VHP is registered by the EPA as a sterilant, which EPA defines as “ a

Gundersen Health System
Hydrogen Peroxide Vapor
Sterilization
(HPV)
Educational Program for Good Practices in Sterilization Process
Based on AAMI ST79
Moving intoAuthor:
a new
eraToro(*)
of Sterilization
Gisela
Background
Goals
VHP is registered by the EPA as a sterilant, which
EPA defines as “ a substance that destroys or
eliminates all forms of microbial life in the
inanimate environment, including all forms of
vegetative bacteria, bacterial spores, fungi,
Targeted audience
fungal
spores
and
viruses.”
Professional and technical staff working in Central Sterilization and Operating Room. Professionals from various areas of Health.
Implementation of improved practices in the management of CSSD are a challenging to achieve for Health Care Facilities in the
country due:
• No local regulations to control the proper execution of sterilization procedures.
• Decentralized Procedures.
• Professional and Technical Personnel who are assigned to perform their duties in CSSD have little or no experience in handling
Sterilization, Cleaning, Disinfection, Monitoring, Validation, Records and traceability processes.
• Little importance from the Facility Administration that do not consider the CSSD Equipment Central as a Critical Area.
• Lack of information from the Surgical Staff in the verification of monitors and the application of traceability in sterile packages.
EPA: pesticides – Vaporized Hydrogen Peroxide. US Environmental Protection Agency retrieved 2008
Advantages
Development of skills
• Lower temperatures and concentration of sterilant.
• After the training the worker of CSSD and operating theater will be able to :
*• Reduces
risk
of
damage
to
instruments.
Understand the importance of proper implementation of the procedures during the sterilization process.
• Shorter
turn
over
time.
• Know the different sterilization process and their application.
*Time
frame
of turn
over time
is minutes
• Control the
use, application
and interpretation
of monitoring
tools, process. validation and traceability for steam
sterilization and disinfection
according to AAMI ST 79 2013.
compared
to hours.
• Provide documented, valid, reliable and traceable results.
ETO 14.5 hours
• EDUCATIONAL DEVELOPMENT STANDARD
HPV
25
min,
35min,
or
55min.
• Upon completion of training the worker of CSSD and operating theater will:
• Saving
production
costof quality indicators.
• Learn toolson
to validate
sterilization systems andand
implementation
• Establish the central as a critical area.
*Less sets of instruments, due to faster turn
Methodology
Tools
over time.
Explanation.
Blackboard.
• Environmental
savingsProcess check list.
Directed training.
Onsite workshops.
Record
* Emissions to environment is H2O.
Observation.
Discussions of covered topics.
* No abatement system or additional venting.
* No DNR permits required.
Benefits
• Infection Control worked along side of Central
Service to help educate staff on the quality
assurance products being used to monitor the
sterilizers.
*biological indicators
*various chemical indicators
•• ToHPV
is
produced
from
a
solution
of
liquid
Educate outlines and sterilization protocols. AAMI ST79: 2013 standards.
H2O2
and
water.
• To Standardize professional practices based on scientific criteria and
recommendations,
motivate
and create new
• international
Generators
dehumidify
thestaffambient
air.habits and
behavior in daily practice in CSSD and operating room.
•• Administrative
Vapor is circulated
in
the
enclosed
area
at
a
personnel involved as part of the educational program.
programmed
concentration,
time,
and
• To Develop skills to CSSD staff in the management and interpretation of the
temperature.
monitors,
process validation testing, lots and records, integrated
management and traceability Blog for the sterilization process.
• Vapor is circulated back through the generator
• To Train Surgical staff on general topics of sterilization, interpretation of
and
a
catalytic
converter.
This
breaks
it
down
internal monitors, Lots identification and inclusion thereof in the Surgical
to water
oxygen,
which
is vented outside.
History
patientsand
to achieve
traceability
manually.
Preparing for the use of HPV
While still using ETO sterilizers we replaced 2 of our 4 sterilizers
with 2 Low Temperature Hydrogen Peroxide sterilizers.
Using our Electronic Instrument Management System we
identified all the items being processed by the use of ETO.
We then referenced the Instructions for use (IFU) to identify
those items that were compatible for sterilization using hydrogen
peroxide.
Surprisingly in this process we learned that some of the items
that we had been processing by ETO could actually be steam
processed. So we worked with the operating room staff to
remove these items, and in turn we were able to go from 96 ETO
items to 26 ETO items processed.
Potential
24 hour period
Crucial Education for Staff
•
•
The use of Hydrogen Peroxide validation of sterilizers.
* Appropriate use of the 3 cycles.
* Lumen restrictions.
* Weight of items.
*Loading of the chamber.
* Changing containers of Hydrogen Peroxide.
Ulceration of skin on contact.
Hazardous vapor to eyes and respiratory
system.
Process changes for the use of Hydrogen Peroxide Sterilization.
*No longer placing absorbent materials in the instrument sets or
sterilizer loads.
* Items need to be completely dry.
* Special metal container.
Loads will abort if above criteria is not followed.
Where
can
I
get
Contact
Hours?
About the author
References
ETO…
870
MIN
PER
LOAD
60
• 553 health workers related to the central sterilization
standards trained in AAMI ST-79
2013.
1.66 LOADS
50
•
12,522
surgical
procedures
per
month
have
validation
routine
(Challenge
Pack
Process
to
HPV…28 MIN PER POAD
include biological indicator). 150,264 per year.
40
51.42
LOADS
↑
302%
• 8640 surgical procedures per month tracking is done Manual.
30
35 MIN PER LOAD
CONCLUSIONS
41.1 LOADS
↑ 242%
• The implementation
of Good Practice,
process20changes is achieved by giving the members
of the health team training tools updated with the best scientific evidence available.
55 MIN PER LOAD
10
26.18 LOADS ↑ 154%
0
ETO
HPV cycle
HPV 28
MIN
HPV 35
MIN
HPV 55
MIN
(1) ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 (Consolidated Text) Comprehensive guide to steam
sterilization and sterility assurance in health care facilities
• Conferences
Today
we
are
safer,
have
less
expense,
and
are
• Gisela Toro M.D. – Anesthesiologist
• Seminars
more
environmentally
friendly
with
our
low
• Infection Prevention Division - 3M Ecuador S.A.
Workshops
temp
sterilization
system
in place. The shorter
• Title:
Technical Training•Manager
cycle
give(Universidad
us •the
capability
todeprocess
Hospital
• USGSwill
University
CatólicaIn-Services
Santiago
Guayaquil)far
more
thanonin
theof•medicine,
past.
• Professor
Faculty
College
of Nursing USGSIn-services
Printed
Publication
• [email protected]
• Online Educational
Programs
The
increase in efficiency
ensures 100%
of
• be
Vendor
Education
Programs
sterile devices will
available
for our
patients
in a timely manner.
(2) ANSI/AAMI ST77:2013 Containment devices for reusable medical device sterilization (manufacturer’s document)
(3) www.accessdata.fda.gov/cdrh_docs/pdf11/k112805.pdf
(4) www.accessdata.fda.gov/cdrh_docs/pdf13/K132060.pdf
(5) web.orthofix.com/Products/Products/SKYHAWK%c2%ae/SH-1403%20SkyHawk%20Plate%20IFU%207-152014%5b3%5d.pdf
(6) www.aesculapusa.com/assets/base/doc/instructions/aic/sterilcontainers/SterilContainer_System_and_SterilContainer_
S_System_in_Steam_Sterilization_SOP-AIC-5000238.pdf
(7) www.depuysynthes.com/binary/org/DPY_SYN/About_DePuy_Synthes/IFU-0902-00-836%20Rev.%20D.pdf
(8) www.smith-nephew.com/documents/resources/steam%20sterilization.pdf
(9)
www.biomet.com/orthopedics/getFile.cfm?id=2194&rt=inline
(10) ifu.acumed.net/PKGI-76-B.pdf
Internet references sited on February 16, 2015