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Archive July 2016 XVII, No. 7

How We've (Nearly) Eliminated Flashing

The New York Eye & Ear Infirmary of Mount Sinai went from flashing nearly half of its instruments to hardly any.

Editha Esquieres, RN, MHA, CNOR


flash-sterilize DANGEROUS SHORTCUTS Nurses and techs are likely to cut corners in the cleaning process when they flash-sterilize unwrapped instruments.

Back when it was still called flashing, we sure were doing a lot of it. As recently as 2011, we were flash-sterilizing nearly half (44%) of our instruments here at the New York Eye & Ear Infirmary of Mount Sinai. Yes, I know that's awfully high, especially for one of the most prominent otolaryngology and ophthalmology hospitals in the world, but we were flashing not because we wanted to, but because we had to — our instrument inventory couldn't keep pace with our increasing surgical volume. Fast forward to today: We've virtually eliminated immediate-use steam sterilization (IUSS). If a 19-OR hospital that performs 29,000 surgeries per year can get close to zero, you can, too, by following 4 simple steps.

Set up for failure
Back when we were flashing excessively, it was nearly impossible for our nurses and reprocessors to turn instrument trays over quickly enough to keep up with our volume and our surgeons' habits. On the one hand, many of our cataract and ENT surgeons operated with their own instruments and wanted them reprocessed between cases. On the other, we didn't have enough of our own standardized instrument trays in rotation for our other surgeons.

Besides feeling pressured and rushed, nurses and techs felt guilty, too, knowing that you're only supposed to flash in an emergency and we were routinely sterilizing unwrapped items for immediate use. Plus, when you wash and flash-sterilize instruments between cases, there's a tendency to cut corners in the cleaning process, not brushing, soaking, wiping or flushing as thoroughly as you should. Fortunately, the keys to reducing our IUSS rate were as obvious as the problem.

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