Double-Stacking In Your Washers Could Kill Someone: No More Excuses

I had one of those "please call me" text messages this evening from an old friend who just started a job as a new Sterile Processing manager at a small hospital.

His concern was of both a practical and ethical nature -- yet all too common in hospitals around the United States:

"Hank, we only have one washer -- and we have all these ortho trays to process. If I stop letting them stack trays in the washer this place will literally grind to a halt.

What do I do?"

We see this situation often during our onsite consulting assessments, even in facilities with multiple washers, but who have growing volume that pressures them into taking one of the easiest shortcuts there is in the reprocessing world -- shove it in, and hope it comes out clean on the other side.

The (Very Basic) Science of Clean vs. Sterilization

I have never pretended to be a scientist, nor do I intend to start anytime soon. I'll leave that to the folks who have MS or PhD after their names. As for me and my MDiv, we'll stick to basic science. And what basic science should tell us is that if water & detergent can't access particular instruments during a washing cycle (i.e. they are stacked directly on top of each other), then all that is happening to those instruments inside is they are getting a little warmer than they were when they went in. That's not cleaning. That's a carwash with your windows rolled up -- and that's not what anyone's instructions for use calls for during the automated washing phase.

The Reason for the Holes

A common retort that we hear at this point from technicians is that, hey, "this multi-level instrument case has holes it -- and the trays can be sterilized together, so it should be fine." Again, I'm not a device engineer or validation scientist -- I'm just a lowly consultant with some ideas -- however, I do understand that steam sterilization works through vacuum/pressure, while our washers work through entirely different mechanical means. The design functions of the holes in various vendor cases/trays do assist with water drainage during the washing cycle (if they were validated to be washed with the instruments at all), but their primary purpose is to facilitate the pressurized steam sterilant penetration during the sterilization phase of reprocessing. The presence of holes on vendor instrument cases does not intimate anything as far as what is required to properly clean them.

AAMI ST79:2017 Doesn't Mince Words

If your equipment and device IFUs don't convince you, maybe the AAMI ST79:2017 document will:

7.6.4.3.4 Loading mechanical cleaning and disinfection equipment

When loading mechanical cleaning and disinfection equipment, personnel should do the following: 

....m) Separate multi-level sets so that all surfaces are exposed to impingement action.

n) Open trays with lids/covers so that the contents are exposed and water can drain freely. 

It's about People, not just a Process

At the end of the day, this is not just about compliant processes. Ignoring the basic science of cleaning, turning a blind eye to nationally recognized industry recommendations, and shrugging off manufacturer instructions for use is not an option that's available to you as a Sterile Processing professional -- just to keep the surgeries churning in your operating room suites. This is about real people and real risks of being a willing participant in cutting a corner that could cause a surgical site infection or even take a life. That's not why anyone of us got into the Sterile Processing industry, and if your facility has surgical volume that is exceeding the capacity of your washers -- you DO NOT have to compromise your ethics to keep your CFO happy. You can and should #StopTheLine, and develop a plan to give your team the tools & time they need to clean these trays the way they should be.

If you don't know how to handle this conversation in your hospital, please email me at [email protected] and we will help you. You don't have to fight this battle alone. But it is a battle that must be fought.

What say you?

Hank Balch is the Founder and President of Beyond Clean. You can follow him on Instagram @WeFightDirty, and find his Fighting Dirty video series on YouTube. He is an international thought leader and has written over 150 other Sterile Processing articles and commentary, along with published articles in Becker's Hospital Review, Infection Control Today, AAMI News, AAMI BI&T Journal, Outpatient Surgery Magazine, and contributions to Healthcare Purchasing News. Hank's CS/SPD team in Louisville, KY was named the "2016 CS/SPD Department of the Year" by HPN. He has also served as the founding President of the South Texas Association of Sterile Processing Services and President of the Kentuckiana IAHCSMM Chapter, in additional to being nominated for the 2017 President-Elect & 2018 President-Elect of the International Association of Healthcare Central Service Materiel Management.