Positive IDs for Positive BIs

October 1, 2002

Positive IDs for Positive BIs

By Rose Seavey, RN, MBA, CNOR, ACSP

A positive biological
indicator (BI) can be a nightmare for the infection control, sterile processing
and surgical staff. How can you be sure if a questionable product has been used
on a patient? The last thing you want to tell a patient is, "We 'may' have
used a product on you that was not sterile, but we are not sure. We will take
precautions just in case."

How can you be sure if a questionable device was used on a patient? The
answer is positive identification of products used on each patient, specifically
patient record cards. If a facility has a BI, having positive identification of
which patients the questionable items were used on is helpful.

At The Children's Hospital of Denver (TCH), patient record cards have been
used for the last seven years. These cards are attached to every surgical
instrument set or package processed. Prior to sterilization, patient record
cards are attached to peel packs and wrapped items with sterilization indicator
tape. Instrument containers used at TCH have a dedicated pocket to slip the
patient record cards into.

TCH uses a bar code system that prints identification labels for each set or
instrument. The label is attached to the patient record card along with the
sterilization sticker that contains the sterilization load information. Prior to
implementing the bar code system at TCH, instrument identification was hand
written on the patient record card.

Ideally, no items should be released until the results of the BIs are read to
be negative for growth. Nevertheless, we know this is not always realistic due
to limited instrument budgets, increasing surgical cases and the push for
quicker turnarounds.

When instruments are used on
a patient, the operating room (OR) staff removes the patient record card from
the peel pack, packages or container. The cards from all instrument used during
the surgical case are collected, placed in a bag to contain them, and then a
patient identification label is attached to the bag.

These bags are then collected for the entire day and sent to the sterile
processing (SP) department where they are kept at least until all of the
biological results are read. If a recall procedure is instituted and not all of
the devices were retrieved, we go through the cards to look for the items.
Having the patient identification on the bag lets us know if an item was used on
that patient. We immediately notify the physician that indeed, a questionable
device was used on the specific patient. He can begin any necessary precaution.

Rose Seavey, RN, MBA, CNOR, ACSP, is director of sterile processing and is
2003 president-elect of the American Society for Healthcare Central Service
Professionals (ASHCSP).