Sterilization and Storage Environment Conditions for Certified Perioperative Nurse (CNOR)

Sterilization and Storage Environment Conditions

Guidelines:

• Sterility is event-related and is dependent on the amount of handling, the conditions during transport and storage, the quality of the packaging material, and adherence to the packaging material manufacturer’s IFU
  • Limit exposure to:
    • Moisture
    • Dust
    • Direct sunlight
    • Handling
    • Temperature and humidity extremes
• Decreases the potential for contamination and degradation of sterilized items

Considerations:

• In an ASC, perioperative nurses may be responsible for processing the instruments.
• In other facilities, even though perioperative nurses may not be part of the day-to-day processes that occur in an SPD, they are responsible for:
  • Point-of-use treatment of instruments
  • Transport of instruments
  • Storage of instruments
  • Recognizing when sterilization failures have occurred
  • Recognizing when sterility has been compromised

Nurse’s role:

• Store items in an appropriate space with protection against humidity and recontamination
  • Per CDC, sterile storage area should be a limited access area with a controlled temperature (may be as high as 75 degrees F) and relative humidity (30-60% in all work areas except sterile storage, where the relative humidity should not exceed 70%)
• Sterile supplies should be stored far enough from the floor (8-10 inches), the ceiling (5 inches unless near a sprinkler head, then 18 inches from sprinkler head), and outside walls (2 inches), to allow for adequate air circulation, ease of cleaning, and regulatory compliance
• Medical and surgical supplies should not be stored under sinks or in other locations where they can become wet.
  • Sterile items that become wet are considered contaminated because moisture brings with it microorganisms from the air and surfaces.
• Closed or covered cabinets are ideal but open shelving may be used for storage
• Inspect packaging for defects prior to opening to sterile field
  • Any package that has fallen or been dropped on the floor must be inspected for damage to the packaging contents (if the items are breakable).
  • If the package is heat-sealed in impervious plastic and the seal is still intact, the package should be considered not contaminated. If undamaged, items packaged in plastic need not be reprocessed
• Follow facility policies and procedures

Pitfalls:

• Transportation and Handling of Sterile Instruments and Supplies:
  • When instruments of other items are transferred and/or handled frequently, such as when personnel transport items to and from a centralized SPD, more opportunities for contamination of surgical instruments occur
  • Transporting instruments also increases the risk of packaging tears, strikethrough, and moisture
  • Measures to protect during transport:
    • Closed carts and cases and clean transport vehicles
    • Minimize handling

Examples:

• Currently, air quality in US ORs is maintained by implementing engineering controls that include sequential air filtration and maintaining positive air pressure, at least 20 air changes per hour, relative humidity between 20% and 60%, and temperature between 68° F and 75° F (20° C and 24° C)

Linchpins (Key Points):

• Sterility is event-related
• Limit exposure, transportation, and handling of sterile instruments and supplies
• Inspect packaging for defects prior to opening
• Follow facility policies and procedures