Soaking solutions; hand sanitizer violations; identifying mysterious gray stains

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Q I work at an ambulatory surgery center and at the end of a surgical procedure our OR team has always placed used instruments into a ring stand basin which contains irrigating saline. The ring stand with instruments are then moved across the hall to the OR instrument workroom and are left soaking in the basin until they can be washed. The surgery center was recently acquired by a large healthcare organization and we are being scrutinized by a group of consultants who have mandated many changes on how we do things, including processing instruments. One such mandate was to discontinue placing our soiled instruments in saline immediately. They are really nitpicking on many small things like this. I can appreciate change when it is warranted but does it really matter if instruments are placed in the irrigating solution? We are just keeping them moist to prevent soil from drying.

A It is very important to keep soiled instruments moist to prevent organic matter from drying on them. However, saline solution should never be used as an instrument soak as it is extremely caustic and can cause corrosion and damage to the instruments. For the same reason blood, which consists of saline, and organic matter should always be wiped from instruments during the surgical procedure. Soiled instruments can be kept moist by:

• placing a water-moistened towel over the instrument and then placing them in a closed transport container or sealed plastic bag;
• utilizing a treatment solution such as an enzymatic spray, gel or foam; and
• placing in a commercial package designed to create and maintain moisture.

Q Our Safety council recently conducted an inspection of the SPD and as a result has required us to remove all alcohol-based, hand-sanitizing products and dispensers throughout the entire department. We were told that the products were in violation with municipal fire code regulations. At the same time, I have noticed that other departments still continue to use hand sanitizers and dispensing stations. Why the double standard?

A Alcohols are flammable. Flash points determine the temperature at which a particular organic compound gives off sufficient vapor to ignite in air. The Flash Points of alcohol-based hand rubs range from 21°C to 24°C (70°F to 75°F), depending on the type and concentration of alcohol present. Alcohol-based hand-hygiene agents must have an alcohol concentration of 60 percent to 95 percent to be effective. State or municipal regulations might dictate when and where such agents may be used and be placed within a facility. You might want to discuss your situation with the appropriate source from your safety council to grasp a better understanding of why your hand sanitizer was in violation and others within the hospital were not. It seems as though it would make sense for the council to establish a detailed policy on this important matter and for the hospital to consider product specification and standardization.

Q We have been experiencing intermittent issues with a mysterious gray-colored staining on our packaging materials, tray liners, peel pouches and wraps. What is perplexing is that the stains only appear on some packages in the same load, some of the staining is on the inner wrappers while other staining is on the outer wraps. Our Biomed has assured me that our steam and water quality is excellent. Some lab samples of the stained packages has tested positive for aluminum. I have noticed that some new aluminum trays, containers and cassettes we recently purchased are also discoloring and I was wondering if they might have something to do with our problem.

A Certain chemicals, detergents and steriliants can have a caustic affect on certain metals such as aluminum; the metals can degrade and slough off and deposit on wraps and other items in the sterilizer. I don’t know enough about your situation to determine if that is indeed the cause of your problem. The fact that your aluminum cases, etc. are discoloring is indicative of some problem which may be relevant. You need to verify that you are following the manufacturers IFUs for the aluminum devices you are using, including cleaning protocols, proper use of chemical agents and sterilization processes. I would investigate and document what is being packaged in the stained packages – do they contain the aluminum products in question? You also want to be certain that you use quality aluminum products as there are different grades and types of aluminum. Anodized aluminum is superior but like all other devices proper care and handling must be applied to ensure and maintain it’s serviceability. Anodizing is a process, which gives aluminum a protective surface of aluminum oxide, which is scratch and corrosion resistant and is not electrically conductive. A non-anodized metal is not corrosion resistant and it can become reactive having an adverse impact on other metals, which come into contact. An electrolytic couple reaction dissolves and corrodes other metals. Further, a non-anodized aluminum material will oxidize when exposed to steam or water during routine cleaning, decontamination, and sterilization, producing a white powdery film. In addition, non-anodized aluminum scratches easily and will discolor through routine use becoming cosmetically unsightly. Surgical instruments can also corrode, rust and stain when they come in contact with the non-anodized material. What is imperative is to keep metals protected from corrosion. In fact, aluminum material has a MilSpec for corrosion resistance that all manufacturers of sterilization containers need to meet in order to sell products to the federal government. That is why pH-neutral detergents are necessary for cleaning aluminum containers to avoid corrosion when the caustic or acidic cleaning agents or chemicals remove the anodized surface.