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).