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What Customers Pay You To Know About Sterilization and Disinfection
By Dr. Sheila Dunn

Do you have customers who "sterilize" vaginal specula in dishwashers or soak surgical instruments in Barbasol? We've all heard these horror stories. Moreover, we know that this is a subject that customers really need help with. Yet most distributor salespeople would opt for a root canal over taking time to learn the boring details about sterilization and disinfection.

Knowing the answer to a customer's question can give you a competitive edge, take the focus off price and uncover new selling opportunities. Besides good customer service and timely product deliveries, your knowledge is the most important value-added element that you bring to your customers. It can be the factor that determines who an account chooses to do business with.

And here’s another benefit. Looking at a practice's sterilization and disinfection practices may uncover selling opportunities for items such as: autoclaves; sterilization pouches; chemical indicators; biological indicators; high-level disinfectants, check strips, soaking bins; rubber utility gloves; eyewashes; OSHA Compliance manual, training video, newsletter; personal protective equipment (gowns, masks, etc.).

Test Your Knowledge

Anyone who has been in this business for a while will know the answers to the questions below. Both old timers and novices can test their knowledge of the following common customer queries.

Q: When do we autoclave? When can we just use a disinfecting soaking solution?

A: Sterilize (autoclave) instruments or devices that enter a patient’s vascular system or other normally sterile areas of the body. Autoclaving removes all bacteria, fungi, viruses, etc. and renders an item sterile. Steam autoclaves, by far the most prevalent type of sterilizers used in physician offices, are designed to operate at 250ºF for 30 minutes or in flash mode at 270-273ºF for 10 minutes. Usually items are wrapped in pouches so that they continue to maintain sterility during storage before use on a patient.

Use high-level disinfectants when the heat or pressure of an autoclave would damage the device to be disinfected. Good examples of these items are flexible sigmoidoscopes and endoscopes.

Note: Some practices use high-level disinfectants to clean vaginal specula; others autoclave them. Both are acceptable, but it's overkill to first soak specula in high-level disinfectant and then autoclave them. Save your practices money and exposure to hazardous chemicals by suggesting that they simply soak in soap and water, then autoclave.

Q: What indicators do we have to run to be sure our autoclave really sterilizes?

A: Use chemical indicators with each load. A common type of chemical indicator is a tape that changes color after the run has occurred.

Use biological indicators each week. Government and professional agencies (see table below) recommend biological indicators (BIs) for monitoring sterilization cycles. OSHA relies on CDC guidelines as a widely recognized and accepted standard to be followed by health care facilities. The CDC states, “…proper functioning of sterilization cycles should be verified by the periodic use (at least weekly) of biologic indicators. Heat sensitive chemical indicators (e.g., those that change color after exposure to heat) alone do not ensure the adequacy of the sterilization cycle.”

Most physician offices and clinics use “spore tests” as biological indicators. Spore strips or ampules are placed in the center of the load and the sterilization cycle is run as usual. If the autoclave process achieves sterilization, the spores on the strips will be killed. To determine this, incubate the strips overnight and read results by a visual color change. Some medical offices mail off these tests to be incubated and read; others do the test on site.

Q: What are OSHA requirements for working with glutaraldehyde?

A: Clean and rinse instruments to be disinfected prior to soaking. If mucous and lubricants aren't scrubbed off before disinfection, many bacteria and viruses (including the HIV virus) can survive throughout the soaking cycle. Also, OSHA requires the following:

·          Workers who clean and rinse instruments must protect themselves from splashes and sprays by wearing gowns, rubber utility gloves, and face protection.

·          Have a Material Safety Data Sheet (MSDS) on file and be sure all employees who use glutaraldehyde have read it.

·          The soaking bin must be labeled with the name of the high-level disinfectant and the hazard warning.

·          Use in a well-ventilated area or, if this is not possible, specify that the soaking container is to be tightly covered at all times except when workers are inserting or removing objects from the solution.

Q: When using glutaraldehyde-based soaking solutions, do we need a fume hood? Do employees need to wear monitor badges?

A: No, although prolonged exposure to glutaraldehyde is dangerous. Employers must protect employees from its vapors which irritate eyes, skin, and the respiratory system. OSHA’s permissible exposure limit of 0.2 parts per million of glutaraldehyde was invalidated by court order in 1992. Even so, one or two covered soaking solutions in a medical practice is surely below that limit. If you use glutaraldehyde extensively, employee exposure may exceed healthful limits, even if containers are kept closed. At that point, consider providing employees with glutaraldehyde detection monitors and buy a fume hood or sophisticated ventilation systems.

Q: Does OSHA require that we use check strips to determine potency of soaking solutions?

A: No, but if wet instruments are repeatedly inserted into soaking solutions, it makes good sense to use them, especially near the end of the disinfectant's soaking period. Most managed care plans, when auditing medical practices, require checking the potency of these solutions.

Q: Does OSHA require that we switch to peroxide-based disinfectants?

A: OSHA does not recommend products. And, the fact is, peroxide-based disinfectants are less toxic than glutaraldehydes. But before switching, check soaking times and shelf life. The  new peroxide-based products (which of course are more expensive) may be harmful to skin and eyes and can corrode metal. Also, advise accounts to check with the instrument/scope manufacturer to be sure that the peroxide-based product has been tested for corrosion, lens-clouding or other problems, because using a non-approved product may void the warranty.