The proper cleaning and decontamination of medical instruments is a crucial part of safe patient care. In recognition of that fact, we have a community of experts who are dedicated to the development of standards that help to guide sterile processing professionals.
A standard for sterile processing is only as good as its clarity and the practical application it offers for those who work in the field. In that context, I’m delighted to tell you about a comprehensive update to ST79, the widely used standard for steam sterilization in healthcare facilities.
With this major revision, which includes a user-friendly reorganization of content, ST79 is more relevant and valuable to sterile processing personnel than ever before. I’m proud to have been a member of the standards committee that worked on this revision.
The noteworthy changes include new guidance on HVAC systems in relation to the well-being of sterile processing personnel, and revised guidance on the placement of instruments.
On the first point, it helps to know about another standard: ANSI/ASHE/ASHRAE Standard170, Ventilation of Health Care Facilities. This document offers guidance, regulations, and mandates for facility designers, and it defines sterile processing as a critical area. In order to harmonize with the ASHRAE document, the new version of ST79 includes language in section 22.214.171.124 that explains that facilities should identify which version of ASHRAE 170 will be used, based on when the HVAC system was initially installed or last upgraded.
In the 2017 version of ST79, there is a new Annex Q that describes alternatives for keeping cool in the sterile processing environment. The guidance will help organizations to establish and implement systematic processes for monitoring HVAC performance parameters. If a variance in the HVAC parameters occurs, sterile processing personnel—in combination with a multidisciplinary team that includes, for example, the facility engineer, infection preventionist, risk manager, sterile processing manager or designated personnel—should conduct a risk assessment. The effect of the HVAC system parameters falling out of range is variable. A small variance for a short period of time may not be of clinical concern, whereas a large variance for a longer period may have clinical significance. A risk assessment provides necessary information to guide appropriate response measures.
Annex Q explains that personnel wearing personal protective equipment, or PPE, in the decontamination may overheat and perspire. Unfortunately, just lowering the room temperature may not be an effective way to reduce body temperature because not enough skin is exposed to the air for perspiration to evaporate and cool the body. However, there are steps that can be taken to heat or cool the body as needed. The new annex discusses alternative cooling methods for personnel working in the decontamination room.
On the second point noted above, ST79 also now offers clearer guidance on placement of instruments. Previous editions stated that instruments should be held open and unlocked. This guidance resulted in confusion because some surveyors thought it meant the instruments must be held wide open. In the new version of ST79, we eliminated the word “open” to alleviate the potential for confusion. It now states that “ratcheted instruments should be unlatched. Racks, pins, stringers, or other specifically designed devices can be used to hold the instruments in the unlatched position.”
Additionally, information on Immediate-use steam sterilization (IUSS) has been included in section 10, instead of just being mentioned in the introduction. As we know, the only difference between IUSS and terminal sterilization is IUSS has little or no dry time.
Finally, I want to point out that the use of ST79 applies to a wide variety of facilities. As noted in the introduction to the standard, that list includes hospitals, ambulatory surgery facilities, physicians’ offices, cardiac catheterization laboratories, endoscopy suites, radiology departments, dental offices, and other areas where sterile products are reprocessed, stored, and used.
Rose Seavey, MBA, BS, RN, CNOR, CRCST, CSPDT, is president and CEO of Seavey Healthcare Consulting. She serves on the AAMI standards program. Additionally, Seavey has contributed to the development of multiple sterile processing resources from AAMI, including the book Sterile Processing in Healthcare Facilities: Preparing for Accreditation Surveys. Seavey served on the AORN Board of Directors from 2008-2010 is a former president of ASHCSP (2003). She has received numerous merit awards from AORN and IAHCSMM.