3m Attest Auto Reader - 290

[EBENEZER ASIRVATHAM]

I would like to hear some feedback from current users about this new attest autoreader for 1292 RRBI.

[jrc]

I have been using it for years and love it. If you get it, be sure to specify to have all the wells set up for the BI you will be using in your area. The default is to have half the wells for the blue and half for the brown.

[klammon]

We have had one for just a month. We LOVE it! Great support from our Rep in revising our protocol. He and I did a tandem inservice to train staff, and the transition has been easier than I had thought it would be.

[FSG]

We have had it for some time and it is great! It is great to have a product that will alert you to a positive BI. It will however, give false readings if you "tap" the vials on the reader instead of the table, which you shouldn't do anyway, but just a reminder.

[Cindy Bee]

We have the older model but love that ability for rapid readout- I have instituted a bios must be read before the load is released policy as well.

[CSS TECH]

How long can you delay incubation of the Attest biological indicator for steam sterilization?The reason I am asking this question is because one of my co-workers forgot to put an ampoule in the incubator last night. The ampoule has stayed outside for about three hours.
A supervisor came and ordered the whole load to be rewrapped because he said the ATTEST was not good anymore! I told him I was against his decision, but since he is a supervisor (with no qualifications except his seniority), he had the last word. I still do not understand what he meant by "ATTEST not good anymore".
Could you guys help me understand a little bit? Thanks!

[chipmoore]

Verify w/ 3M.
For self Contained BI's, as long as the capsule isn't crushed for the media to start growing, leaving it out of the incubation process is OK for a few hours. Remember, BI's in an EO cycle often went throught areation before incubation.
Chip Moore
Getinge
Rochester, NY

[Cindy Bee]

Perhaps he meant the parameters set by your facilities policies were not followed and made his judgement call based on that? BI's are one on the tools we use to verify we are producing a sterile product when a lawsuit occurs. When policy is not followed carefully it leaves a window of opportunity for a good lawyer to create "reasonable doubt" I always follow the rule when it doubt throw it out. I cannot find any reference in my 3M book as to a deadline, just one to wait 5 min after removing from the sterilizer to make sure its cool. While he may have had other options but he took the safe bet and rewrapped. Dorothy Larson from 3M 800-936-6808 would be the most qualified to answer this. Let us know.

[CSS TECH]

Chipmoore and Cindy Bee, thank you both for your answers. Chipmoore, you brought a very interesting subject about BI's in an EO cycle going through areation before incubation. In my facility we don't don't that and I have been questioning that from the beginning. We will discuss that in another thread.
Cindy Bee, the supervisor's decision to rewrap the load was completely wrong and his judgement poor. One of the commonly asked questions about the #M attest is this:
How long can you delay incubation of the 3M Attest biological indicator?
And you know what the answer is? Read this:
We recommend a biological indicator be incubated as soon as possible so the
results can be obtained sooner. 3M has not done testing to determine how long incubation can be delayed. However, there is some data on other self contained biological indicators that suggest incubation can be delayed for up to 5 days
(Graham, G.S., and C.A. Boris, Chemical and Biological Indicators, Chapter 3,
Sterilization Technology. Edited by Morrisey and Phillips, 1993:36-39.)
There is a study made by SGM BIOTECH INC, and in the conclusions of the report we read:
"Delaying the culturing of exposed biological indicators, whether they have been exposed
to saturated steam at 121°C or to ethylene oxide at 600 mg, 54°C and 50% RH or contain
Geobacillus stearothermophilus or Bacillus atrophaeus respectively, beyond the two
hours specified by ISO (1) or the four hours recommended by USP (2) does not affect
resistance performance. There was no significant affect on SMCP calculated D-values of
either self-contained or strip biological indicators. Delays of up to seven days at
controlled room temperature still allowed the determination of all D-values within ±20%
of those calculated when cultured immediately (less than fifteen minutes of delay before
incubation). Such stringent time limitations therefore appear to be unnecessary."
Based on this report, the supervisor made the wrong decision to have the load rewrapped
saying the Attest was not good anymore!

[jrc]

@CSS TECH: The decision may not have been based upon the recommendations of the manufacturer, but that does not automatically mean it was a bad decision. I believe the point Cindy Bee was making is that if your hospital has a policy in place stating how soon the BI is to be placed in the incubator, you must follow that policy.

Management is responsible for making sure policies are based upon good information, but they are equally responsible for making sure the policies are followed. When a regulatory agency or JCAHO come to survey your facility, they want to make sure you are following your policies. If they find you are not even doing what you said you will do, then they have cause to question if you are doing what the regulatory agencies say.

In the absence of policy on this, the supervisor must make a decision based upon weighing the cost of the extra work against the potential risk to the patients. If there is no policy, it seems the supervisor determined the potential risk to patients was unacceptable and, therefore, ordered the load to be reprocessed.

While it is regrettable you had to do extra work, it seems to me the supervisor made a good-faith decision either based upon hospital policy or concern for patient safety. I could not fault that. I would, however, see to it that a new policy is instituted based upon the manufacturer's instructions, and the entire department is educated on it.

[SHIRLEEN VANOCKER]

I agree with jrc. As department managers, we sometimes need to make decisions that may not seem right, or may seem a lot of work for nothing; however, the manager is ultimately accountable when there is a problem, and perhaps your manager was thinking about liabilities, what would be best for the patient, etc. Please give your manager some leeway, as we do not know everything either, and sometimes make judgement calls that we feel would be the best decision at the time! He/ she will really appreciate the support.

[CSS TECH]

Jrc and Shirleen, you have to defend a supervisor's position because you too are supervisors. I understand your position. I didn't have to do any extra work like Jrc thought. I am working at a supervisory level too, but I have to defend what is right, not a supervisor who made a wrong decision.
"We sometimes need to make decisions that may not seem right" but we may not make wrong decisions. In this case, the supervisor made the wrong decision by having the load rewrapped.

[Harvey Johnson]

CSS TECH,
I totally agree with your post! (surprise!)
A gut reaction to a situation can sometimes be as dangerous as a delayed reaction.
A supervisor owes it to his/her employees take a few minutes to consult available resources (3M for one!) before making a decision affecting department costs and productivity to that degree.
JMHO,
Harv