Sterilization: AORN's Updated Guideline for Enhanced Patient Safety

Sterilization is the cornerstone of infection prevention in the perioperative setting. AORN's newly updated guideline on sterilization provides crucial guidance for perioperative teams, addressing emerging challenges and reinforcing best practices.

What's New in the Sterilization Guideline for Perioperative Teams?

AORN's sterilization guideline undergoes regular review to incorporate the latest evidence and address evolving practices. This update tackles several critical areas:

• 3D-Printed Devices:

  The increasing use of 3D-printed devices in healthcare presents unique sterilization challenges. The guideline provides guidance on appropriate sterilization methods for these complex devices.

• Short Cycle Sterilization:

  The practice of short cycle sterilization, while sometimes necessary, requires careful attention to detail. The updated guideline provides a clear definition of short cycle sterilization, aligning with CMS standards, and offers recommendations for its safe implementation.

• Transporting Sterilized Items:

  Transporting sterilized items between facilities poses logistical and environmental control challenges. The guideline offers enhanced direction for ensuring the sterility of items during transport, including considerations for vehicle conditions, environmental control, and minimizing movement to prevent damage.

• Water Quality:

  The ANSI/AAMI ST108 guideline emphasizes the importance of water quality for steam sterilization. AORN's updated guideline aligns with this standard, providing recommendations for monitoring water quality to ensure optimal sterilization efficacy.

AORN collaborated with HSPA and APIC to update the guideline

Developing effective guidelines requires collaboration. AORN worked closely with its Guidelines Advisory Board, as well as liaisons from organizations like the Healthcare Sterile Processing Association (HSPA), the Association for Professionals in Infection Control and Epidemiology (APIC), and the Society for Healthcare Epidemiology of America (SHEA), to ensure the guideline reflects the expertise of a broad range of stakeholders.

Key Changes and Enhancements to Best Practices in Sterilization

While many established sterilization practices remain unchanged, the update includes several key enhancements:

• Short Cycle Sterilization Clarified:

  The guideline now includes a formal definition of short cycle sterilization, specifying requirements for wrapped or contained loads, manufacturer's instructions, dry time, and packaging that permits storage.

• Monitoring and Validation:

  The importance of routine monitoring and validation of sterilization processes is emphasized, including physical monitors, sterilization parameters, and chemical and biological indicators. A new table has been added to the guideline to easily identify the recommendations for routine sterilizer efficacy testing.

• Water Quality Monitoring:

  New recommendations address monitoring the water used in steam generators and boilers, aligning with ANSI/AAMI ST108, to ensure steam quality and purity.

Implementing the Sterilization Guideline: Bridging the Gap Between Knowledge and Practice

Successfully implementing the updated guideline requires a systematic approach:

• Gap Analysis: Conduct a thorough gap analysis to identify areas where current practices deviate from the guideline recommendations.
• Prioritization: Prioritize areas for improvement, focusing on those with the greatest impact on patient safety and regulatory compliance.
• Interdisciplinary Collaboration: Engage key stakeholders, including sterile processing staff, perioperative nurses, infection preventionists, and facility leadership, to develop and implement action plans.
• Policy and Procedure Updates: Revise existing policies and procedures to reflect the updated guideline recommendations.
• Staff Education: Provide comprehensive education to ensure all staff members are knowledgeable about the updated guideline and its implications for practice.
• Resource Utilization: Utilize the resources available from AORN, such as the guideline document itself, as well as articles like the one published in the July 2020 AORN Journal detailing the challenges and lessons learned about off-site sterilization centers.

What are Some Common Sterilization Concerns?

The guideline also addresses common concerns and misconceptions:

• Immediate Use Steam Sterilization (IUSS):

  The guideline reinforces that IUSS (formerly known as flash sterilization) can be performed safely when manufacturer's instructions are strictly followed, including protocols for cleaning, decontamination, sterilization, and transfer to the sterile field. Logging reasons for IUSS and tracing the item to the patient is crucial for surveillance.

Sterilization’s Impact on Patient Outcomes: Preventing Infections

The ultimate goal of the sterilization guideline is to prevent infections and ensure patient safety. By adhering to best practices and implementing the updated recommendations, perioperative teams can minimize the risk of infection and provide consistent, high-quality care to every patient.

The AORN Sterilization Guideline is available now in eGuidelines Plus and in the 2025 print guideline book and ebook. Access these valuable resources and empower your team to enhance patient safety through effective sterilization practices.