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If you are performing a standard sterilization cycle, drying time is included. Instruments/trays removed from an autoclave should never be wet, if they are, you need service. If instruments are immediately needed, which is usually the case in an ASC, they should be immersed in cool sterile H2O, not saline.

Marie D. (Director, Surgical Services/Director of Nursing) at April 5, 2012 (12:12 pm)

As David notes, it is essentially "flashing" the instruments. If the instruments can be immersed, they can be placed in sterile water or iced sterile saline or water(from the MH cart) to accelerate cooling. Passive cooling is not a requirement. The presence of water droplets is irrelevant- they are made from condensed steam. If the sterilization cycle has been completed, the instruments are sterile even if wet. If the cycle has been abbreviated for any reason, the instruments would not be considered sterile.

Carl Noback (Medical Director/Chief Surgeon) at February 28, 2012 (6:06 pm)

I am rather surprised by some of the answers here. The correct answer is, "When they are no longer hot enough to burn the patient or the OR staff, but also when the humidity in the package has equilibrated with the surroundings to ensure that the packaging is not compromised as a sterile barrier by condensed moisture."

The first part of this is obvious. The second, less so, but still important. Even if the water that causes the moisture in the packaging is sterile (i.e., from condensed steam), the surroundings are not. If the sterile barrier is wet, good risk management requires that you assume an unsterile instrument. See AAMI ST79 for more on this.

You can make non-contact temperature measurements using infrared thermometers to determine whether the item is at a maximum of body temperature, or, if left to cool and dry completely, at room temperature (full disclosure, we sell these, but so do other people).

If the instrument is removed from packaging before it arrives at the sterile field, and the instrument is wet, you are asking for an infected patient. Likewise for instruments with wet packaging.

Jonathan Wilder (Administrator/Director/Manager/Owner/Exec. Officer) at February 28, 2012 (4:29 pm)

Time to go back to Alexander's Care of the Patient in Surgery. These answers were part of my training back in 1986. Steam droplets came from inside the jacket yes? The steam cycle test registered effective? yes?

Just don't burn your fingers! It's hard to scrub burned fingers for 10-7 or 3 minutes and its harder to slap instruments into the surgeon's hands without groans and owies.

Maria Todd (Administrator/Director/Manager/Owner/Exec. Officer) at February 28, 2012 (4:13 pm)

As David notes, it is essentially "flashing" the instruments. If the instruments can be immersed, they can be placed in sterile water or iced sterile saline or water(from the MH cart) to accelerate cooling. Passive cooling is not a requirement. The presence of water droplets is irrelevant- they are made from condensed steam. If the sterilization cycle has been completed, the instruments are sterile even if wet. If the cycle has been abbreviated for any reason, the instruments would not be considered sterile.

Carl Noback (Medical Director/Chief Surgeon) at February 28, 2012 (3:46 pm)

How are you shortening the cooling time? The instruments need to be cooled on there own time. The instruments need to be cooled prior to use, but do not need to be stored for a specific period of time. You need to be able to track instruments while the biologicals are being processed in case of failure of passing. You will need to follow up with the surgeon.

Steven S. (Administrator/Director/Manager/Owner/Exec. Officer) at February 28, 2012 (3:18 pm)

Yes, you can use them immediately. It would be the same as flashing in a flash case. Instruments should be cool enough to handle. Water inside the case is sterile and would normally evaporate as they are dried. The only risk you run is if the water saturates the bottom of the cover and starts a wicking effect.
Instruments should ideally be dried before they leave sterile processing. Emergent cases are the exception and should be documented as such in the operative record.
As with hot instruments they should be cooled according to manufacturer instructions before they enter the patient, to prevent burns.

David K. (OR Manager/Supervisor) at February 28, 2012 (3:13 pm)

I would also like to expand on this question to ask....IF it is acceptable to open the instruments immediately, are the instruments still considered sterile if water droplets are present?

Lynn Feldman (Administrator/Director/Manager/Owner/Exec. Officer) at February 28, 2012 (3:09 pm)