When It’s
Safe to Flash
I
f you perform an on-line search of the words, “flash,”
“sterilization” and “safety,” then you’ll find more than 167,000
documents to click through. Such is the nature of the discussion
that invariably brings into question the efficacy of a flash sterilization
regimen. Of course, for smaller institutions with a limited number of
instrument sets, increasing demands on the OR leave little choice
but to selectively rely on flash sterilization. To do so in a manner
that does not compromise staff or patient safety requires that the
following conditions are always met.
1. Work practices ensure effective cleaning and
decontamination, as well as proper inspection and
arrangement of instruments into the recommended sterilizing
trays or containment devices, before sterilization.
2. The physical layout of the department work area ensures
The flash sterilization cycle, itself, is preprogrammed to a specific
direct delivery of sterilized items to the point of use.
time and temperature setting established by the manufacturer.
3. A set of best practices is developed and followed for the
These settings are based on the type of sterilizer — gravity or pre-
aseptic handling of sterilized items during their transfer from
vac, and the configuration of the load — porous or non-porous.
the sterilizer to the point of use.
Processed items are unwrapped. Since drying time is not part of
4. The item is immediately used following flash sterilization.
the preprogrammed flash cycle, goods are assumed to be wet at
It can not be overemphasized that thorough cleaning is the
the end of the cycle.
cornerstone of effective sterilization, and it begins in the
There is no storage or shelf life of flash sterilized items because
decontamination area. For sterilization to do its job, items must be
of the higher probability of contamination after the sterilizer door is
free from soil that affords protection to the bacteria that is beneath
opened and the items are removed.
it. The accepted standard for the degree of cleanliness is
One of the few points of universal agreement about flash
visibly clean.
sterilization is the acknowledgement that implantables should not
In addition, the water used to perform the final rinse of a device
be flash sterilized. Careful planning, appropriate packaging and
should have a low endotoxin content to reduce the levels of
inventory management — per AAMI ST-79 — should eliminate any
pyrogens on processed devices that could cause pyrogenic
need for flash sterilization of implants. a73
reactions in patients.
Improving the Outcomes
of Manual Cleaning
D
espite the technical and cleaning process improvements process. These items are all accurately controlled and monitored in
brought about by mechanical washer-disinfector systems mechanical washer-disinfectors but are subject to human error or
in the SPD, many instrument manufacturers continue to judgment in manual cleaning.
create instructions that include manual cleaning. In order to improve the manual cleaning process, the following
The biggest advantage of manual cleaning is instruments can be steps should be taken to consistently control as many of these
processed as soon as they arrive in the SPD. Cleaning is most variables as possible.
effective if the bio-burden is removed from instruments before they The temperature of the water plays a key role in the effectiveness
are allowed to dry. By having the capacity and available staff to clean of the detergent. Lower temperatures might not allow the active
instruments as soon as they arrive, chemical usage may be ingredients in the detergent to be released. Higher temperatures
significantly reduced, and workflows should be smoother. cause proteins to coagulate on device surfaces and become difficult
In addition, the manual processing of lumens or other delicate to remove. For optimum cleaning, the water temperature should be
instruments reduces the need for specialized wash carts maintained between 109°F and 113°F. The water temperature in the
and accessories. sink basin should be monitored on a regular basis and adjusted
In turn, this reduces equipment costs and eliminates the space as necessary.
needed for dedicated accessories to accumulate instruments until a While not all instruments require the same amount of attention to
safe load is deemed sufficiently full to process in a mechanical become effectively clean, minimum standards should be established
washer-disinfector. to ensure a consistent process that produces safe instruments. The
Unfortunately, the benefits of manual cleaning come with a most important part is visual verification that an instrument is clean
significant degree of process variability. Temperature, time, detergent before it moves on in the process.
concentration, and cleaning action are all key factors in the cleaning
continued on page 4
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