Wet Loads

IAHCSMM Discussion Forum: Sterilization: Wet Loads
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Archive through February 10, 2003  1   02/10 03:24pm

By Barry Govenor on Friday, May 02, 2003 - 08:16 pm: Edit

Our department had trouble with wet loads and had much difficulty in finding the source (overloaded
autoclave cart, steam filters, water supply lines, steam supply lines, etc.) After all that I have just mentioned were addressed, we still have had problems from time to time (mostly overloading and rushing the dry time, I suspect).
Pre-heating the load in the autoclave before starting the cycle (15 minutes) and a half hour dry time (with the load still in the autoclave) has eliminated many of our problems.

Barry Govenor Pittsburgh

By Anonymous on Monday, June 30, 2003 - 05:12 pm: Edit

We always rewrap all items in a wet load. There is a chance that packs which appear dry are indeed wet inside which means they will not be sterile long. If it was not overloaded, which is should never be, then wet packs indicate that there is a malfuction. We had wet packs for a few days and found that the OR workroom were packing up wet instruments which do not"dry" during sterilization. When the instrument were wrapped dry, the wet loads stopped. Any other times we had wet loads, there was a problem with the sterilizer.

By Anonymous on Wednesday, December 03, 2003 - 08:12 am: Edit

This is a question in regards to wet loads. We all know the procedure to follow in regards to recalling everything in that load,rewrapping the load etc. But I would like to know what other hospital do in regards to wet load? What is your policy? And what action is taken in your facility if the policy is not followed by other CS empoloyees. Any help with this would be very appreciated.

By Anonymous on Friday, January 02, 2004 - 01:48 pm: Edit

Might want to look at the types of items sterilized in the wet load. Do you mix loads by that I mean linen and instrumentation. If you do this may be the cause.

By Anonymous on Friday, January 02, 2004 - 07:14 pm: Edit

IF the CS employee is a known non conformer, than there is only one way of dealing with that problem and that would be to initiate disciplinary action. I do not tolerate inefficiency in my department, especially when I am the ultimate in charge of CSD. I will not risk having sent out anything from a wet load to the OR knowing that it was not sterile. We do rewrap and resterilize all wet loads. What else information are you looking for?

By Carlos Terrones (Carlos) on Saturday, January 03, 2004 - 01:15 pm: Edit

Our department also had problems with WET PACKS, we also mix loads but this hasn't been a problem for us one of the problem we had over loaded, not properly loaded also encountered was our case load had increase we are running larger loads, we sterilize a lot of loaners which there trays are heavy, also found out many of the vendors loaner tray come in platic containers which have many layers with instruments which made it dificult to dry, our pre-vac sterilized set at 45 minutes drying time, at the end of cycle we leave the load in sterilizer for 30 minutes then pull the load out and let it sit out side for another 30 minutes or until it's cooled down, sometime it's dificult to know if it's dry until the tray is opened, then we follow recall procedure. I hope this helps.

By Stephen M.Kovach on Tuesday, January 06, 2004 - 01:03 pm: Edit

I first want to start my comments off with who I am and that I am now working for a company called healthmark and i am not pushing any of thier products but if they can help i will say that also if I know of a product from anybody else to help solve a concern I will do the same. My name is Stephen M. Kovach.
Wet steam occurs when steam does not have enough calories to completely vaporize. Since all of the steam has not vaporized, all of the calories are not present when the steam condeses and lack of sterilization may result. Wet steam can come from a number of sources. Some are as follows: too many instruments, causing liquid consensate to drip onto items on lower shelves, too low a sterilizer jacket pressure which causes the steam in the chamber to consense on the walls. Obstructed drain scren or ineffective drain trap causing liquid water to build up in the bottom of the sterilizer. Symptoms of the latter include packs on the bottom shelf which are wet on the bottom and a ring of mineral deposits around the bottom of the chamber. Condensation inside steam pipes leadng to the serilizer can cause wet steam to enter the sterilizer from the boiler. These are just a few of the many reason for wet steam. Products are available to help solve concerns on steam issue both wet and superheated. One such product is from healthmark(www.healthmark.info) called the integraph which is a diagnostic tool to tell the operator if something is wrong and then goes on to identify the probglem and it is made just for this reason to help understand wet and super heated steam issues. Also Chuck Huges provides a service for testing sterilizers in detail as an independant source. I hope this helps wet and super heated steam do not have simple answers and some times take a lot of work to really solve the concern. Good Luck. Thank you (Stepehn M. Kovach) CPD Guy.

By Anonymous on Tuesday, January 27, 2004 - 11:04 pm: Edit

Does anyone have a policy in place concerning wet loads and surgery needing an item from that load for an immediate case, especially if the item can not be flashed in the OR. Is there an acceptable scenario in this case?

By Adam on Tuesday, June 08, 2004 - 04:45 pm: Edit

JUST WONDERING IF ANYONE RE WASHES THE TRAYS FROM A WET LOAD. WE'VE ALWAYS RECALLED AND RE WRAPPED BUT WE HAVEN'T BEEN RE WASHING THE TRAYS.

By Anonymous on Tuesday, June 08, 2004 - 07:58 pm: Edit

i hadn't heard of that. What would be the rationale for this?

By Adam on Wednesday, June 09, 2004 - 12:31 pm: Edit

Something about the steam leaving a film on the inst. I haven't been able to find info to support this but several of the techs I work with seem to have been told to re wash the trays due to this (film?).

By cmacisaac on Tuesday, June 15, 2004 - 09:24 am: Edit

We were actually called to the OR just prior to the procedure being started to view the film on a basic tray. We realised the possibility of it resulting from reprocessing without rewashing and since that have made it a policy to rewash before reprocessing.
Cindy

By Adam on Tuesday, June 15, 2004 - 03:50 pm: Edit

DO YOU HAVE ANY OR KNOW WHERE TO FIND DATA TO SUPPORT THIS?

By Ray on Tuesday, June 15, 2004 - 06:03 pm: Edit

Hi Adam,
There is no recommendation or regulation that states you must re-wash your instruments from a wet load. You should change the linen towel if used, tray liner if used, re-moisten any items with lumens & insert new chemical indicators and this should be enough.
Films or residues can be caused by several things; HARD water (fairly common)poor quality steam or soap/detergent residues left behind from processing.Hope this helps.
Ray A.

By Ray on Tuesday, June 15, 2004 - 06:06 pm: Edit

Adam,
Think about it, if there was a residue there that necessitates re-washing.....what makes it safe the first time if the film exists? Steam is your sterilant not your enemy. If you have a film, you have other problems.
Ray A.

By Adam on Tuesday, June 15, 2004 - 06:51 pm: Edit

We've never seen this film but half of the staff here are telling me we need to rewash(old habits). I'm actually trying to prove them wrong so thanks for the info.....Ray.

By Ray on Tuesday, June 15, 2004 - 08:09 pm: Edit

Adam,
Ask them to confirm that even though the loads are wet , aren't the instruments supposed to be at their most sterile/usable point, they should be completely sterile. Just because they are wet doesn't mean they are unclean,it just means the load was wet and could potentially be contaminated, that's why you unwrap and resterilize. However they may have had problems with poor quality steam (minerals) or residues left there from decontamination solutions in the past.
Ray A.

By Monika S on Wednesday, July 21, 2004 - 11:58 pm: Edit

Could somebody please give me something in black & white as how to handle a situation please? We had 2 trays come up with literally about 4-5 drops of water on the bottom of the plastic trays after they had been sterilized. They were opened the next morning for a case. My believe is that they were not fully dryed before they were sterilized or there was water left in the hoses. They were the exact same sets. Do you recall the whole load, or do you consider that an isolated incidence? I'm getting several managers saying that it is definitely an isolated incidence as the other sets were opened for the same case and they were dry. For future reference, if they are not all set to be used for the same case, couldn't you check a couple of the largest sets? Thanks

By miki on Saturday, July 24, 2004 - 02:45 pm: Edit

Dear Monika
It is very clear
AAMI/ANSI ST-46 para. 5.9.1 says......packaging apears to be wet should not be used......., instead, such items should be returned to the decontamination area for reprocessing.
The answer to your 2nd question is:
You must challenge each cycle. The PCD (Process Challenge Device)must be placed in the worst location to represent the "worst case". usually it is close to the bottom of the door. If the PCD was positive, - all the load is considered as sterile. If the PCD failed, - you should reject all the load.

By jbarr on Friday, August 20, 2004 - 03:31 pm: Edit

All,
I have not found the wet pack issue to be very clear, especially after reviewing many standards, AAMI, AORN, IC, etc. Especially with rigid containers. The "wet" container is obviously considered contaminated, however, I feel the rationale for considering the whole load contaminated is the old adage that if you have any doubts, consider items unsterile. It has even been suggested by a rigid container manufacturer (clinical consultant) that if only two or three trays are wet, and the sterilizers have been checked and functioning properly, it may be a container issue. Has anyone heard this? Also, steam quality is very significant.

By Chip Moore (Chipmoore) on Monday, August 23, 2004 - 08:08 am: Edit

Is the container metal or one of those plastic kind w/ multiple layers for ortho items? What are the weights? 20 Lbs or less? Greater than 25 lbs?
Define wet. Visible moisture inside or damp wicking material. Are you letting the load sit for at least 1/2 hour before opening and doing so away from A/C down drafts.
One "wet" item doesn't mean a contaminated load but it's a reason to look for root cause to include a sterilizer working to Mfg spec, a steam supply that's at least 97% free of moisture and well trapped at the point of each sterilizer connection and finally, good practices for wrapping/loading.
Chip Moore
Getinge
Rochester, NY

By jbarr on Tuesday, August 24, 2004 - 12:46 pm: Edit

Chip,
We are looking at the steam supply, traps, etc. I am curious regarding your comment that "One "wet" item doesn't mean a contaminated load . . ." This is the question I am asking. It appears that those who wrote previous messages would disagree. Sounds like everyone is looking at this as a black & white issue . . .I am asking where is the standard that states that one wet pack should render the entire load contaminated regardless of other indicators? I would certainly agree that caution is necessary, as in, were parameters met?, is this a re-occuring issue?, etc.

By Chip Moore (Chipmoore) on Tuesday, August 24, 2004 - 01:38 pm: Edit

AAMI ST46, Steam Sterilization and Sterility Assurance, paragraph 5.9.2 Handling & Inspection states "Any items with torn packaging or packaging that appears to be wet should not be used." "Rationale: Items with torn or wet packaging are considered contaminated."

I can't find where it's written that one wet pack should be the basis for a contaminated load and your last sentence sums it up for me.
Chip Moore
Getinge
Rochester, NY

By Ray on Wednesday, August 25, 2004 - 05:46 am: Edit

When you open the door and remove the load and upon inspection, find a droplette of water on a tray or package, your first thought should be water! This package is contaminated! Next question should be, "Is this sterilzer working properly...well maybe", This makes the entire load suspect. It could be the sterilzer, at least a quick dozen challenges with equipment, from dry times to improper sterilizer settings, to loading, to the mass of metal in the tray and load. I call the whole load suspect/contaminated.
There are no maybe's or probably's.
Ray

By miki on Thursday, August 26, 2004 - 02:44 pm: Edit

The Autoclave is a link in the chain of de-cotamination. A very important link.
The personal in the SSD should not be involved in taking difficult decisions. Only YES or NO, black or white! The US as well as Eu standards define very clearly acceptance cretirias for sterile goods.
If you have wetness problems, look for the source were the problem is created. Dont try to minimize the problem by leaving it another 30 minutes in the machine.
Consult your sterilizer manufacturer.

By CPD GUY on Wednesday, September 01, 2004 - 09:10 am: Edit

Wet packs.

This topic comes up a lot.

In searching for other information I found this on wet packs.

In reading the document from Zimmer I found on the web. They have a
section dealing with wet packs.

I wanted to share this with you on this subject.

This is right from the Zimmer hand book.

Instrument sets with unusual density or design characteristics that may
create moisture problems (i.e., wet
packs) from condensation may need special packaging and/or extended exposure
and/or drying times.

Where rigid container systems are used in place of wraps, gravity
displacement cycles are not recommended,because cycle times are too long to be practical.

Additional sterilization information is available upon request. In the
USA call 1-800-348-2759. For calls outside the USA call the local international access code + 1-574-267-6131.

Thick-walled plastic items, such as mallet or driver heads or acetabular
gauges,
may have poor heat conductivity. To prevent condensation of steam on their
surfaces,these items require an extended exposure time to attain the required
temperature.

If the interior of the case is wet after the sterilization cycle, do not
attempt to remedy the situation by:
a) opening the case immediately after sterilization
b) increasing only the drying time, unless testing shows that the exposure
time was adequate to attain sterility
c) drilling additional holes into the case for added drainage

During initial sterilization runs some formaldehyde from the gauge surfaces
may vaporize and become noticeable. After a few sterilization procedures,
the odor should be no longer apparent.

Again, please download the complete document. They Zimmer have done an
excellent job with this care and handling information.

http://www.zimmer.com/web/enUS/pdf/Surgical_Cleaning_Instructions_Final.pdf

The internet is great for finding information.

I have a question. Hopefully you all can help me. It has nothing to do with
wet packs

I am trying to find information on multi-layer trays. Like the orthopedic
trays. The questions is are orthopedic companies telling users to make sure
that trays that have more than one layer of instruments to have each layer
of instruments taken out and washed separately if they are going into the
automatic washer. I can not find anything written on this. Can anybody
share with me what they do and do they have anything written from the
manufacture.


Thank you
and
Remember
Always Keep it Clean.

Stephen M. Kovach
Director of Education
Healthmark Industries Co.
1-800-521-6224/ext.6621
Fax - 1-586-774-6473
www.hmark.com
CPDGUY@healthmark.info

By Amy Serrano on Friday, September 03, 2004 - 09:07 am: Edit

Hi, who remoistens the lumens before sterilizing? Do you practice that when you put the tray together prior to sterilization?

By Anonymous on Sunday, October 03, 2004 - 08:11 am: Edit

We have a new cloth wrap, after sterilizing, we are finding beads or pools of water under the 1st fold of the wrap.
Inside the instrument tray, the second wrapper is dry.
The tray is on the 1st or second rack of the cart, and the cart is the first cart in the sterilizer over the hole.
The sterilizer is pressure pulse, steam.
Is there anyway that we can eleminate this pooling problem,
Thank you

By Chip Moore (Chipmoore) on Monday, October 04, 2004 - 07:51 am: Edit

Heavy duty, nonwoven wrap material requires extra efforts for dry loads. Maybe the folded material is retaining moisture at the first fold (too much material/too many layers).

Chip Moore
Getinge
Rochester, NY

By brendapaul on Wednesday, October 27, 2004 - 02:38 pm: Edit

Does anyone know of any standards pertaining to covering loads in the sterilizer to prevent water droplets?

By GHSCorp on Thursday, October 28, 2004 - 09:26 am: Edit

brendapaul - We manufacture an absorbent Sterilizatoin Cart Liner which is multi use - they prevent staining as well as water dripping from one shelf to the lower shelves. If you would like more information or free samples, please contact General Hospital Supply Corporation at (800) 548-1004. Thank you!

By Anonymous on Thursday, October 28, 2004 - 01:57 pm: Edit

When does the water droplets occur? If it is during the sterilization cycle, then you would need to check the steam quality. IF its after the completion of the cycle, then maybe your door is too wide open, causing condensation. Check these options first, before adding more stuff into your autoclave.

By Brenda Paulsen (Brendapaul) on Thursday, October 28, 2004 - 02:15 pm: Edit

We have done steam quality checks, trap checks, drying time etc. What we found was that when we switched to the polypropylene wrap the problem came to light. (obviously the cloth wraps were absorbing the moisture) So....by covering any wrapped items on the second or bottom shelf with a cloth cover we were been able to wick the moisture. However,a new OR director does not want this practice done anymore and has re-ordered all new testing. HELP!!!!

By CPD GUY on Thursday, October 28, 2004 - 02:40 pm: Edit

Healthmark has some products that might help you with your wet load / packs concerns. Contact me one on one for more information and help with your concern on this issue.

Thank you
and
Remember
Always Keep it Clean.

Stephen M. Kovach
Director of Education
Healthmark Industries Co.
1-800-521-6224/ext.6621
Fax - 1-586-774-6473
www.hmark.com
CPDGUY@healthmark.info

By mike on Friday, October 29, 2004 - 07:06 am: Edit

What kind of trays are you talking about,plastic,metal containers and how heavy
are they.Do you get droplet all the time no matter
what the load size.Try using hospital towels
under item and on top.Leave racks in sterilizer
longer and don't put them under A.C ducts.
We used to have same proplem but we have new
machines now.Don't put items under solid beems.

By klemmramm on Friday, March 11, 2005 - 09:12 am: Edit

i want to know if is right to sterilize implants that are no completly dry? What can be done to avoid infection in wets implants?

By Anonymous on Saturday, March 12, 2005 - 03:10 pm: Edit

If there are droplets on the implants Vs pooling water in the bottom of the trays. A little droplet is not a problem, but if they come from decontam with water running out of the trays, you need to dry your trays and implants out.
If you are referring to water on the implants in the tray after sterilization (not flash)that could indicate an excessive steam problem.


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