sterile processing
By David Taylor , MSN , RN , CNOR
Sterile Storage Could be Compromising Patient Care , Safety
Many factors need to be considered regarding sterile storage of instrumentation and supplies . Although sterile storage is a critically important aspect of sterile processing ( SP ), many SP professionals do not understand how the environmental controls that govern this process can dramatically affect patient safety and negatively impact the organization ’ s bottom line .
When developing infection prevention-related policies and practices for storage and supply areas , it is important that SP leaders not only know the infection prevention policies established by their institution , but also understand standards established by the American Society of Heating , Refrigerating and Air-Conditioning Engineers ( ASHRAE ), which can vary depending on the date the storage space was established .
The first step SP leaders should take is ensuring their organization is compliant with all building code requirements . Once this has been established , the next step is to satisfy the Centers for Medicare and Medicaid Services ( CMS ) requirements for ventilation . Note : Criteria for new or renovated spaces ( versus existing space ) may vary . Contacting the healthcare organization ’ s Facilities team should be sufficient to determine which standards must be met . Keep in mind , however , that industry standards and local building codes can vary , and one ’ s organization will need to meet the most restrictive of the two .
Supply storage areas that support SP ’ s mission must follow all building codes and satisfy CMS ventilation requirements , which include the following : 1
• Positive air pressure relationship to adjacent areas
• Minimum outdoor air exchange ( two per hour )
• Minimum total air exchange ( four per hour )
• Maximum relative humidity ( 60 percent )
• Temperature range ( 71-78 degrees F ; 22-26 degrees C )
Although this is not an exhaustive list , other things to consider regarding SP supply storage include :
• All patient-care supplies should be stored away from the edge of a sink to avoid possible splash contamination .
• All patient-care supplies must be at least five inches from the floor . If fixed or mobile wired shelving is used , ensure the lowest level shelf is covered with a solid surface ( plastic cover ) to avoid possible splash contamination during cleaning .
• Storage must maintain an 18-inch clearance from the ceiling ( or the sprinkler head if co-located ) to allow for the proper function of the fire and safety sprinkler system . It is important to know that the 18-inche rule applies laterally , away from any sprinkler heads as well .
• Corrugated cardboard material delivered to healthcare areas should be unpacked and broken down and removed in a timely manner . Use of corrugated cardboard cartons in healthcare storage areas must be assessed by the healthcare epidemiology team to
ensure that the use of such cartons does not compromise the cleanliness or sterility of patient supplies .
• Internal shipping boxes ( not corrugated boxes ) may be used to dispense sterile and clean supplies but should be discarded when the box has been emptied .
• Doors should remain closed to maintain temperature , humidity , air flow ( positive ) and air exchange compliance .
• Wooden pallets should be limited to the transportation use by logistics and delivery personnel . Only pallets made of synthetic material are allowed in storage rooms where patient care supplies are located .
What follows are some photographic examples of sterile storage areas I experienced as a consultant . Although a clear splash guard is present to prevent water contact with supplies , notice the instrument set and supplies next to the sink ( Figure 1 ). Instruments sets , peel packs and supplies near a waters source or wet areas increase the risk of a sterile item becoming compromised ( Figure 2 ).
Figure 1
Figure 2