Steam is the most preferred, least expensive and most reliable method of sterilizing your non-heat-sensitive instruments and equipment for surgery. Let's see how familiar you and your staff are about steam and other low-temperature sterilization options.

1. Put these low-temperature sterilization options in order by cycle time from shortest to longest.

a. hydrogen peroxide gas plasma, vaporized hydrogen peroxide, ozone, ethylene oxide, peracetic acid
b. ethylene oxide, hydrogen peroxide gas plasma, vaporized hydrogen peroxide, peracetic acid, ozone
c. peracetic acid, hydrogen peroxide gas plasma, vaporized hydrogen peroxide, ethylene oxide, ozone
d. ozone, vaporized hydrogen peroxide, ethylene oxide, hydrogen peroxide gas plasma, peracetic acid
e. vaporized hydrogen peroxide, peracetic acid, hydrogen peroxide, gas plasma, ozone, ethylene oxide

c. peracetic acid, hydrogen peroxide gas plasma, vaporized hydrogen peroxide, ethylene oxide, ozone

Peracetic acid's 23-minute cycle makes it a good just-in-time sterilization method for heat-sensitive devices that will be used immediately. A hydrogen peroxide gas plasma cycle takes 28 to 55 minutes, depending on the sterilizer. Vaporized hydrogen peroxide sterilizes devices in pouches or wrapped trays at 122 ?F during a 55-minute cycle. The cycle time for ethylene oxide can be 12 hours or more in order for each load to properly aerate. While each ozone load is low-cost because there's no sterilant to purchase — only water, oxygen and electricity — the 4.5-hour run time is a drawback.

2. Which practice should you follow when reprocessing sterile packs and individually wrapped items?

a. reprocess all sterile packs and items every month
b. reprocess sterile packs and items every 6 months
c. reprocess the most commonly used sterile packs and instruments monthly
d. reprocess unopened packs or individual items only if the external integrity has been compromised

d. reprocess unopened packs or individual items only if the external integrity has been compromised

You are no longer required to reprocess unopened packs or individually packed instruments unless the external integrity has been compromised. This is known as "event-related sterility." The instruments will remain sterile for an indefinite period unless the outer package has been compromised. You need to be diligent when recognizing or identifying affected packages or packs. Reprocessing should take place as soon as possible or the packages should be removed from the storage area to prevent inadvertent use.

3. In light of conflicting information relating to the hang time of endoscopes, what's the longest-allowed time period between reprocessing and use on a patient?

a. 5 to 7 days
b. 10 to 14 days
c. up to 3 weeks
d. unlimited time

a. 5 to 7 days

Limited data are available, and studies have shown varying results. It appears that while a 10- to 14-day hang period appears safe, the lack of data does not provide the industry with the comfort in knowing that waiting for that period of time will be in the best interests of patients. AORN and APIC suggest a 5- to 7-day storage period between reprocessing and use.

4. What are the ideal conditions for flash or immediate-use sterilization?

a. any approved sterilizer can be used
b. process can occur in place of purchasing additional instrument sets
c. routine sterilization of unwrapped or uncontained loads continues to be inappropriate and should be cited as a violation
d. none of the above

c. routine sterilization of unwrapped or uncontained loads continues to be inappropriate and should be cited as a violation

It is crucial that you have a common understanding of what is meant by "flash" sterilization, since there have been technological changes that require a more nuanced understanding of this term. Flash sterilization has traditionally referred to a very short sterilization cycle for a very small and unwrapped load. One of the major concerns with this process has been that, because loads were unwrapped, the sterility of the devices could not be maintained after they were removed from the sterilizer. However, as sterilizers have improved their abilities to allow for steam penetration, it has become possible to effectively sterilize wrapped or contained (in specialized metal containers, pouches or cassettes) loads in short cycles.

Sterilization of unwrapped or uncontained loads should not be routine practice, but should be used only for an urgent and unpredicted need for a specific device (such as when an instrument is drop-ped). Don't use open containers for short-cycle sterilization. Flashing is acceptable as long as loads are wrapped or contained and facilities follow manufacturers' guidelines for all devices involved. If you're routinely short-cycle sterilizing, use closed containers designed for such a process and deliver devices to the sterile field in covered form.

All sterilizers must be cleared by the FDA to run short cycles and validated by their manufacturers to perform effectively in those cycles for defined validation loads.

5. What is an acceptable process for cleaning and disinfecting laryngoscopes?

a. wipe down the handle and blade with a germicidal wipe
b. wipe down the handle with a germicide and high-level disinfectant or, if approved by the manufacturer, sterilize the blade
c. sterilize the handle and blade in an approved sterilizer
d. none of the above

b. wipe down the handle with a germicide and high-level disinfectant or, if approved by the manufacturer, sterilize the blade

Laryngoscope blades are considered semi-critical items and therefore at a minimum must undergo a thorough pre-cleaning and visual inspection followed by high-level disinfection with an approved product. The blade must be dried before being used on another patient. If the manufacturer's instructions allow for sterilization of the blade, it can be sterilized as long as the specific instructions are followed. The handle can be thoroughly wiped down with a hospital approved germicidal product.

6. Which of the following steps is appropriate for monitoring the sterilization process?

a. a chemical indicator is placed in each load
b. each load is monitored with mechanical indicators (time, temperature and pressure, for example)
c. a biologic indicator is performed at least weekly and with all implantable loads
d. all of the above

d. all of the above

The monitoring of sterilizers is critical to maintaining an infection-free environment as the process can fail if sterilizers malfunction or the operator doesn't adhere to best practices. It's imperative that you correctly monitor the different types of sterilizers according to government requirements and manufacturers' instructions.