Articles

Staying Ahead of the [Risk] Curve
 

Shawn Wright, Owner, Southwest Sterilizers, LLC

Staying ahead of the curve is something you know well, as experts in your field.  The world changes at an extremely fast pace, and as professionals, your job is to keep one eye on what’s current and one eye on what’s coming.

Unfortunately, the world of infection and infection prevention is still a bit of a mystery for many highly trained professionals in the medical field;  yet, “superbugs” and antibiotic-resistant bacteria aren’t waiting for all of the professionals to catch up.  In fact, in 5 years, the number of HAI’s (healthcare-associated infections) is estimated to increase approximately 10 percent according to the CDC¹, totaling hundreds of thousands of cases.  At the same time, fortunately, we’ve also seen a rise in advancements and regulation in the sterile processing industry.

What about you?:  Do you have a sterile processing program in place for your practice?  Do you know how well your office is handling the most critical components of your sterile processing?  Does your staff stay abreast of best practices in sterile processing?

The key to staying ahead of the risk curve and maintaining the safety of your staff and patients is to use the best technology available and to follow a few simple but crucial steps.

According to OSAP, the CDC, and the ADA, every office must have a dedicated Infection Control Coordinator (ICC) to take responsibility for your office’s role in public safety.  Let’s take look at a few of the responsibilities as they relate to sterile processing:

Staff Training: Your staff is the frontline for your patients’ safety and your reputation, so it is critical that they have proper sterile processing knowledge and equipment training.  The “hows” and “whys” of using the autoclave/sterilizer in your office are much more complex than simply pressing a button.  Each year new advancements in the tools you use and their material of construction can mean new methods of sterilizing are required, and it’s up to your ICC to know this and make sure your processes reflect changes.

  • Questions: Does your ICC have access to the manufacturers’ Instructions For Use (IFUs) for all the equipment your staff is expected to sterilize? Has your sterilizing process been validated to ensure that your staff is correctly loading and preparing equipment prior to sterilization?

Equipment Reliability: It sounds simple, but how do you know that the equipment you are using is reliable and accurate?  The parameters needed to achieve a full six-log reduction in bacterial load are extremely critical;  however, it’s not uncommon for these machines to slowly develop issues that affect performance over time.  Every equipment manufacturer recommends that the machine be tested and maintained for safety and accuracy at regular intervals, which can be designed to prevent degradation before it becomes a problem that forces you to cancel appointments.  If you are still using manual type autoclaves, consider reducing your risk and investing in a digital machine that meets the latest FDA guidelines and contains internal performance indicators.  Don’t let your equipment increase your risk.

Testing: Did you know that your autoclave can stop properly sterilizing long before the machine gives any indication of an issue or stops working?  There are many inexpensive and reliable ways to definitively test the sterile processing in your office, and some of them can be performed in-house.  Biological testing is the only definitive method of verifying the effectiveness of a sterilizer and your sterile process.

The key to staying ahead of the risk curve is knowing what your risks are and having a solid sterile processing program in place for mitigation.  Your staff is the first line of defense in your office, and with support from you and a robust compliance program from your Infection Control Coordinator, you can ensure your staff’s and patients’ safety, as well as protect your reputation.

Building a solid sterilization monitoring program is easier than you think.  Southwest Sterilizers was started to address the confusion related to sterile processing and to help professionals stay ahead of the risk curve.  Like you, my mission is to keep members of my community healthy and safe.  We are here to be your Infection Prevention Partner.

¹ Rettner, Rachel.  “Superbug Forecast:  Infections Will Increase in US.” LiveScience (online).  August 4, 2015.

²Article originally published in NMDA Journal, Fall 2106.

The Top Three Autoclave ‘User Errors’ Your Staff May Be Committing without Realizing It
 

Shawn Wright, Owner, Southwest Sterilizers, LLC

Over the years, we have serviced autoclaves from all different manufacturers and of all sizes.  After you’ve been in this business for a while, you start to see patterns:  the life cycle of “wear and tear” items such as door gaskets, the quirkiness specific to a make/model, and patterns of “User Errors” that are usually the result of a lack of knowledge/training about these seemingly simple machines.

These User Errors are the cause of many autoclaves being brought into our shop for “service.”  As part of our normal process, we evaluate each sterilizer from the bottom up, to make sure we address not just the symptoms but the root cause of any issues.  More often than you’d think, our tests reveal that there might not be anything wrong with the machine itself:  the issues have been caused by User Error, so we end up conducting a training session for staff instead of a machine repair.

We believe in empowering our community through a focus on education, so today, we want to talk about the top three preventable causes of user-related service calls we receive:

  1. Staff not conducting regular maintenance on the autoclave.
  2. Staff not changing the water in the autoclave’s water reservoir at the prescribed intervals.
  3. Staff not following proper loading guidelines for your particular autoclave.

Regular Maintenance

There is regular maintenance for any autoclave that can easily be done by your staff that can help keep your machine running efficiently between regular technician safety checks.  A few of the most common “gaps” in maintenance are below:

Daily

  • Always run a warm up cycle on the machine before you use it. Just like you preheat your oven to ensure your food will cook at the appropriate temperature for the length of time the recipe calls for, “preheating” your autoclave will ensure that your machine is functioning properly to kill any bacteria hiding on your equipment.
  • Inspect and clean the outer and inner flap of the door gasket. Any residue or build up is likely to compromise the ability for the door gasket to seal properly.  Also, any tears or fissures in the rubber of the gasket – even micro-tears – can compromise the integrity of the seal and cause issues with the autoclave not building enough pressure to sterilize.

Weekly

  • Clean your autoclave chamber with a manufacturer-approved cleaning agent (Chamber Brite for Tuttnauer; Speed-Clean for Midmark; etc). Not all cleaning agents are appropriate for your autoclave chamber, so make sure you use the right product.  Cleaning off the buildup is absolutely critical to sterilization.  You know what they say about Vegas, right?….well, “what happens in your autoclave, stays in your autoclave.”  The problem with this isn’t just aesthetic:  waste particles left in your chamber or on racks/trays can transfer to the instruments in your future loads, compromising the sterility of those instruments.  Cleaning is the cornerstone of your sterile processing; your autoclave must look and act the part.

Changing the Water

We have had several clients who when asked, “When’s the last time you changed the water in the reservoir?”, answer, “Hmm…I don’t know.”

It’s easy to forget about this part of the machine, but not changing the water is like not draining your bathwater and bathing in it over and over (and over!) again.  Chances are if you did that, you wouldn’t get very clean, and neither will the instruments you’re trying to sterilize.

You should change the water – using Distilled Water – at the following frequencies:

  1. At least once every week; or
  2. Every 20 cycles (so, if you run more than 20 cycles in a week, you’ll need to change the water more than once per week).

Once they know the machine’s water requirements, clients have told us that they will often clean the machine and change the water on the last working day of each week, so they can start the next week off fresh and not have to worry about this on Monday mornings.

Clients have told us that using Log Sheets, as we recommend, to document everything related to the autoclave has been very helpful to keep them on track and accountable.  This can be used for daily/weekly maintenance, water changes, any error messages you receive, etc., so that everyone who uses the autoclave knows when the weekly maintenance has been performed, when the water has been changed, and if there have been any errors or alarms.  Additionally, keeping log sheets can be extremely helpful to use as a reference when the machine needs to be taken in for service.  We are always happy to provide Log Sheets free of charge, so please feel free to contact us if you would like one.

Proper Loading of the Autoclave

If you’re starting to get the impression that these seemingly simple machines aren’t really all that simple after all, you would be absolutely correct.  And this extends to how you load the machine: what and how you place individual instruments, packs/pouches, and muslin-wrapped items into your autoclave chamber matter if you want to make sure the equipment has been effectively sterilized.

You should always follow the manufacturers’ sterilizing requirements of the specific items you’re including in a load, making sure you don’t mix metals, that you’re opening hinged items so all surface areas are exposed, that you use the appropriate cycle time, etc.

The User Error related to loading that is most common is overloading the machine.  I completely understand why staff do this:  They want to get as much equipment ready for use again as quickly as possible.  However, there are very specific guidelines set forth by the manufacturer regarding size and weight of loads that the machine can confidently process (i.e. sterilize), and you certainly can’t have anything touching the sides of the chamber itself.  The Operation Manual for your autoclave provides an abundance of information, including guidelines for loading.  If you don’t have a copy of the Operation Manual for your autoclave, we would be happy to provide you with one.

Knowing the challenges inherent in this, several clients have asked us to conduct a Load Study for them: to analyze what and how they’re loading their autoclave, to assess if they’re using the proper cycle parameters, and most importantly, to prove that the loads are being properly sterilized.  Those whose processes are verified through the study have the peace of mind of knowing they are taking the proper measures to ensure staff and patient safety.  In many studies we’ve done, however, clients have found that adjustments needed to be made to their process – some of them very dramatically.  Every time this has happened, clients have been shocked that their processes had issues and they are horrified that they hadn’t been loading their sterilizer properly this entire time.  At the same time, though, they are thrilled that we’ve helped them create a new process that is supported through study data.

Addressing User Errors is a simple way to keep your autoclave functioning properly, to keep your staff and patients safe, and to save you money on services (which includes the service charges themselves and the lost revenue that can result from your sterilizer “breaking down” at the most inconvenient time).  If you read our article in the Fall 2016 issue of this Journal, you may remember we talked about the role of an Infection Control Coordinator (ICC) in your office.  The ICC can take the lead in ensuring that your staff understand these important requirements and are keeping your autoclave in tip-top shape.

Very few products these days seem to be built to last, but if properly maintained through steps taken by your staff and regular inspections by a trained technician, your autoclave can easily be a sound 15 to 20-year investment.

¹Article originally published in NMDA Journal, Winter 2017.