Letters to the Editor

Article Outline

• Flash sterilization
• Using a leading zero with decimals
• References
• Copyright

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Flash sterilization 

In the comprehensive continuing education article “The New Era of Flash Sterilization” (Vol 86, July 2007), the author does a great job of describing the issues and concerns regarding flash sterilization, including increased risk of infection, delayed biological confirmations, higher costs, inconsistent practices, and contamination during transport. We believe, however, that the article omitted a very important issue—the premature aging of a device and its components due to rapid, high-temperature exposure and then rapid cooling.

Multiple components such as metals, glass, ceramics, and plastics make up complex instruments such as endoscopes, phacoemulsification hand pieces, and ultrasonic scalpels. The various materials expand and contract at different rates as they go through the thermal shock of the flash cycle. This method of sterilization creates pressure exponentially with erratic mechanical forces, thereby compromising the components of these frequently used devices and the capability of the components to function collaboratively.

The article reiterates that flash sterilization is overused to compensate for insufficient inventory of instruments and for convenience. Reimbursement systems, budgetary restraints, increased surgical volumes, and quick turnover also are listed as reasons this practice may be abused. The Centers for Disease Control and Prevention, the Joint Commission, and AORN all affirm that flash sterilization should be kept to a minimum and should not be used as an alternative to purchasing additional instruments, to save time, or for convenience.

Initiatives to substantially minimize the use of flash sterilization should begin with an investigation of why it was necessary to flash sterilize in the first place. It is often difficult and time consuming to identify the root cause of flash sterilization needs; however, facilities that have correct and functional equipment inventories, compliant staff members, and accountable managers and that can function without using frequent flash cycles will perform more efficiently and economically in the long run.

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Using a leading zero with decimals 

I enjoyed the article about the different types of nurses in today's OR (“Why Work in Perioperative Nursing? Baby Boomers and Generation Xers Tell All,” Vol 86, October 2007). I am a Gen Xer myself; I celebrated my first year of OR experience on October 27! I loved the personal excerpts from the participants in the study.

I then focused on the article “Medication Safety: Just a Label Away” (Vol 86, October 2007), which is quite a hot topic in the OR. With all the do's and don'ts of medication labeling, I found it surprising that Figures 1 and 6 on pages 621 and 624, respectively, were included. Both pictures depict labels, one filled in by hand and one preprinted, marked with “.25% marcaine.” Doesn't the Joint Commission recommend that all decimals have a leading zero?

I enjoy the magazine and think it's a great resource! I just wanted to bring this to your attention.

I am writing in response to the article “Medication Safety: Just a Label Away.” The article was well written and informative; however, I noticed inconsistency with recommended practices. In Figure 1 and Figure 6, a syringe is shown labeled “.25% marcaine.” One of the labels was a preprinted label. According to the Joint Commission's National Patient Safety Goals¹ and AORN,² a leading zero must be used to prevent errors. The labels should have read “0.25% marcaine.”

In addition, the standard is to label the medication when it is transferred to another container or immediately prior to the transfer. It should not be done in advance. The empty syringe and medication cup in Figure 1 appear to have been labeled in advance of the delivery of the marcaine. Implementing recommended practices in the OR will improve medication safety and prevent errors.

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References 

1. Official do not use list. The Joint Commission. http://www.jointcommission.org/NR/rdonlyres/2329F8F5-6EC5-4E21-B932-54B2B7D53F00/0/06_dnu_list.pdf). Accessed November 6, 2007.
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2. AORN guidance statement: Safe medication practices in perioperative settings across the life span . In: Standards, Recommended Practices, and Guidelines . Denver, CO: AORN, Inc; 2007;p. 337–343
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