Using more than 1 indicator/integrator

[CSGIRL]

Does anyone use more than 1 indicator/integrator per set? In an article that I was reading, it was talking about using 2 indicators/integrators in rigid containers (1 in opposite corners) and 2 indicators/integrators on each level of a multi-level set (1 in opposite corners). This is a recommendation from AORN. This article is in the Healthcare Purchasing News. Has anyone implemented this practice?

[Harvey Johnson]

AAMI ST79 section on internal integrators only states an internal CI should be used with each package, tray or rigid container, placed in an area considered to be least accessable to steam penetration. Doesn't address how many.
That said, we usually place multiple CI's on multi level trays and inside paper sterilization envelopes placed inside trays.
The OR looks for these as additional indications the items have met parameters.

[CSS TECH]

Very interesting topic. Thank you Girl from bringing it up. Curiously, whenever more than one indicator were found on a tray, my staff had to face a PSN report. The claim was that the previous indicator was not removed. Now that our new policy is to use one indicator on each layer when there are more than one layer, and on each corner of regular trays, we don't hear those kind of complaints anymore.
Spd, is it a good practice to place paper sterilization envelopes inside trays?

[Harvey Johnson]

Funny how those complaints disappear.....
You are correct CSS, unapproved containment devices, particularly peel pouches have been banned from trays.
Our department had been using glassine envelopes until the manufacturer refused to supply information about using them for sterilization containment.
We now use the manufacturer approved paper sterilization envelopes (pouches) from Healthmark designed to hold items inside trays for sterilization with no problems.
We use them to hold count sheets also, eliminating the AORN fear of lint or ink transferring to instruments.

[wperez]

AORN did make this recommendation, however is is not evidence based or backed by scientific data. We follow the AAMI standard. Placing integartors in two corners of a tray does not make any sense to me. It needs to be placed in the most dense location. I also agree that multi tier trays need to have an indicator on each level.

[jrc]

AORN did make this recommendation, however is is not evidence based or backed by scientific data. We follow the AAMI standard. Placing integartors in two corners of a tray does not make any sense to me. It needs to be placed in the most dense location. I also agree that multi tier trays need to have an indicator on each level.
Since when did AORN need evidence to issue a recommendation? Their whole "We're poisoning our patients because the paper in count sheets leeches toxins into the steam that then deposit on the instruments" thing is so far-fetched it's laughable.

[wperez]

I'm not following your comment. I was referring to the question regarding indicators and placement of same. In response to AORN recommendations, I would not change my practice simply on an unsubstantiated recommendation. Before AAMI makes a recommendation it is evaluated, studied and verified before it becomes a standard. AORN does state along with the recommendation that it is not substantited by scientific data therefore you can follow it if you chose to, however you are on your own if some adverse situation should arise. I would like to state that this is my practice and I'm in no way stating that you should do the same.

[CSS TECH]

With the permission of all of you I am writing this reply. I truly want it to be my last on this forum. I really want to leave and I am asking people to let me leave! In peace!
Where that idea of placing integrators in "two corners of a tray" came from? I said each corner, assuming trays are quadrilateral! Does that make two?

[jrc]

I'm not following your comment. I was referring to the question regarding indicators and placement of same. In response to AORN recommendations, I would not change my practice simply on an unsubstantiated recommendation.
My point was that some people within AORN do that a lot. I was bringing up another example of fearmongering based on no credible evidence.

[wperez]

OK I got it! Have a great weekend!

[RHF]

CSS TECH,

I hope you reconsider leaving, you have a lot to offer. If it's because of time constraints that's understandable; but if it's due to personality conflicts, well I hope you reconsider and give it more time.

Richard

[CSS TECH]

CSS TECH,

I hope you reconsider leaving, you have a lot to offer. If it's because of time constraints that's understandable; but if it's due to personality conflicts, well I hope you reconsider and give it more time.

Richard
Sorry Richard! I am not coming back, at least not yet, although as an IAHCSMM member I have the right to fully participate to all forums available on this site. Allow me however to just say the following:
A few members wrote to me privately asking me to support the policy of placing one integrator on each corner of a tray. I explained the logic behind that decision, but some of those members still want me to come to the forum, explain and defend my position. In the beginning I refused, but the insistence was so strong that I decided to make my explanation public. However, I want everybody to be aware that this it not a reply to anybody’s post, not even to the member who stated that “placing integartors in two corners of a tray does not make any sense to me. It needs to be placed in the most dense location.”
When the decision to place one integrator on each corner of trays was made (four corners, not two!), not too many in my facility understood the reasoning behind it. I even heard some co-workers saying that it didn’t make any sense, like others here might have said, but the results were really clear. It took months before everybody became convinced of the sense that policy makes. About 95% of the trays we process show all four integrators presenting the same picture: the line goes all the way through the end of the channel. Another 4% present all the integrators with the line passing the “accepted” area. Certainly the 95% and the 4% reach acceptable levels and are happily used by the OR. However, another 1% shows at least one of the four integrators failing. This 1% usually is rejected by the OR. Does this make sense now?
I certainly address controversial issues, and I ask everybody to forgive me. One day I said wood and paper cannot be sterilized by steam properly. That also didn’t make sense to almost everybody. However, when we consider that wood and paper are made of organic cells, how then could they be sterilized at all?

[wperez]

What do you do with trays that have 3 tiers are you placing integraters in each corner on each level? What is the cost of sterilizing your trays? Are you using intergaters or indicators in your trays? Good luck to you in all your future endeavers.

[CSS TECH]

1-We try to keep multi layer trays to a minimum, and the few that we have are treated like any other tray.
2-The cost of sterilizing my trays are probably high, but not higher than the priceless life of a human being. Again, the mentality of saving money! Is money more important than life? Do some people pick up chemical integrators when they fall on the floor? I guess yes!
3-Is there any fundamental difference between "integrator" and "indicator"?
"Chemical integrators are Class 5 integrating indicators which are designed to react to all critical variables." I don't see any advantage in playing with words this way!
4-I just came to satisfy a request made by some members. It was not my intention to become engaged in any debate. ADIOS!
And remember your words: "CSSTECH is not someone I wish to communicate with."