John Rowe, CIS, CHL, CRCST.
Manager, Sterile Processing
University Health System, San Antonio, TX
It is the responsibility of the Central Service/Sterile Processing Department to provide cleaned, tested and sterilized instrumentation to the OR on a daily basis. Tray volumes can fluctuate widely depending on the number of add-on procedures, turnovers, traumas and of course, late tray deliveries. This all occurs in addition to routine issues such as staff shortages, equipment downtimes and supply backorders. Mix in the occasional water leak or flood and you’ve got a typical day in the CS/SP department! Despite the challenges, sterile instruments are processed and delivered to the OR so patients can have life-saving procedures in order to continue on with their lives.
But how soon can you safely handle recently sterilized trays?
We all know that the standard autoclave reaches temperatures ranging from 270 to 275 degrees Fahrenheit, and even after the drying cycles, trays emerge from the chamber still hot (usually around 135 degrees). We also know that wet packs can occur if trays are improperly handled and placed on cold surfaces prematurely. But what if the OR needs a tray immediately? How long should the procedure be delayed until the tray can be delivered? In the Instructions For Use (IFUs) for the various containerization methods, as well as disposable blue wraps, the manufacturers recommend following the autoclave manufacturer’s IFUs. The autoclave manufacturers instruct users to follow AAMI standards as listed in ST79. Following the thread, the first answer given by the AAMI standard is to follow the containerization manufacturer IFUs. This brings the CS/SPD professional right back to where they started with no clear answer!
Needless to say, knowing what to do can sometimes be a challenge if we just read IFUs.
But the question remains, how long should a tray cool down? AAMI does go on to say a minimum of thirty minutes is recommended, while two hours is the best practice. In the ‘real world’, it can be challenging to hold a tray for longer than thirty minutes (let alone two hours) in certain situations, especially if a tray is blue-wrapped.
Contamination can occur easily to any hot tray, and a common method to check the temperature of a tray is to touch it. This touch method was once suggested to this CS professional by a sales rep, to which my next question was “What if it is still hot?” The pause and quizzical expression I received as a response told me that this particular rep had not considered his ‘test’ could lead to contamination.
Another method to test the temperature is to use an infrared temperature gun, which will give a good indication of the external temperature of a tray. But if the tray contains dense metal mass or is heavily packed, the core temperature can vary widely from the gun reading.
The way forward is for every facility to take the cool down process as seriously as the cleaning and sterilization processes. Although IFUs state general timeframes, such as a minimum 20-minute dry time, this doesn’t consider the cool down time. Also, since each department varies in facility layout, workflow patterns, and various logistical concerns, there isn’t a hard and fast rule that can apply to everyone. But in delving into the meat of AAMI guidelines, interpreting IFUs, and finding a balance to meet high OR demand, each department should develop Standard Operating Procedures (SOPs) which will provide safe, sterile instrument trays to the OR. In juggling day-to-day challenges it can be difficult to find the time to write SOPs, but we owe it to each and every patient we serve to put forth the effort to achieve the best possible outcome. And remember, trays should cool to room temperature before handling.