Sterilizer maintenance; protecting the sterile field; establishing internal relationships

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Q What is the recommended cleaning and care procedure for sterilizers and how often should the inner chamber be cleaned? My staff tells me that my predecessor used a vinegar mixture for cleaning the sterilizer walls. Is this a good idea?

A The sterilizer manufacturer’s instruction manual should be consulted for the exact procedures to be used on their sterilizer equipment. Sterilizer makes and models differ and therefore processes may vary somewhat. In general, the following is common protocol:

• The sterilizer chamber should be cool prior to performing any maintenance or cleaning process.
• The chamber screen strainer should be removed at least daily and cleaned thoroughly. All lint or other debris deposits must be removed from the screen. The use of a soft brush and mild detergent will help facilitate the cleaning process and the strainer may be flushed by holding it under running water. The screen strainer may need to be cleaned more than once a day depending on volume and load contents. For example, if you are processing lots of linen or textile loads, a significant amount of lint may clog the drain and affect the sterilizer’s functioning.
• The chamber walls should be cleaned at least weekly with a mild detergent and a long-handled sterilizer cleaning brush or mop. Abrasives or steel wool pads should never be used when cleaning an inner chamber, as they may damage the corrosive resistant surface which protects the chamber walls from corrosion caused by steam and boiler water treatment chemicals.
• Chamber drain-lines may be flushed weekly with a mixture of trisodium phosphate or hot water and a mild detergent solution. Do not use household drain cleaning agents.
• Carefully inspect the door gasket daily for any cracks or defects and wipe clean with a lint free cloth.
• Loading racks, carriages and baskets should be cleaned at least daily with a mild cleaning agent and wiped dry with a soft lint free towel.
• There are many cleaning products, agents and accessories on the market specifically designed for the proper care, cleaning and maintenance of sterilizers. It is not advisable to create your own cleaning mixtures without the expressed instructions of the sterilizer manufacturer.

Q I work in a small community hospital where our sterile processing technicians are responsible for setting up the sterile field in the OR. All sets are opened and sterile instruments are arranged aseptically on the instrument tables and Mayo trays. This allows faster case turnover as the surgical team can quickly move from one procedure room to another. The OR committee now wants us to set up all cases in one designated room rather than an OR. The tables and sterile field will be covered with sterile drapes while staged and transported to the OR. I am uncomfortable with this idea, do you think a sterile field should be moved?

A Preparing and maintaining a sterile field for patients undergoing invasive surgical procedures is the cornerstone to infection control, as it reduces the risk of microbial contamination and cross infection. Failure to adhere to strict aseptic practices during invasive procedures can place the patient at risk of injury and serious life-threatening infections. I believe that the sterile field should be prepared in the location where it will be used and that it should not be moved. Moving the sterile field from one location to another increases the potential and likelihood for contamination. The environment where surgery and sterile instrumentation is opened for use must be controlled and secure space with minimal traffic and unnecessary movement.

Q I am responsible for the Sterile Processing Department and currently report to Materials Management but there is some reorganization underway at my hospital and there is discussion about placing the Sterile Processing Department under the OR. I am against this reorganization and am very happy with the current arrangement. I feel I am in a better position to challenge the OR when they suggest we cut corners. Do you have information on reporting relationships that would assist me in my goal to keep the OR from controlling SPD?

A Unfortunately, I cannot state one proven method or organizational structure that can support your “goal” or serve that of every hospital. Reporting relationships run the full gamut and there are examples of successes and failures to every scenario. Institution working mechanisms are as varied as the many individual personalities that occupy them. Key factors to success include appropriate alignment of the human and material resources which are necessary to get a job done. The appropriate application and utilization of resources is of paramount importance. There must be an appropriate fit of skills and people — in other words, the right person in the right job, armed with the knowledge, accountability and professionalism to carry out the tasks at hand. A balance of authority and responsibility is essential. Organizational restructuring alone will not necessarily assure smooth operations or cure the ills that may exist between combatting departments. Superior interpersonal relations, mutual respect, open communications, integrity and teamwork are the driving forces to success.