Wet Loads

Q: “Our facility has been dealing with wet loads for the past six months or so, and we keep increasing our dry time to eliminate it. We now are doing 90 minutes of dry time. Is this normal?”

A:

In short, no.

I have dealt with this same issue at an old facility of mine, where we also responded by increasing our dry times. It certainly stands to reason, but, in truth, it rarely eliminates wet loads.

Put on your Sherlock Holmes “deerstalker” cap because you’ll need to do some investigative work to determine the root cause of your wet loads.

Are you taking pictures of the sterilization rack and contents and documenting the wet load configuration? Load configuration can be one of the causes of wet loads if rigid containers are placed over wrapped items/linen packs or if containers/trays are placed too closely together.

• Items should be evenly spaced about a finger width apart (≈1 to 1.5 in or ≈2.54 to 3.81 cm).
• Rigid containers and heavier trays should be on the bottom rack, while lighter wraps and peel pouches should be on the top.
• The recommendation is to take a picture of the sterilization rack and examine the configuration to see if anything jumps out visually.

Next, you will want to follow up with some documentation of the load.

Cycle: What cycle was used? When I was a baby tech still learning my trade, I accidentally started loads on a Gravity cycle instead of Pre-Vac.

Overpacked tray: Are you noticing a specific tray that is continually present on these wet loads? It could be an overpacked tray with dense metal mass or potentially some heavy sets weighing over 25 lb.

Contents of tray: What were the contents of the load(s)? All sterilizers have a weight limit for cycles, so it could be possible that you’re overloading the sterilizer itself.

All these questions can be investigated with proper wet load documentation.

But the most likely potential root cause of your wet loads would be that you probably have an issue with steam quality.

Steam: Steam should be 97–98% dry saturated steam and 2–3% water. At my aforementioned facility where I was dealing with wet loads, testing revealed that we had 92–93% saturated steam and 7–8% water. This was the cause of our wet loads and was solved with some new steam traps installed on the steam intake line.

Autoclave drain: Blocked or clogged autoclave drains would conceivably slow down the vacuum process in pre-vacuum sterilizers. Make sure your chamber drain is checked and cleaned as recommended by the manufacturer.

Wet items: Check if items are getting loaded into the sterilizer wet. Too much water in the chamber before sterilization can throw off the optimum wet/dry steam ratio (97–98% dry to 2–3% wet), so make sure you are drying items before packaging them for the autoclave.

If the initial documentation and pictures don’t immediately identify a particular culprit, my first step for identification of the root cause would be to have a reputable company perform a steam quality check on your autoclaves to determine the wet/dry steam ratio and then move on to other potential causes.

Q: What is it like to work with Stephen Kovach?

A:

In a word, “Exhausting.”

I am kidding, of course. . .. Stephen Kovach is my idol, mentor, and hero, and I am beyond lucky to call him a good friend. He has a passion and enthusiasm for sterile processing which is unmatched in our industry. His face would appear on just about every industry professional’s “Mount Rushmore” of educators, who have made a positive impact in our history.

A few months ago, Stephen and I had breakfast at McDonald’s. His friends and colleagues will agree with me that this is considered fine dining by Kovach-ian standards. It was at this breakfast that Stephen informed me of his intention to retire, and he asked me if I would be willing to take over this article from him (for all those wondering who Adam Okada is and why he is writing Stephen Kovach’s Sterile Processing article).

I was, at first, excited. What a great opportunity! I love writing and sterile processing, so it seemed to be a perfect intersection of my favorite things.

Then reality set in.

There is an incredible history behind this article and an incredible legacy and precedent that has been set. It started with the legendary (and fellow “Mount Rushmore” face) Ray Taurasi. I remember one of Ray’s responses to a question in one of these HPN articles was something that I had been using in my day-to-day sterile processing life for almost 20 years.

After 19 years, the article passed on to Stephen, who has been writing these since 2020. Stephen has a lifetime of experience, and his brain is an encyclopedia of sterile processing knowledge. He is often my first text if there is a question that has me stumped, and he always seems to have the answer. If not the answer per se, he will provide enough information for me to arrive at the correct answer on my own, which is so much more valuable!

It is difficult to comprehend how many professionals have read Stephen’s words of wisdom over the years and improved upon their practices.

While there is plenty of pressure, I promise that I will do everything I can to live up to the astronomically high bar that’s been set by Stephen and Ray. I will research every article to try and provide the best possible answers to your questions. Keep those questions coming to HPN!

A personal message to Stephen: You are the reason I am here. Watching you present on washer disinfectors 7 years ago gave me a direction and purpose to my career that I didn’t previously have. Your infectious enthusiasm for best practice has inspired so many in our industry. Through them, you have helped positively impact their patients. I can’t accurately put into words how much you mean to me and this business, but you have certainly made an indelible impression. Put simply, thank you for everything you’ve done for me, and everything you’ve done for all of us.

Enjoy your retirement, my friend. Let’s grab a “Big Mac” soon!