Super-heat explained; a sink in every room; healthcare air 101

Submit your questions
email: [email protected]
phone: (941) 927-9345 ext. 202

Visit the Archive

Q I have often heard the phrase “super-heated steam” but to be honest, I really don’t understand what it is. Could you please explain this and how it can affect sterilization?

A Super-heated steam refers to steam quality issues where the steam does not consist of the proper moisture ratio and as a result the steam becomes too hot and dry. A sterilization load can become superheated, which is a condition in which dehydrated textiles are subjected to steam sterilization. The package or product becomes too dry and causes destructive effects on the strength of the cloth fibers. In addition, the dehydrated textiles absorb moisture that may compromise the efficacy of the sterilization process by not delivering the required steam contact to the packaged goods. In some situations packaging materials may actually show charred marks from the excessive heat.

Q I am the director of an ambulatory surgery center and we are adding on new ORs and expanding sterile processing space. The architectural consultant told me that we must have a sink in the clean processing preparation room. Our current facility does not have one and we have never had an issue with AAAHC accreditation. I have not been able to find any regulations on this. The only information I can find that refers to hand washing states an alcohol dispenser is acceptable. Thank you in advance for any information.

A Hand-washing stations should be located in all areas where the processing and sterilization of medical devices is performed, including the decontamination room(s), clean preparation, packaging, sterilization and sterile storage areas. Hand-washing stations include a designated sink exclusively for hand washing and waterless alcohol based hand-rub dispensers. Hand-wash stations should also be in all personnel support areas (e.g., lounges, dressing rooms and rest rooms). In the event that water, soap, or sanitizers are dispensed via electronic sensors, there must be a backup system in place. For more details see AAMI ST79 (2017) 3.3.5.7, 3.3.6.2

Q What is meant by medical grade air, and where could I find documentation to keep on file for state inspections? I work in a colonoscopy lab and I need to use this type of air to dry the outside of scopes. We currently use tanks labeled “compressed air.” I am not sure if this is what should be used. When I called our medical gas company asking questions, they could not give me a clear answer nor provide any specific details on the composition of their medical air. I would appreciate any information or assistance you can offer.

A Air that is used during the reprocessing of surgical instruments, endoscopes and other medical devices is now called instrument air. Instrument air is not used for patient respiration. AAMI (Association for the Advancement of Medical Instrumentation) Standard ST79  (2017) 2.56 defines instrument air as the following:

Medical gas that falls under the general requirements for medical gases as defined by NFPA 99 (Health care facilities code), is not respired, is compliant with the ANSI/ISA 7.0.01 (Quality standard for instrument air), and is filtered to 0.01 microns, free of liquids and hydrocarbon vapors, and dry to a dew point of -40ºC(-40ºF).

You will want to confirm that the air you are using meets these requirements. Your supplier should provide you with the necessary documentation for your files and portable tanks should be labeled appropriately and clearly identifiable. If a supplier is unable or unwilling to provide you with the required documentation or satisfactorily respond to your questions, then it is time to find another service supplier.

Q Does AAMI or the Joint Commission have any policies or recommendations on what to do if an instrument is missing from a used set that is returned to CPD for re-processing? At the hospital I used to work at we had a policy that required CPD to immediately inform the OR clinical leader if a set was returned with missing instruments. If this wasn’t done and subsequently an instrument was found in a patient, CPD was held responsible. I don’t want to be responsible for such an incident and feel this hospital needs to get a policy in place. My manager disagrees. What is standard practice and where can I find supporting documentation?

A I am unaware of any relevant AAMI, or TJC standard. Having such a policy in CPD is a management decision and in my opinion there should be such a policy. There are, however, recommendations and standards for the OR regarding the protocol and necessity to perform instrument counts in the OR. If counts are not done appropriately and an instrument is left in a patient, the OR is accountable. CPD is not responsible.

Notifying the OR when an instrument set is returned missing an instrument is a very good policy! This helps in the possible retrieval of an instrument that may have been left in the OR, or was inadvertently placed in the laundry or trash. The OR leadership can also review the count sheet to be sure the instrument was accounted for at the end of the procedure.