Sterilization

1-Mr Hughs is a honor having you answering couple questions about sterilization, how you became an expert in sterilization?

I came to the healthcare industry as a certified Health Education teacher, hired by the Castle Sterilizer Company to be the Corporate Trainer regarding instrument reprocessing. After completing an in-house training program, I studied and passed the national sterile processing exam offered by Purdue University. Thereafter, through many years of participation in AAMI working groups, attending and speaking at local, national and international Conferences, writing articles and newsletters, designing and patenting sterility assurance products, and finally establishing and running my own firm that specialized in sterilization validation testing, I became recognized by my peers and the healthcare industry as an expert in sterilization.

2-According to AAMI guidelines SPD departments have to make routine, preventive and scheduled maintenance of equipment also calibration, how important became this issue in other countries?

In the many developed countries that I have visited, I find they take sterile processing very seriously. They routinely comply with AAMI and ISO standards regarding equipment maintenance and calibration.

3- A chief of Anesthesiologist agree in theory that instruments should be clean prior to sterilization but contends that even if there a gross protein on the instrument, it would be sterilized and free of bacteria, they do agree that foreign protein left on instrument will create complications in wounds but not infections. What will be a good approach to explain better this statement?

It is important to know and support best practices which are defined by our national standards. For example, AAMI ST79 which covers steam sterilization and ST58 which covers chemical sterilization, both state that reusable devices should be thoroughly cleaned prior to sterilization and should not be considered sterile if visible soil is present after sterilization. Compliance with standards is required to maintain accreditation by national survey organizations as well. That being said, from a science point of view soil has been proven in studies (Alfa) that it can be a barrier to sterilization and therefore, our best practices are evidence based which is good to know.

4- Record Keeping : is The fifth management tool is Record keeping, which is considered an absolute essential for any facility involved in the sterilization of instruments and materials for disbursement in one of your articles, why became an issue for some healthcare facilities having been fined by Joint Commission visit?

Proper documentation and record keeping is the lifeboat for healthcare facilities, especially sterile processing departments as they show you have are in compliance with national standards. From a legal point of view, sloppy documentation is equal to sloppy care.

5- Stethoscope hygiene habits and attitudes in a UK medical school setting. Students completed a questionnaire using Likert-scale questions and free-text answers. A total of 308 questionnaires were completed from a potential 750 students (41%); 22.4% of respondents had never cleaned their stethoscope and only 3.9% cleaned their stethoscope after every patient..!! What will be a real approach to get mind conscious up cleaning a stethoscope for sterile students?

Training and education is needed to get compliance with national standards. Training is the what we should do and education is the why we do what we do. Unfortunately, many HCWs receive training without education. This makes it easy to take short cuts which include improper cleaning of instruments, poor hand hygiene and in this case, limited to no cleaning of stethoscopes.

6- Mr Hughes you travel around the world meeting as many facilities possible, what is the mayor issue that had you been found in sterilization equipment overseas ?

The major issue I see in sterilization equipment is a lack of respect for manufacturer’s instructions for use (IFU). Both cleaning (ultrasonics, washer-disinfectors) and sterilization equipment are complex devices which require extensive training and education as to their proper use and maintenance. While some instruments can be processed using a standard cycle, most complex instruments require special cycles for cleaning and special cycles for sterilization to be achieved. Having and following the equipment and instrument manufacturer’s IFUs is critical for sterile processing personnel regardless of what country they live and work.

7- Laboratory experimental study that compared the effectiveness of five methods of disinfection for the removal of biofilm in gastrointestinal endoscopes new transparent tubes of polytetrafluoroethylene (Teflon®) were used as specimens to simulate the channels of flexible endoscopes. After pre-cleaning the tubes were intentionally contaminated with Pseudomonas aeruginosa and subjected to disinfection methods. As a result, none removed 100% of these biofilms.

Any new equipment for process flexible endoscopes?

Flexible endoscopes are some of the most complex and difficult instruments for healthcare workers to reprocess and best practices must be followed regardless of the equipment being used. For example, pre-cleaning must be performed at point of use as soon as possible in order to help prevent biofilms from forming. Pre-cleaning and formal cleaning must include proper water quality, proper detergent and dilution amounts, proper cleaning implements, etc… along with no delays. Unfortunately, these steps are challenging and not always followed as meticulously as they should. As far as new equipment, Medivators who is the market leader for automated endoscope reprocessors, recently received FDA clearance for a new AER with the following language. “The Medivators Advantage Plus Endoscope Reprocessing System tests, cleans, disinfects and rinses endoscopes, such as fliheroptic and video endoscopes between patient uses. The Advantage Plus system is indicated to provide high level disinfection of heat sensitive semi-critical endoscopes and related accessories. Manual cleaning of endoscopes is not required prior to placement in the Advantage Plus system. The scopes must be precleaned immediately after use.”

8- The very real and growing concern over infectious diseases lead to better techniques of sterilization, some schools for sterilization just pulled the info for the final test ,but not on the real world ; also is a load of new sterile technicians coming for future job openings but not well trained due the lack of externships in the market place.

In your personal opinion is a grow for sterilization technicians and better education in the future?

Yes, I believe so and this is evident by the recent law that was passed by the Governor of New York. Effective January of next year (2015), all new hires by hospitals for sterile processing duties must be certified. While existing technicians are grandfathered in, they are not allowed to change employers without having to show certification as well.

9- what’s is the BEST Company in your knowledge that had been master the sterilization process?

. Not sure what you mean? Certainly manufacturers of steam sterilization processes are recommended over other forms as stated by the CDC, AAMI and other recognized organizations. Steam under pressure is very forgiving and allows for the processing of a wide range of reusable medical devices providing the proper parameters are met.

10- As a SPD technician, I like to have more certification or diplomas about sterilization , what certification or degree will be more appropriated that follow a better understanding of sterilization procedures?

Either IAHCSMM or CBSPD certification is highly recognized and both offer different levels of certification depending on your area of interest.

Mr Hughes .I like to thank you for answer tis questions for our readers and hope can have you in future interviews.

Gustavo Rodriguez
Sterile Processing Technician

California,94596

Sterilization

Tuesday, January 28, 2014

Central Processing Department in the world.

Interview with Mr Chuck Hughes VP, Infection Prevention Consulting Services