Archive June 2017 XVIII, No. 6

Guaranteed Delivery of Sterilized Sets

Our crosscheck program verifies that wrapped and rigid instrument trays arrive in the OR ready for use.

Fatima Vergara

Fatima Vergara, RN, BSN, CNOR, RNFA


The 2 times we delivered contaminated sets to the OR were 2 times too many. We were fortunate that no patients suffered infections, but we realized we had to improve the coordination and communication between the ORs and the sterile processing department to ensure unsterilized instruments never again reached the sterile field. We came up with a standard sterility verification method to confirm the sterility of instruments in wrapped instrument trays or rigid sterilization containers. Here's a step-by-step guide to how you can implement our checkpoint method, which we call the "Four-Five Points Check" system, so named because OR and SPD staff members verify the sterility of instruments multiple times by checking sterilization indicators in wrapped trays or rigid containers. OSM


1. SEVERAL LOOKS The program centers on a 4-point check of wrapped instrument trays and a 5-point check of rigid instrument containers. We added both sets of checklists to instrument count sheets — a line for each that staff members in SPD and the OR must complete — for easy reference and consistent application. Now staff members in both areas sign off that they've confirmed each item on the checklists.

Rigid Containers
Wrapped Trays
1. Chemical integrator strips placed inside instrument trays have turned from white (unsterile) to black (sterile).
1. Chemical integrator strips placed inside instrument trays have turned from white (unsterile) to black (sterile).
2. The dots in the middle of filters placed at the top and bottom of containers have turned from beige (unsterile) to dark brown (sterile).
2. Stripes on the sterilization tape have turned from red (unsterile) to yellow (sterile).
3. The blue dots on the 2 exterior locks have turned from blue (unsterile) to black (sterile).
3. The wrap has no wholes or tears.
4. The indicator bar strip on the index card attached to the containers' exterior has turned from white (unsterile) to black (sterile).
4. The load locator barcode stamp is present.
5. The load locator barcode stamp is present.

SPD staff mamebers

2. PROPER PLACEMENT SPD staff members lay a chemical integrator at the bottom of wrapped trays or rigid containers and tape another integrator to the instrument count sheet, which is placed on top of the instruments. They sign the count sheet and wrap the tray or close the container. The load locator barcode and/or indicator stamp is affixed to the outside of the wrap or container before it's put in the autoclave.

load sterilized instruments

3. OFF THEY GO A member of the SPD staff completes the 4- or 5-point check, as appropriate, for each load of sterilized instruments before they are placed in case carts for transport to the ORs.

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