MANAGING A STERILE PROCESSING DEPARTMENT IN CRISIS:

HOW TO STAY COOL WHEN YOUR SPD GETS TOO HOT

FRANK MYERS, MA, CIC INFECTION PREVENTIONIST III

UC SAN DIEGO HEALTH SYSTEM

POTENTIAL CONFLICT: MR. MYERS HAS SPOKEN OR J&J ETHICON

OBJECTIVES

• Define the environmental parameters for SPDs

including heat, humidity, monitoring and air

exchanges

• Conduct a risk assessment of Sterile Processing to

determine remediation strategies after a disruption

in the HVAC system

• Identify three important actions to take when

temperature and humidity exceed established

parameters

WHO HAS GUIDELINES AROUND HEAT AND HUMIDITY IN SPD

• AORN, AAMI

• ASHRAE and ASHE

• State Guidelines (often behind ASHRAE)

• CMS

• OSHA

HVAC FAILURE

• Portable Air Conditioners

• Need to duct hot air from these somewhere

• Cause air eddys

• May kick up dust depending how they are vented

• Can not supply more air so pressure differentials may be

impacted

RECREATING AND HVAC SYSTEM

• Air may be cleaner if vented in from a HEPA

• May allow pressure differentials to be reestablished

• But GREAT thought has to be made on how to

recreate a HVAC system

AIR CAN BE DIRECTLY SUPPLIED TO WHERE PEOPLE ARE WORKING

HIGH DUSTING IS OBVIOUSLY A CONCERN HERE

KNOWLEDGE NEEDS TO BE VERY HIGH ON FACILITIES PART AS TO WHAT THE

AREA IS

Why is this a massive problem?

CALIBRATION

WHAT ARE THE MOST IMPORTANT VARIABLES?

• Risk assessment needs done. Preferably before the

event.

• Temperature & Humidity needs to be in range that

allows:

• Staff to work safely (sweat and exhaustion)

• Sterilizers to function

• Not just upper range (wet loads)

• Indicators to work correctly (check your IFUs)

• Humidity specific

• Fire risk

• And Prolonged (2 weeks) humidity can cause IC issues

AIR EXCHANGES AND PRESSURE DIFFERENTAILS

• Need to Operate within Guidelines • But this is an internal disaster

• Risk of denying services versus threat of current environment

• Risk Management and leadership to decide whether to notify regulatory bodies

• Air Exchanges • What is needed for safety

• Disinfectants and chemicals

• Beyond that is there IC data

• Pressure differentials • No published papers in a non-OR non BMT suggesting real

benefits

WRAPS, PAPER AND LOW HUMIDITY

• The IFUs clearly have temperature ranges and humidity ranges

• Requirements around OR is daily measures • Many of us have measurements more often

• Be sure to say that the variance must be greater then 24 hours before actions are taken

• Paper and wraps deteriorate • Manufacturing Site

• Transportation

• Off site storage

• Loading Dock

• Transport to sterile storage room

AORN SUPPORT FOR DAILY

• What are the recommended humidity ranges for an operating room?

• Answer:

• The recommended humidity range in an operating room is 20% to 60% based upon addendum d to ANSI/ASHRAE/ASHE Standard 170-2008. Each facility should determine acceptable ranges for humidity in accordance with regulatory and accrediting agencies and local regulations. The center for Medicaid and Medicare systems has modified their requirements to allow for the 20% lower limit effective June 2013. Temperature and humidity should be monitored and recorded daily using a log or electronic documentation of the heating, ventilation, and air conditioning (HVAC) system.

• Resources

• Recommended practices for sterilization. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:513-540.

• ANSI/ASHRAE/ASHE Addendum d to Standard 170-2008: Ventilation of Health Care Facilities. 2010. www.ashrae.org/File%20Library/docLib/Public/20100714_ad170_2008_d.pdf. Accessed November 30, 2012.

• Centers for Medicare & Medicaid Services. State Operations Manual Appendix A: Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. Rev;84.2013;. http://cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pd. Accessed July 15, 2013.

• Updated July 18, 2013

DON’T MINIMIZE FROM 2008 CDC STERILIZATION

GUIDELINES • . Relative humidity is the single most important factor influencing the activity of

gaseous disinfectants/sterilants, such as EtO, chlorine dioxide, and formaldehyde

• Physical Facilities. The central processing area(s) ideally should be divided into at least three areas: decontamination, packaging, and sterilization and storage. Physical barriers should separate the decontamination area from the other sections to contain contamination on used items. In the decontamination area reusable contaminated supplies (and possibly disposable items that are reused) are received, sorted, and decontaminated. The recommended airflow pattern should contain contaminates within the decontamination area and minimize the flow of contaminates to the clean areas. The American Institute of Architects recommends negative pressure and no fewer than six air exchanges per hour in the decontamination area (AAMI recommends 10 air changes per hour) and 10 air changes per hour with positive pressure in the sterilizer equipment room. The packaging area is for inspecting, assembling, and packaging clean, but not sterile, material. The sterile storage area should be a limited access area with a controlled temperature (may be as high as 75oF) and relative humidity in all works areas except sterile storage, wherethe relative humidity should not exceed 70%)..

• Ensure the sterile storage area is a well-ventilated area that provides protection against dust, moisture, insects, and temperature and humidity extremes. Category II.

• 454, 819, 836, 969 (every citation is a professional standard with no citations)

WHEN THE SYSTEM GOES DOWN

• Establish current conditions, stability o conditions

and expected return to normal operating

conditions

• Consult your risk assessment as to how those

variables are weighted in importance

• Inform administration and risk management, advise

as to what the risk assessment directions are

THANK YOU QUESTIONS?