The Association of periOperative Registered Nurses (AORN) is reporting that the Joint Commission will now be looking more broadly at all of the critical processes included in sterilization when interpreting standards and surveying facilities, including processes for flash sterilization. According to AORN, this means that any healthcare facility accredited by the Joint Commission will need to be able to demonstrate the use of a complete and effective process of sterilization for all sterilization modalities.
Cleaning, decontaminating, sterilizing and transporting are essential steps in the sterilization process -- steps that are recommended by AORN, the Association for the Advancement of Medical Instrumentation (AAMI) and other organizations.
The take-away message from this updated position is that "regardless of the sterilization modality, it's the entire process that has to be in compliance," says Sheila Mitchell, RN, BSN, MS, CNOR, perioperative nursing specialist in AORN's Center for Nursing Practice.
Mitchell said users should refer to AORN and AAMI recommended practices for comprehensive guidance on the complete sterilization process, including AORN's Recommended Practices for Sterilization in the Perioperative Practice Setting in Perioperative Standards and Recommended Practices, 2009 ed., pages 650-653) and the ANSI/AAMI ST-79 2006/AI:2008 Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities (2008 ed., pages 43-79 and 116).
"Perioperative nurses not familiar with the AAMI ST:79 standards can contact their facility's sterile processing staff for more information," Mitchell says, adding that relevant recommendations from the AAMI ST:79 guide are in included in AORN's Recommended Practices for Sterilization in the Perioperative Practice Setting.
In a release on its Web site, the Joint Commission reports that it “has been in discussion with multiple professional and trade organizations in regard to the common and proper use of sterilization using steam. Recently, some decisions have been made which will have an impact on the interpretation of standards as well as the survey process.”
The Joint Commission says that in reviewing this method of sterilization, several issues have emerged, including:
-- The terminology used to describe the sterilization process. Flash sterilization is the most common term used to describe certain types of steam sterilization that do not utilize a full (also known as terminal) cycle. Originally, this term meant sterilizing unwrapped instruments using steam for 3 minutes, at 270 F. at 27 to 28 lbs of pressure. Over the last several decades, a number of improvements have been made to this process, such as longer exposure of the instruments to steam, the use of special trays and packs to hold and protect the instruments, and the routine use of biological indicators. To help sort out confusion about nomenclature, this document will only refer to steam sterilization as described above (3 minutes at 270 F at 27 to 28 lbs of pressure).
-- Indication-related issues that involve the selection of the sterilization cycle or method. Previously, the selection of a sterilization cycle or method was a primary focus during a survey. Now surveyors will be looking more closely into all aspects of the sterilization method or cycle (see the next bulleted item regarding process-related issues). Examples of findings would be a high percentage of steam sterilization using less than a full sterilization cycle, as well as exclusive use of this process for certain types of instruments.
-- Process-related issues involving the way that a given sterilization method is executed. Examples of findings would be failure to adequately clean the instruments before sterilization, lack of chemical indicators, and transporting uncovered instruments back to the operating room after they have been sterilized.
