This article appears in the September/October issue of Surgical Products.

Dr. Hudson Garrett is currently employed as the Senior Director, Clinical Affairs for PDI. He holds a Bachelor of Science degree in Biology/Chemistry, a dual Masters in Nursing and Public Health, and a PhD In Healthcare Administration. In this interview he discusses methods of OR sterilization, their limiations, and how hospitals can get better results.

SP: Assess how some of the tried and true methods of OR sterilization are in terms of limiting and/or preventing the spread of various healthcare-associated infections? 

Garrett: Sterilization is a proven method for achieving total kill of microorganisms, however breaches frequently occur within the process. When immediate use sterilization is utilized, there is increased risk for potential breaches in the process, and you also may not have the biological indicator prior to closing the patient, which is of course problematic. When sterilization is used, the process should be regularly validated, the equipment frequently inspected, and the staff members involved in the process should receive ongoing continuing education. The use of immediate use sterilization should be limited to emergency situations where traditional sterilization methods cannot be used.

SP: Obviously, these HAIs are a significant problem. Is that a result of those aforementioned methods not being effective? Are those methods being done improperly or not done at all? Is it a little bit of both?

Garrett: Breaches in sterilization are certainly a risk factor for a patient contracting a healthcare-associated infection, but they are by no means the only concern. HAIs are caused by a variety of breakdowns in the chain of infection transmission, most notably failure of healthcare providers to properly sanitize their hands when clinically indicated. Many infections are transmitted via the hands as vehicles for transmission. Hand hygiene with either soap or water or an alcohol based hand rub can dramatically reduce the risk for transmission of HAIs.

SP: What can be done to attack the problem of HAIs in the OR? How can the results of sterilization efforts be improved?

Garrett: Most infections are transmitted as a result of one or more of the following: contaminated hands of the healthcare worker, contaminated environmental surfaces, and/or the patient’s own skin flora. Instruments and other supplies can be sterilized, and this will reduce the presence of bioburden, however it will not eliminate the risk for infection transmission totally. Operating room clinicians should practice rigorous hand hygiene, routinely clean and disinfect contaminated environmental surfaces, and properly use preoperative skin antiseptics to reduce the presence of flora on the patient’s skin. These basic infection prevention interventions will further reduce the risk for transmission of HAIs.

Sterilization methods continue to improve thanks to continuous innovation, but we still find breaches in policy and procedure due to lack of staff training and other reasons. Staff members involved in the sterilization process should receive extensive ongoing training to ensure competence. Additionally, a robust monitoring program is critical to success.

SP: Do you think this is an issue on the rise or decline right now? Is this a problem that can be fixed? If so, how?

Garrett: Thanks to the efforts of many key organizations such as the U.S. Centers for Disease Control and Prevention (CDC) and the Association for periOperative Registered Nurses (AORN), the incidence of HAIs has drastically declined in many categories, however there is always room for additional improvement. The sterilization and infection prevention technologies that exist today are important tools in the battle to reach zero, however the most significant variable is the healthcare staff that use these tools. Products and technologies may kill bugs, but people prevent infections.