SELF-STUDY SERIES
that hold instruments during steam ster- ilization should have holes in the bottom that allow condensate to drain away from the instruments. Using a tray with too few holes prevents good drainage and leads to excessive condensate collection and wet packs. The best practice is to use a “standard” surgical instrument tray that has multiple perforations or a wire-mesh bottom. In addition, technicians should choose a tray that is large enough to evenly dis- tribute the metal mass in a single layer without piling instruments on top of each other. Heavy metal mass caused by piling instruments leads to excessive localized condensate.
Furthermore, instruments should be disassembled for steam sterilization per the device manufacturer’s IFU. Leaving instruments assembled if the IFU require disassembly may trap steam that can con- dense and contribute to a wet pack. Each type of containment device plays an important role in condensate removal and device drying. Containment devices include sterilization wrap, pouches, and rigid container systems. Technicians must choose a containment device that’s con- firmed for a particular steriliation cycle and dry time. Consult the containment device’s IFU for additional requirements that will ensure proper function of the packaging/container and drying of its contents. Examples of misuse include: • Using a wrap too large for the tray, which creates excess layers and folds that trap condensate and can result in wet packs.
• Using non-validated silicone mats and inserts in containment devices, which can prevent good drainage.
• Loading instrument weight higher than recommended by the containment device and sterilizer IFU, which can cre- ate excessive condensate that may not dry. In calculating weight, include all accessories used with the containment device, including silicone mats, steril- ization bags/holders, indicators, locks, filters, etc.
Loading the steam sterilizer
Sterilizer carts should be loaded and con- figured in a way that ensures proper con- densate drainage and drying of the entire load. Instrument trays and rigid container systems should lie flat on shelves to ensure even distribution of metal mass and proper positioning of all available drainage holes. Overloading the shelves and compressing packages can trap steam during drying,
Sponsored by
causing condensate at the end of the cycle. It’s important to ensure space between items on shelves.
Also, items should not touch the steril- izer chamber walls, and instrument tray(s) or other packages should not be placed directly on the floor of the sterilier cham- ber because this can prevent drying. Allow at least three inches between the sterilizer’s walls and ceiling and the containment devices and other items in the load, to facilitate steam removal and drying. Peel pouches should be placed stand-
ing on their edges, with the plastic side of one facing the paper side of the one next to it. If necessary, technicians can use instrument trays, wire baskets, pouch organizers, or other sterilizable stabilizers to hold the packages in proper position for sterilization.
Items with concave surfaces and cup-like designs should be angled with the concave- side down for drainage. Placing curved surfaces, bowls and cups upright collects excessive condensate in those features that may not dry by the end of the cycle. Steam sterilization produces condensa- tion that drips from items, chamber walls and rack rails. Items on each level must be placed in ways that prevent drips from above from pooling on or in them. onfig- uring the load requires the technician to decide which items to include and where to place them on the sterilizer cart. A general rule of thumb is to place items that produce the least amount of dripping condensate on top shelves and those the produce the greatest amount on the bottom. For example, heavy rigid container systems with a great deal of metal mass should be placed on the bottom sterilizer rack, and lighter sterilization pouches with little metal mass should go at the top. Technicians should be aware of drainage points in the items. Some rigid container systems have bottom filters that promote draining. ligning a bottom filter of one container over the top filter of the container below can cause condensate to drip directly into the container below, potentially creat- ing excessive condensate. This is especially true when stacking items. Stacking should be avoided unless the containment device manufacturers have validated this practice. Another general rule to follow is to place wrapped items above containerized items, especially when using synthetic wraps. It’s better to sterilize wrapped textiles and instrument sets in separate loads, but if they are mixed, place textiles on shelves above instrument sets.
28 May 2022 • HEALTHCARE PURCHASING NEWS •
hpnonline.com
Absorbent shelf liners can absorb con- densate from the items on that shelf and reduce condensate dripping to shelves below. However, do not substitute nonwoven disposable wrap as a shelf liner because it pools condensate instead of absorbing it. It’s also important to review all IFU for the sterilizer, instruments, and contain- ment devices to determine the correct dry times for a particular load. Standard sterilizer drying times may differ from those required by specialty surgical instru- ments or containment devices. To prevent wet packs, it’s imperative that technicians reconcile all related IFU to ensure that all devices in a load are properly packaged and thoroughly dried.
Removing and cooling steam sterilized items
Because hot items placed on or in a cold place causes condensation in packs, hot items and loading carts should be placed in a low-traffic area away from air condi- tioning or other cold air vents, to prevent quick cooling and condensate formation. Also, avoid placing hot items on cold sur- faces or stacking them. These too can cause condensation.
Items must be cooled before moving them to storage. ANSI/AAMI ST79:2017 Section 10.3.1 states, “the time allowed for cool- ing should consider the type of sterilizer being used, the design of the device being sterilized, the temperature and humidity of the ambient environment, and the type of packaging used.” Adequate cooling time could be two or more hours depending on these four variables. Consider using remote temperature-sensing devices to confirm that items have cooled sufficiently. ne final tip to avoid trapping moist air that may convert to condensate as it cools, technicians should not place warm pack- ages in plastic dust covers.
Knowledge and action prevent wet packs
Steam sterilization is a wet process, but it doesn’t have to lead to wet packs. Sterile processing technicians who understand the steam sterilization process, know the causes of wet packs, and reconcile the requirements from all relevant IFU can prevent the factors that are creating a wet- pack risk. They can improve processes and employ best practices that discourage excessive condensate, pooling and poor drainage. The power to prevent most wet packs is in the able hands of sterile process- ing professionals. HPN
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46
