dirty-surgical-instruments