What must you consider when reprocessing heat and moisture-sensitive devices?
Petra Stößer-Pfefferkorn: Heat and moisture-sensitive devices today are often equipped with high-tech features, like optical, ultrasound and electrical parts, and are, in most cases, extremely expensive. For this group of instruments, the challenge is to provide not only protection of the material but at the same time a fast reprocessing turnaround. The need is to ensure short cycle times for low-temperature and steamsterilised devices to enable intense and flexible use for all groups of instruments in the operating room.
How has STERRAD with ALLClear Technology helped you address these challenges?
STERRAD technology works at a low temperature (approximately 50°C) and under absolute dry conditions (<5% moisture) – so we reach an optimal level of material protection without any corrosion of metal parts or damages due to thermal tensions, and reach a sustainable elasticity for all synthetic materials. That’s why all our high-tech instruments, like ultrasound scanners and transducers, 3D optics and flexible endoscopes, are treated safely and gently in the STERRAD 100NX with ALLClear Technology.
Four different cycles offer the optimal adjusted options for our complex and sensitive instruments, with various H2O2- concentration levels, program sequences and cycle times.
Has STERRAD with ALLClear Technology helped you balance safety and efficiency?
Yes, absolutely. With STERRAD, we can rely on a safe and material-protective sterilisation process on hand. At the same time, we benefit from short cycle times – the planning flexibility of surgical procedures is much higher, and we can use the devices with maximal efficiency. Moreover, the level of investment regarding the necessary number of instruments can be reduced, considering the fast instrument turnaround. Gentle process conditions significantly extend the lifetime of instruments, so expensive repairs can be delayed or completely avoided – these are important when talking about efficiency and cost savings. In terms of safety for our healthcare staff, we must underline that the biggest advantage of the STERRAD sterilisation process is working without hazardous substances. Despite a concentration maximum of 59% hydrogen peroxide in the cassettes, the user does not come into direct contact with the agent. Because of the final plasma phase, the sterilisation process ends with only non-toxic residues.
How has the new STERRAD with ALLClear Technology, released in 2017, as opposed to the older STERRAD 100NX, benefitted you in your daily CSSD routine? Why did you upgrade to the latest ALLClear Technology?
The central sterilisation department (CSSD) of the HELIOS hospital in Aue, Germany, has worked with the STERRAD 100NX technology since 2015. Before that time, thermosensitive instruments were sterilised with a formaldehyde steriliser with cycles lasting several hours. The short cycle time of STERRAD suddenly allowed a much faster instrument cycle from the operating room to the CSSD and back.
At the same time, the pool of identically constructed instruments could be reduced in the hospital. After exchanging information and negotiating with the central headquarters of HELIOS AG and ASP, it was agreed in mid-2017 to exchange the STERRAD 100NX for the newgeneration STERRAD 100NX with ALLClear Technology. A smooth transition from the heritage machine to the new one was enabled through the same release method of the sterilised load based on the STERRAD sterility guide and the independent monitoring system.
What is your experience with ALLClear Technology, compared with other heritage machines? Which new functionality gives you the greatest benefit?
The new preconditioning phase before the start of the actual sterilisation cycle helps to organise the reprocessing process, especially for flexible optics, in a more stable manner.
After being used on the patient, the flexible optics are cleaned in the decentralised endoscopy department, disinfected, dried and stored in trays.
The treated flexible optics are then transported within the hospital to the CSSD, where they are packed into sterile barrier systems and sterilised in STERRAD with ALLClear Technology.
An inherent risk of this process is naturally, the residue moisture that could occur. Also, the temperature of the instrument is hard to control as it varies due to the in-house logistics of the hospital. Those risks are minimised with the new adaptive preconditioning cycle. In addition, the newly designed user interface and the bigger display compared with the heritage STERRAD 100NX system received praise from the CSSD team.
To which degree does your documentation system deliver information on the efficiency and capacity use of the STERRAD system?
The HELIOS hospital of Aue uses the documentation system instacount by Invitec. This documentation system has functions that include a packing assistant with various user interfaces, media support (image, sound, video, PDF), the use of barcodes or transponders for set identification and barcode-based steriliser loading, and load release for sterilisers. Other functions include detailed load tracking and sterile item tracking, powerful production statistics on item and set level, and individual instrument tracking by data matrix recognition. With this information, we can also follow and understand the efficiency, reliability and capacity utilisation of our STERRAD units.
Do you think that developments in maximising patient safety will lead more often to the final step of sterilisation of flexible bronchoscopes after therapeutic use?
Complementing the disinfection step with a final sterilisation is absolutely welcomed to maximise patient safety, and a challenge for the future. However, this cannot yet be practically realised in the hospital in Aue for a number of different reasons, which include personal, spatial and device-related factors. Flexible endoscopes are currently reprocessed in the endoscopy department.
When adding a sterilisation step, these processes must be integrated into the CSSD. Lots of reconstruction and renovation works would be necessary to create the conditions to realise the change in the reprocessing process of flexible bronchoscopes.
What is the benefit of using ASP technologies for compliance?
Compliance and documentation are highly important parameters for all our workflow processes in the CSSD. With the STERRAD sterility guide database, ASP offers a helpful tool for releasing instruments after sterilisation in the STERRAD. Thus, the user has the assurance that the material compatibility is given, as well as that the geometric properties of the instrument are suitable for the STERRAD method.
That is why the ASP technology makes it easier for us to evaluate and implement the instruments in our own quality management and instrument-tracking system. From a technical point of view, the monitoring and measuring equipment – H2O2 measurement and independent monitoring system – in the STERRAD helps to parametrically evaluate the sterilisation process and ensure the release of sterile goods for use.
