Table C: Flash Sterilization Audit/Education Program

Table C: Flash Sterilization Audit/Education Program

Station Set-up and Question

NOTE: All sterilizers were set to gravity sterilization settings.

Answer Selection: Bold/Underlined Print Indicates Correct Answer

Practice Principle as Supported by AORN, AAMI, CDC, Institution policy and procedure, Manufactures Recommendations

Percentage of Staff Missing Question

1. A tray of cystoscopy instruments was displayed.
Q: How long should this tray of instruments be sterilized?

A. 3 minutes
B. 10 minutes
C. 15 minutes
D. Should not be Flashed

Porous items and lumened instruments must be flashed for 10 minutes in a gravity sterilizer

16%

2. The same tray of instruments as in question #1 was again displayed. The chemical integrator and autoclave printout supported a ten minute autoclave run.
Q: This tray was sterilized for 10 minutes. Is it sterile?

A. Yes
B. No

All valves in the tray were closed. Steam cannot penetrate through closed valves. This tray should be considered unsterile secondary to improper instrument preparation.

59%

3. A tray of minor non-porous and non-lumened instruments was placed in an autoclave. A previously used chemical integrator was left in the tray. The autoclave jacket pressure was set at 20 lbs of pressure. The printout indicated a flash cycle of 3 minutes.
Q. Is this tray sterile?

A. Yes
B. No

Although the integrator indicated that the parameters of sterilization had been met, the autoclave jacket pressure of 20 lbs would not have allowed the autoclave to sterilize the instruments in three minutes. Closer review of the printout would have shown a three minutes flash run but at a temperature of 257 degrees F. Correct temperature setting should be 271-273 degrees F. Staff are expected to know the correct operating parameters of the autoclaves. This tray is presumed to be unsterile.

33%

4. A 3-M mini driver drill assembly was displayed. A list of the manufacturer’s recommendations is posted next to each autoclave.
Q. How long do you flash sterilize this tray

A. 10 minutes
B. 15 minutes
C. 55 minutes
D. Should not be flashed

AORN recommends to “check with the manufacturer of the equipment being used to determine the correct cycle for the particular equipment.” In their haste, many staff forgot to look at the posted recommended parameters.

50%

5. A Dyonics arthroscopic shaver was displayed.
Q: This tray was flash sterilized for 10 minutes. Is it sterile?

A. Yes
B. No

Although 10 minutes was the appropriate time, the suction valve for the shaver was closed. This instrument should be considered un-sterile secondary to improper instrument preparation.

57%

This outcome is the same as question #2 which tested the same principle.

6. A typical tray of minor non-porous and non-lumened instruments was placed in an autoclave. The chemical integrator lying in the bottom of the autoclave indicated that the conditions of sterilization had been achieved.
Q: is this tray sterile?

A. Yes
B. No

A three step process must occur when assessing the success of a sterilization cycle.
1) Read the printout to see if the run was successful and what parameters were used.
2) See if the chemical integrator or indicator responded to a sterilization cycle.
3) Inspect the instruments to assure that they were properly prepared and the appropriate cycle was chosen.

The printout at this station was blank indicating that the autoclave had not recently run. The integrator was not placed in the tray and was most likely an old integrator from a previous run.

22%

7. The following question was posted on an autoclave.
Q: What type of Autoclave is this?

A. Gravity only
B. Hi Vac only
C. Gravity/Hi Vac Combined

Staff are expected to be familiar with the capabilities of the equipment they are using. Fundamental to that is an understanding with regard to the type of equipment they are using.

40%

8. A Craniotome was on display.
Q: How long should you flash sterilize this tray?

A. 3 minutes
B. 10 minutes
C. 55 minutes
D. Should not be flashed

Specific power instrumentation is posted at each autoclave. Manufacturer’s recommendations must be followed.

50%

As in question # 4 the haste of the moment caused the staff to forget that the proper parameters were posted at the autoclaves.

9. A microaire 2000 was on display.
Q: How long should you flash sterilize this tray?

A. 3 minutes
B. 10 minutes
C. 30 minutes
D. Should not be flashed

Specific power instrumentation is posted at each autoclave. Manufacturer’s recommendations must be followed.

50%

As in question # 4 the haste of the moment caused the staff to forget that the proper parameters were posted at the autoclaves.

10. A Padgett dermatome was on display.
Q: How long should you flash sterilize this tray?

A. 3 minutes
B. 10 minutes
C. 55 minutes
D. Should not be flashed

This Padgett requires gas sterilization. Staff may not only injure patients with improper practice but also can damage or shorten the effective life of instrumentation if improper sterilization parameters are used.

36%

11. A tray of maxio-facial implants was on display.
Q: How long should this tray be flashed?

A. 3 minutes
B. 10 minutes
C. 15 minutes
D. Should not be flashed.

AORN, AAMI, and the CDC recommend against the flash sterilization of implantable devices. If necessary you must use a 10 minute cycle and a biological indicator.

7%

12. A single orthopedic screw was lying on a huck towel in a tray.
Q: how long should this screw be sterilized?

A. 3 minutes
B. 10 minutes
C. 15 minutes
D. Should not be flashed

As above. Staff were also reminded that if the towel they are using came from a previously sterilized tray, they need to moisten it before placing it in the autoclave. This prevents the phenomena of localized superheating which inhibits the sterilization process.

15%

13. A tray with an orthopedic screw and plate lying on a huck towel was on display.
Q: This tray was brought to you from the autoclave. Should you accept is as sterile?

A. Yes
B. No

The tray had no integrator and biological indicator. The current polity of the OR directed scrub staff not to accept trays without integrators. Also, the tray contained no biological indicator and contained implants. This is contrary to recommended standards.

7%

14. A tray known as a “Flash Pak” was on display.
Q: What is this used for?

The “Flash Pak” is one of several industry available trays to assist OR's with the problem of transporting moist flash sterilized instruments through open hallways without exposing them to potential pathogen contamination. They also allow for more efficient use of the flash sterilizer by allowing the operators to perform multiple room runs and not tying up the autoclave for a particular room.

1.5%

15. A tray of instruments was on display. The tray still contained the internal wraps used to separate and organize the instruments.
Q: The outside wrapper of this tray was torn so it was flashed for 10 minutes. Is it sterile?

A. Yes
B. No

The issue for this tray is that all internal wrappers need to be removed. Once sterilized, these papers are so dry that they reduce the moisture in the saturated steam creating a physical phenomenon called superheating. Superheating inhibits the process of steam sterilization.

28%

16. A tray of laparoscopic endoscopes and light cords in a Sterris container.
Q: Are these instruments sterile?

A. Yes
B. No

The chemical indicator on the Sterris container had not changed indicating a process failure.

30%