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How can sterile processing technicians prevent wet packs? Technicians can use techniques and best practices that reduce pooling and excessive condensate throughout the preparation, steam sterilization and storage process. Although this will not address every cause of wet packs, our decades of experience have taught us that technician activities, including improperly prepared and loaded items, are contributors.
Figure 1: Operational factors that
contribute to wet packs are under the control of sterile processing technicians.
proper drainage of condensate and vapor- ization of residual moisture.
2. Operational factors Operational factors include all the activities performed during instrument processing procedures, such as preparing and pack- aging the instruments, loading the steam sterilizers, and removing and cooling items before transport to storage. All operational factors are under the control of sterile pro- cessing technicians.
Preparation and packaging Items should be prepared and packaged in a way that minimizes the pooling and creation of excessive condensate while also promoting drainage. When too many items are packaged together, are grouped into one area of the package, or have too much metal mass, excessive condensate and/or localized moisture can collect that is difficult to vaporie at the end of the cycle. Positioning items in a way that allows water to pool or that traps steam that condenses creates excessive moisture that is difficult to vaporie at the end of the cycle. Excessive moisture can also accumulate if heavy instrument sets are placed in inappropriate trays (those with no drainage holes, too few drainage holes, or drainage holes incorrectly placed for efficient drainage of condensate.
Sterilizer cart contents and loading configuration Since condensate forms on all surfaces within the sterilizer, the contents in the load and the placement of items can cre- ate opportunities for condensate to pool and prevent drainage. Overloading the sterilizer cart/shelves with items can cre- ate a tight dense load that hinders steam
and condensate evacuation from the items during the drying phase. Because all items drain and drip in the sterilizer, placing heavier items that produce a lot of condensate above lighter items can flood the lighter items with dripping conden- sate. Similarly, placing containers above wrapped items allows dripping condensate to pool on synthetic wrap surfaces.
Removing and cooling items
Even an item that is dry at the end of the cycle can form condensate if handled improperly. Items at the end of a steam sterilization cycle are hot and have moist hot air within. When cooler items touch the hot item, the sudden cooling causes condensate to form, and this leads to wet packs. Placing hot items right out of the sterilizer on a solid surface such as a metal counter is the most common way to create this type of wet pack.
3. Environmental factors Environmental factors include air tempera- ture and humidity. The environment works to create condensate in two ways. First, the temperature in a space can cool packs too quickly and allow the moist air within them to condense and pool. This happens when the room temperature is too cold, or when hot items are placed directly beneath an air conditioning vent that blows cold air onto the hot load.
Second, the environment creates con- densate when cool packs are transported through an area of warm humid air. This can happen on the way to the point of use within the facility, but it is more likely to happen when sterile items move through the hot, humid environment of transport vehicles on their way to other buildings or facilities.
Daily sterilizer inspection and testing Wet pack prevention starts with the steam sterilizer. Technicians should always review sterilier instructions for use to properly perform daily testing and routine inspection. The sterilizers should be inspected and drain screens cleaned at least daily. An obstructed screen can cause moisture to pool in the chamber floor and impede steam removal at the end of the sterilization cycle, which can contribute to a wet pack. It is important to keep the sterilizer cham- ber clean. Radiant heat from clean chamber walls supports effective drying, which aids in the prevention of wet packs. Chamber walls with scale build-up, rust, and load labels and other debris are less effective at transferring heat and drying loads. Sterilizer performance testing is another
important part of the quality assurance process. Some tests can help detect wet steam, which can lead to wet packs. Some daily air removal test packs (Bowie Dick test packs indicate failing results in the presence of excessive moisture from the steam supply. Technicians should know which quality assurance tests, if any, help detect wet steam and should know who to alert when it does.
Preparation and packaging
Technicians can have a huge impact on wet pack prevention by optimizing how they assemble and package instruments after the cleaning process. In addition to inspect- ing instrumentation for functionality and cleanliness, technicians should inspect them for residual moisture. Residual mois- ture can create a “cold spot” that allows condensate to remain after steam steriliza- tion. Instruments are dried using room air air drying, instrument air forced air, or a drying cabinet. Regardless of the method, ensuring that instruments are thoroughly dry will help prevent wet packs. Next, the technician should choose the correct instrument tray or basket. Trays
hpnonline.com • HEALTHCARE PURCHASING NEWS • May 2022 27
Self-Study Test Answers: 1. C, 2. C, 3. A, 4. D, 5. C, 6. B, 7. C, 8. A, 9. C, 10. A
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