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Gone in a Flash

Kristina Pirollo Shares How Her Facility Became a ‘No F-Zone’

Flash sterilization. It’s a process that’s become increasingly scrutinized, and for good reason. In light of inadequate instrument inventories, higher case volumes and the subsequent need to turn devices around more quickly, some facilities have made flash sterilization more of a norm rather than an exception. It’s a practice that could place patients at unnecessary risk – and hospitals in potentially hot water with Joint Commission surveyors who are turning a keener eye on how (and how often) facilities are using flash sterilization.

Now for the good news: Through facility-wide commitment and diligent planning, routine use of flash sterilization can be effectively eradicated, as Mary Washington Healthcare's Stafford Hospital has discovered. Though in its infancy, the one-year-old hospital, located in Stafford, VA, is operating like an experienced veteran that refuses to place infection prevention and patient safety anywhere but on the front-burner. The facility has yet to see a case of Methicillin-resistant Staphyloccus aureas (MRSA) and, thanks to the perseverance of Central Sterile Processing manager Kristina Pirollo, CRCST, CHL, ICI, Stafford Hospital is now considered a “No-F Zone,” which means flash sterilization simply does not occur.

“Ever since I got involved in the medical field in 1989, the thought of flashing due to improper planning or lack of instrumentation has always bothered me,” said Pirollo. Although she acknowledges that flash sterilization is indeed useful in emergency situations – and that AORN, AAMI and the Joint Commission are not asking facilities to abandon the practice altogether, but rather to keep its use to a minimum (that is, in emergency situations or when an instrument is dropped in the operating room) – she chose to pursue a no-flash policy to improve patient care and surgeon satisfaction. It was a quest that fell in line with the hospital’s strong focus on infection prevention and quality.

“I didn’t want to take shortcuts, no matter what,” she said. “I made that very clear from the very beginning, even during my job interview. I told them my goal of going [flash-free] and I told them what I would need to make sure instruments were terminally sterilized. And I was [met with] a tremendous amount of support.”

Boosting inventory, satisfaction

Pirollo knew that implementing a no-flash sterilization policy would require some big changes, beginning with a significant increase in instrument inventory. Her first priority was boosting inventory for the operating room’s most commonly-used devices; she added on from there, ultimately outfitting the facility with enough extra instruments to essentially negate the need for flashing.

To accommodate the instrumentation “extras” and simplify the storage and retrieval process, Pirollo incorporated a wall of louvered panels and bins. The bins are labeled alphabetically and the instruments are heat-sealed and sterilized, and placed in their appropriate bin.

“If the OR ever needs an item or if something drops on the floor, no worries,” she explained. “I have that on my wall, sterile and ready for immediate use. This saves time and money, and goes above and beyond what a surgeon expects.” Further, the immediate availability means the anesthetized patient will not be waiting longer on the table while an instrument is sterilized, she reasoned. Pirollo was proud to point out that the system also passed muster with detail- and process-oriented Joint Commission surveyors. “They took a tour of our [department] and absolutely loved how we had everything set up in such a user-friendly manner. I received no Requirements for Improvement.”

A ‘no flash’ policy also meant Pirollo had to implement stringent loaner instrumentation guidelines to ensure that the instruments are accepted into the Central Sterile Supply Department well in advance of the procedure to allow for proper, thorough processing. Not only must vendors deliver instruments at least 48 hours in advance, they must also be accompanied with manufacturer processing instructions. “There are no exceptions, and the hospital backs me on that,” she said, noting that she has been fortunate to have the full and ongoing support of the hospital’s administrator, OR manager and vice president of nursing.

“We are an extension of the OR and cases can’t be booked without us. It’s understood that we’re all responsible for patients’ lives and that one shortcut or [slip-up] can have terrible consequences. I am not willing to bend on these policies.”

Furthering quality efforts

Eliminating flash sterilization and promoting more effective loaner instrumentation policies haven’t been Pirollo’s only passion, however. An approved IAHCSMM instructor, she places tremendous significance on ongoing education and professional skill set development, and mandatory certification of CSSD staff.

Although Stafford Hospital stipulates that CSSD staff become certified within 24 month of their hire date, Pirollo asks technicians to start the process much sooner – within a couple months on the job. Currently, five of the department’s six technicians are certified and the certification process is underway for the remaining tech.

“We play a critical role in patient care and safety, and certification and education is just an extension of our commitment to doing what’s right. Our saying is that we are an ‘Always Hospital.’ That means we do the right things always, even when no one is watching,” she stressed. “We’re proud to say that we won’t accept anything less.”

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