Q: “The window that separates our decontamination area and our assembly and sterile storage areas was left open over the weekend (roughly 60 hours). We discovered it upon arrival on Monday morning. Do we need to re-sterilize everything in sterile storage?”
First things first: great job catching the problem on arrival and recognizing that it was a problem! I have heard of (and seen firsthand) situations where things like this were simply corrected and “swept under the rug.” It’s much easier to close the window and ignore the possible patient (and staff) safety concerns than it is to open an investigation into the extent of potential risk.
You’ll need to perform a risk assessment (RA), and, in this case, RA will focus on (among other things) the potential patient safety concern of compromised sterile packages.
The main issue has to do with airflow in the two areas.
Decontamination is a “negative” airflow, meaning that the “dirty” air in decontam should flow up into the facility’s filtered vents.
Assembly/Inspection and Sterile Storage is meant to be “positive” so that air flows out when a door is opened to that area.
The idea here is that when a door (or window) between the two areas is briefly opened, the “clean” air should flow into the “dirty” side, and not vice-versa.
This airflow is maintained due to the delicate pressure balance in each room and relies on the doors and windows to these areas being closed. Positive airflow is created because air pressure inside the room is greater than the air pressure outside the room. This is achieved by adding more air into the room. Conversely, exhausting more air from a room creates negative pressure because that room’s pressure is less than the pressure outside. The amounts of air pushed into a room (or exhausted from a room) are specific to the exact area of the room itself.
The longer that a door or window remains open between these two areas, the greater the likelihood the two rooms will “regulate” air pressure–essentially changing the size of the room so the air pressure will change with it. Free-flowing air from the contaminated side could flow into the “clean” area as a result.
Do you have electronic tracking and/or documentation of the airflow between the decontamination area and assembly/sterile storage areas? Some facilities are electronically tracking the positive and negative airflow between the two rooms, so they may be able to tell you when or if that airflow changed, to what extent, and for how long.
If there is no airflow tracking documentation, then you should assume the worst. Correct the airflow immediately by shutting that window as soon as you see it open. This should allow the HVAC system to return the rooms to the proper airflow. This applies to any situation (e.g., when techs in the decontamination area pass devices through the window) where that door/window between the areas is left open.
To perform the RA, I would recommend involving your infection prevention (IP) team, risk management, and facilities management in the conversation. In addition to your sterile storage concerns, there are a few other considerations:
- All surfaces should be disinfected.
- You will likely need to have Environmental Services (EVS) come in to perform a terminal cleaning of the areas.
- Supplies in the assembly/inspection areas may have been contaminated and may need to be discarded.
- Accessories (e.g., computers, insulation testers, borescopes, etc.) may also need to be cleaned and disinfected.
Some people may claim the risk for infectious transmission via airflow between these areas is very low. While I agree that the infection rate is proportionally low, I would argue we don’t fully understand the nature or extent of airborne pathogen transmission. Best to err on the side of caution. If the COVID-19 (SARS-CoV-2) pandemic taught us anything, it was the unforeseen viability of pathogens to travel long distances and survive in adverse environments.1,2,3
To sum up (based on the results of your team’s risk assessment):
- Correct the immediate problem.
- Gather your data and information.
- Make an informed decision.
References:
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Mikszewski, A., Stabile, L., Buonanno, G., & Morawska, L. (2022). The airborne contagiousness of respiratory viruses: A comparative analysis and implications for mitigation. Geoscience frontiers, 13(6), 101285. https://doi.org/10.1016/j.gsf.2021.101285
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Short, K. R., & Cowling, B. J. (2023). Assessing the potential for fomite transmission of SARS-CoV-2. The Lancet. Microbe, 4(6), e380–e381. https://doi.org/10.1016/S2666-5247(23)00099-X
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Wang, Chia C., et al. (2021). Airborne transmission of respiratory viruses. Science 373, eabd9149. DOI:10.1126/science.abd9149
Adam Okada | Clinical Education Specialist, Healthmark, a Getinge company
Adam Okada has 18+ years of experience in Sterile Processing and is passionate about helping improve the quality of patient care by giving SPD professionals and their partners greater access to education and information. He has worked in just about every position in the Sterile Processing Department, including Case Cart Builder, SPD Tech I, II, and III, Lead Tech, Tracking System Analyst, Supervisor of both SPD and HLD, Manager, and now as an Educator. Adam is the owner of Sterile Education, the world’s first mobile application dedicated to sterile processing education, and a former Clinical Manager at Beyond Clean. He has published articles for HSPA’s Process magazine, is a co-chair on AAMI WG45 as well as co-project manager for the KiiP “Last 100 Yards” group, and is the former President for the Central California Chapter of HSPA. Adam is currently a Clinical Education Specialist at Healthmark, A Getinge company, where he works on Healthmark webinars, hybrid events, and educational videos, as well as the "Ask the Educator" Podcast with Kevin Anderson.
