By Rose Seavey, RN, MBA, CNOR, ACSP
A positive biologicalindicator (BI) can be a nightmare for the infection control, sterile processingand surgical staff. How can you be sure if a questionable product has been usedon a patient? The last thing you want to tell a patient is, "We 'may' haveused a product on you that was not sterile, but we are not sure. We will takeprecautions just in case."
How can you be sure if a questionable device was used on a patient? Theanswer is positive identification of products used on each patient, specificallypatient record cards. If a facility has a BI, having positive identification ofwhich patients the questionable items were used on is helpful.
At The Children's Hospital of Denver (TCH), patient record cards have beenused for the last seven years. These cards are attached to every surgicalinstrument set or package processed. Prior to sterilization, patient recordcards are attached to peel packs and wrapped items with sterilization indicatortape. Instrument containers used at TCH have a dedicated pocket to slip thepatient record cards into.
TCH uses a bar code system that prints identification labels for each set orinstrument. The label is attached to the patient record card along with thesterilization sticker that contains the sterilization load information. Prior toimplementing the bar code system at TCH, instrument identification was handwritten on the patient record card.
Ideally, no items should be released until the results of the BIs are read tobe negative for growth. Nevertheless, we know this is not always realistic dueto limited instrument budgets, increasing surgical cases and the push forquicker turnarounds.
When instruments are used ona patient, the operating room (OR) staff removes the patient record card fromthe peel pack, packages or container. The cards from all instrument used duringthe surgical case are collected, placed in a bag to contain them, and then apatient identification label is attached to the bag.
These bags are then collected for the entire day and sent to the sterileprocessing (SP) department where they are kept at least until all of thebiological results are read. If a recall procedure is instituted and not all ofthe 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 onthat patient. We immediately notify the physician that indeed, a questionabledevice was used on the specific patient. He can begin any necessary precaution.
Rose Seavey, RN, MBA, CNOR, ACSP, is director of sterile processing and is2003 president-elect of the American Society for Healthcare Central ServiceProfessionals (ASHCSP).