Steam outages; washer-testing; stringing instruments

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Q From time to time we experience steam outages. Are we required to re-validate/verify the sterilizers performance prior to running a sterile load once the steam is turned back on?

A The need to verify the sterilizer’s proper function after a steam outage would depend on the reason why the steam shut down. If the steam service was interrupted due to a major repair, such as the replacement of the boiler, plumbing, water source, etc., then retesting is recommended. This would include running three consecutive Bowie Dick Tests, and three consecutive tests, using PCDs with BI. All test results would need to be satisfactory. Steam outages for other reasons (e.g., routine maintenance, emergency testing, etc.) would not require you to test prior to reuse of the sterilizer. It is important that you know the nature/reasoning for the interrupted steam service and act accordingly. If you are ever in doubt, then you should definitely do the testing.

Q AAMI standards now require the daily testing and monitoring of mechanical cleaning equipment. We have four relatively new 4-level washers. For the first few weeks that I conducted testing all the results came out perfect, indicating that the washers were performing properly. Over the past couple of weeks, I have been getting conflicting results. One day all the washers will pass, then the next day one will fail for no apparent reason. And then the next day the same washer passes but another one fails. I have tried a few different testing devices but get similar results. All my printouts look fine, instruments look clean, and the washers seem to be functioning fine. I really question the validity of these testing methods. What are your thoughts?

A I am a strong advocate and supporter of the AAMI and AORN recommendations relative to the daily testing of all automated washers. A failed test is a serious matter as it indicates that your processing equipment is not performing at the optimum level, as a result your instruments may not be effectively cleaned. Often conflicting results, such as those you have described, are a result of a faulty washer rack being used between washers. You must recognize that a washer rack is actually in and of itself a piece of equipment. Spray arms on the rack might be occluded, misaligned or defective. Bushings could be cracked or broken, the rack may not align properly to the coupler and water source affecting water flow and pressure. If you are using racks interchangeably between your four washers I would suggest that you identify and label each rack and that when you conduct your testing you include the rack identification on the record sheet. In that way you will be able to identify if the conflicting results are caused by a defective rack.

Q I am an OR nurse and have recently assumed the responsibility to coordinate process improvement initiatives between the OR and sterile processing. My first project is to improve the flow and reprocessing of surgical instruments. I am trying to get the OR staff to restring all ring handled instruments for return to decontamination. They are resistant to this change as they feel it is a cumbersome and time-consuming task. They complain that they don’t often have access to the proper size stringers and that the task often requires more than two hands, one hand to hold and steady the stringer and the other to place instruments onto the stringer. Often times one hand isn’t enough to open the closed instruments or to organize sizes. If the stringer is laid down to free a hand, the instruments often slide and fall off the stringer. I can understand their frustrations and would like some suggestions on how I might be able make the staff more receptive to this change.

A Thinking back to my days in the OR and CPD I can really relate to the problems and frustrations your OR team is experiencing with the stringing of surgical instruments. Making a task less cumbersome and difficult often involves having the appropriate resources and tools. New inventions and technology often evolve out of a need. In my travels I have seen a few impressive new devices that might just address your needs.

1. Adjustable stringers are available in various lengths that are able to be widened by spreading the stringer. The adjustable stringers make it possible to use the stringer on multiple-sized instruments. They would eliminate the frustration and wasted time searching for a specific sized stringer. The adjustable width also allows for opening instruments for better exposure in the washer.
   

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   See Figure 1.

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2. Instrument stringer holders will hold stringers securely in the upright position allowing the user to string instruments with one hand.
   

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   See Figure 2.

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3. Wash cradles also accommodate various sized string handled instruments and truly free up both hands for ease and speed of use.
   

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   See Figure 3.

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I would suggest you consider one or more of these tools to assist both your OR and CPD staff in performing the tedious task of stringing surgical instruments.