Archive Infection Control 2017

The Lowdown on Low-temp Sterilization

Maximize your use of alternatives to the autoclave to reprocess heat-sensitive devices and flexible endoscopes.

Bill Donahue, Senior Editor; and Daniel Cook, Executive Editor

low-temperature sterilization WELL EQUIPPED Low-temperature sterilization systems capable of handling a wide range of devices will help staff prepare instruments for the OR in a safe, timely fashion.

Low-temperature sterilization is the go-to option for killing infection-causing bacteria on devices with plastics, lenses and electronic components that would be damaged by the high heat of an autoclave. Methods include ethylene oxide (EtO), vaporized hydrogen peroxide, hydrogen peroxide gas plasma, peracetic acid and ozone. Nancy Chobin, RN, CSPDM, CFER, the president of Sterile Processing University in Lebanon, N.J., suggests you seek answers to these questions before deciding which option is best for your facility:

  • Does the system's footprint match up with the constraints of the department?
  • Are there specific safety issues that necessitate additional investments, including special personal protective equipment?
  • Will the system's turnaround time suit your needs?
  • Does the system have user-friendly and intuitive features to detect overload or other errors that might compromise sterilization?

Reprocessing recommendations provided by instrument and device manufacturers must be compatible with the parameters of your specific low-temp sterilizers, says Donna Swenson, BS, CRCST, CHL, ACE, president of Sterile Processing Quality Services in Stickney, Ill. Also, ensure low-temp sterilization options are validated to sterilize lumened instruments and, if they are, what length lumens they can handle.

Low-temp sterilization offers a number of advantages, perhaps chief among them avoiding the prolonged cool-down cycle that steam sterilization requires, says Frank Myers, MA, CIC, FAPIC, assistant associate director of infection prevention and clinical epidemiology at University of California, San Diego Health. A newly approved device offers hydrogen peroxide and ozone sterilization in a single cycle. "A dual-system always makes a device better," says Mr. Myers. "If it can't kill bioburden with one method, it can kill it with another." Plus, a mixed-load capability means you can sterilize multiple types of instruments in a single load, which minimizes instrument sorting and offers significant time savings.

DECONTAMINATION DEBATE
Is It Time to Sterilize Every Scope?

high-level disinfection TURNAROUND TROUBLE Some infection control experts believe high-level disinfection isn't adequate to reprocess tough-to-clean flexible endoscopes.

Flexible endoscopes are notoriously tough to clean. In one recent study, 12 out of 20 (60%) reprocessed GI scopes tested positive for microbial growth — even though they were disinfected in accordance with current reprocessing guidelines (osmag.net/C8WRex). Studies like this tend to raise a lot of alarms. So do a series of recent carbapenem-resistant Enterobacteriaceae outbreaks at high-profile facilities, caused by improperly cleaned duodenoscopes.

Donna Swenson, BS, CRCST, CHL, ACE, president of Sterile Processing Quality Services in Stickney, Ill., says most low-temp sterilization methods cannot sterilize long-lumened endoscopes. One option that works very well is ethyl oxide (EtO). But it's an expensive and impractical way to sterilize scopes — cycles take about 2.5 hours to complete and are followed by a mandatory 8- to 12-hour mechanical aeration.

A low-temperature sterilizer offers hydrogen peroxide and ozone sterilization in a single cycle and is validated to sterilize multi-channel flexible endoscopes up to 3.5 meters in length. Ozone can achieve slightly more natural penetration than vaporized hydrogen peroxide in lumened instruments, says Frank Myers, MA, CIC, FAPIC, assistant associate director of infection prevention and clinical epidemiology at University of California, San Diego Health. But having both methods in a single unit packs a powerful decolonizing one-two punch.

Ms. Swenson isn't a big proponent of moving toward sterilizing endoscopes. She believes efforts must focus instead on redesigning the devices and working with sterile processing staffs to reinforce how to clean them properly.

"For scopes that come in contact with non-intact skin or mucous membranes, high-level disinfection may be sufficient," says Nancy Chobin, RN, CSPDM, CFER, the president of Sterile Processing University in Lebanon, N.J. "Don't make any changes to your reprocessing protocols that stray from the current guidelines — at least not yet. Additional guidance is on its way from industry leaders on this topic."

— Daniel Cook and Bill Donahue

Mr. Myers also points out that documentation technology on sterilizers is getting more sophisticated. "Some of the newer systems document complete and validated sterilization cycles electronically," he says. "There are fewer recordkeeping issues and less paperwork to manage. Those are huge gains."

A ballpark investment per sterilizer is about $100,000, says Ms. Chobin, though you must also figure in the costs of associated consumables and the annual service and maintenance costs. OSM

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