We would get calls saying, "Oh, we found a couple drops of water in the bottom of our containers." And we thought that load was dry, and it wasn't. So, again, it impacts patient care when, you know, you're not getting down to the real problem of doing all of your sterilized remitants and whatnot, just following eye abuse. Rising above the buzz of ultrasonic cleaners and the clanking of stainless steel are the ideas and voices that are changing an industry. You're listening to the Beyond Clean podcast, the central nexus for the people, processes, and products that are improving our sterile processing world. Each week we speak with frontline technicians, CEOs, engineers, and entrepreneurs with a common goal to help you fight dirty every instrument every time. Whether you're tuning in for education or inspiration, we're glad you did. Now, turn on those washers and turn up the volume. It's time to go Beyond Clean. All right, Clean Freaks. Welcome back to the Beyond Clean podcast. This is season 32, SPD Fact Check. I'm your host, Bobby Parker, and joining me in studio as co-host for the season is Jamie Amaya. Jamie, welcome back to the studio. Good to see you again. Good to see you. How's everything? It is good. It is derby season around here. Jamie, I'm in Louisville, Kentucky, and it gets kind of mad around here around that time. You don't try to book a hotel anywhere in Louisville around the first Saturday. I had to learn that the hard way whenever my wife and I were getting married, we originally had picked an early Saturday in May. And then later realized, oh, no, that is derby. Like we cannot do that to people. They will not find a hotel. So we actually like to move the day of our wedding because of derby. But I say that to say, this is the final stretch. We're coming around the last bend here in the last quarter mile. We are on episode eight of season 32. And it's going to be a good one, Jamie, where I think in general, we've been talking about myths and misconceptions, but this one feels the mythiest of the myths that we're talking about. But we're talking about cracks, sterilizers, doors today. So I'm excited about it. No, this will be a good one because it is definitely a myth. It's funny. I even googled it just to see if Google was on point. So you got you got the AI somewhere at the top. That's funny. Yeah. All right. Well, we've, we've got the right person to talk to us about this. Today, we're bringing in an SPD educator with a lot of years of experience who's seen a lot of facilities and has actually helped move a facility from kind of the crack sterilizer door practice to a different one today. So I'd love to hear from her about her experience. So we'll be right back after a short break to talk to you about cracked sterilizer doors. We'll be right back. [Music] From the studios of health care HQ, you're listening to Beyond Clean, the global voice of sterile processing. [Music] And joining us now in studio is echo Pondton and sterile processing educator for the offside out at Lee Health in Florida. Echo, welcome to the studio. Welcome to the show. Thanks for having me, Bobby. I'm so happy to be here. Well, we're really excited to get to talk with you. It's been a while since since we've connected with you, echo, but ran into you at HSPA and good to get connected and glad that we got to get you in studio to talk about this, this topic today. But for those who haven't had the opportunity to see your big smile and get connected with you in person, let's do a little bit of introduction. I said you're a sterile processing educator these days, but do you want to tell us a little bit about your sterile processing background, maybe how you found SPD and what you've been doing in the industry? Yeah, absolutely. So I started in sterile processing way back in 2016. I had originally started in the hospital as an EVS employee. I was placed in hospice care to clean the rooms after patients passed away. And I knew that that wasn't where I wanted to stay. So I started looking at other areas that were entry level that I could get into without having too much experience or get on the job training. So I had at the hospital, I was working at a ply for sterile processing and I unfortunately was not selected because I did not have any experience. So I tried another facility and it was a trauma hospital. And they took a leap with me and brought me in and I started as a tech. I got certified. I became an operating room liaison. And then from there, I had attended my first conference in 2019 in Anaheim and it inspired me to become an educator. So I've been an educator. I've been a regional supervisor. I've done traveling. I was a traveling clinical educator with steris for a little while. And I was pretty much waiting for the right opportunity to move down Florida and that happened with Miss Tammy. We connected at the conference in Vegas and she was like, whenever you're ready to come down, I'm ready to have you. So it just kind of all took off from there and I've been down here for about a year and a half now. Yep. And the sunshine's never going to let you leave. I'm sure. No. Yeah, that's really cool. So sterile processing then it sounds like was something you were actively pursuing. I'm curious how did you first hear about sterile processing because it's one of those things that the general public generally doesn't know exists. And even sometimes in the hospital, I've talked to folks in EVS and they're like, what is it that you guys do in there? How'd you hear about it? What made you want to get into it so much? From doing EVS and then my ex-husband was actually in supply chain for hospital and Denver for quite a while. And so he knew of people in sterile processing and I knew of that department a little bit. And when I was looking for more entry level stuff in EVS, I thought of supply chain. I thought of sterile processing. And when I did the interview for sterile processing, it was, oh, so you were going to get into EVS, you know, how to mix chemicals and whatnot. And I was kind of like, well, not really. We just press a button and it fills the bucket up for us. I don't know. But I went and did a tour of the department and I thought, wow, this looks so cool. It's something I've never done before. I'd like to give it a shot. So that's pretty much where it started. Very cool. Well, yeah, to your point was sterile processing being that entry level department, there certainly are a lot of ways to grow and a lot of cool and different things that you can do with this skill set. So I'm excited to be having your educator brain with us here on the episode today. Echo the season that we've been working through. We've been calling SPD fact check and just going through a bunch of misconceptions and knowledge gaps in the industry. The type of thing that would be easy to miss. Maybe if you just had maybe some limited training or even had been in sterile processing for a while. And the topic that I wanted to talk with you about today has to do with sterilization. Even the facility that I started my sterile processing career at had this practice that after the sterilization cycle is over that we would open that steam sterilizer door up. I think the number that we said at the time was about 18 or so before about 20 minutes or so and then we'd let the load kind of acclimate before we pull it out of the sterilizer chamber. There were a lot of reasons given for that and we can get into that in a minute. I'm curious in the years that you've been doing sterile processing, what's your experience been with the sterilizer cracked door? We'll call it legend. Yeah, so when I started at the first hospital, we were very short staff department. So the training was very lacking. A lot of it was just somebody in and out of doing their own task trying to train me and it was always one of those. But we cracked the door because we have to let stuff dry off and cool off a little bit before we pull it out. During that time, I was living in Colorado and a lot of reasoning was because we were at high altitude. Oh, we're so high up here in Colorado that things don't dry correctly. So we have to crack the door to let it sit in there. And over the years of I've learned more and a self-taught that's not the case and elevation really has nothing to do with any of that. Well, and it's that's funny too because going back to my first years in SPD, they said the same thing. You got to crack the door. And a lot of people were that there was no inches. It's just crack it. There was a halfway and an answer. It was just whatever you do it at your leisure, right? So it's funny because honestly, as I was going through my years of experience and I was like, oh, yeah, crack the door, everybody. It was just like a common thing. But then you start to realize, wait a minute, I'm educating myself. I'm learning. I'm doing all this great.
stuff. But from your standpoint, like your thought processes, what do you think is happening in the sterilizer at that time, at the end of that cycle? And then where do you think the idea even came from about why they thought the cracking of the door was essential to our role? So for me, in the very beginning when I was learning that, I thought it made perfect sense that, you know, yeah, obviously it is a lot colder out here in the department versus inside of the sterilizer and you're reading the sterilizer printout and it's 270 degrees inside there. Yeah, that makes perfect sense. So we're going to crack the door and let it kind of hang out. However, then we're sort of masking some of those true problems that are really occurring and you don't think about it at that time when you're not knowledgeable enough to know or to look up an IFU and read the information as to why, you know, or the Amy standards as to why we're not doing that. So, yes. It's crazy how like one thing starts, right? And then everybody just takes it and runs with it and think this is best practice. And then when you start to educate yourself as you grow in the field, you start to realize, wait a minute. These were all tails. I imagine there's probably still a lot of departments out there that are doing this today. I've certainly have seen quite a few and they may be listening to the set episode and you know, eight minutes in, they're not persuaded echo that this is. So when you say that cracking the door may be masking something, something else that's going on in the sterilizer, what do you mean? Can you break that down for us a little bit about what the sterilizers are supposed to be producing at the end of that cycle and what cracking the door does or maybe doesn't do? Yeah. So when I started down here and for Myers, they were actually still cracking the door on the sterilizers. They would open it and let the load sit inside for a little bit before they pulled it out. And I started questioning, you know, as an educator, you have a questioning mindset, well, why are we letting it sit in there? So we kind of talk through some of those things. There are a lot of people who are hesitant because they previously had a lot of wet loads and they said that they had started cracking the door to help the stuff dry. And again, questioning attitude, if you're having a wet load, why do you think cracking the door is going to help to try it further? Is there something else that we need to look at? Is there water quality? Are there, you know, the filters on the sterilizer being changed out? Are we incorrectly loading the sterilizer? Is the packaging material not correct? You know, there's a number of things. Trays are too heavy. All of those kind of factors play into it. And really, the sterilizer is meant to go through all of these phases, you know, you're conditioning your sterilization and then you're drying and whatnot. And granted, yes, we do have extended dry times. And there were things like gravity where you did kind of crack the door on those cycles. But, you know, as long as you're following your IFUs for your packaging, you know, your wrap and your containers, following your sterilizer maintenance and having the chambers cleaned and whatnot, your sterilizer should function appropriately. And when it's not, and you're having wet loads, I mean, you need to start doing some digging to see why what's maybe causing these wet loads. For here, the sterilizers were very old. They had opened with this facility. You know, that was one factor of it. Water quality was another factor. Southwest Florida does not have the best water quality. Neither did Denver, Colorado, either. Water quality across the whole country is terrible. So that's another factor when it comes into, you know, steam and whatnot. Here, we were using silicone mats. A silicone mats hold a lot of water on them because if you put it into your tray and it's still a little wet from coming out of the wash, it's going to have a harder time drying during that sterilization process. Just one of the things that, like I said, they were cracking the door here. They were running things on extended dry times. We were doing a 270, 440 instead of a 30. So we could have that extra 10 minutes of dry time. And then an extra 20 minutes of cracked sterilizer door time. So those are some of the big, big headers when it comes to that. Yeah. And that's a big investment in time that extra 10 minutes of dry and then another 20 in the sterilizer of your equipment downtime. And so, yeah, there's definitely a cost to be paid there, just in an opportunity cost. Do you think, Echo, that if you're having wet pack issues when you're not cracking the door? And so everyone feels, you know, kind of protective about this sacred practice of cracking the door for 20 minutes to make sure that we have, have them dry? Do you think if we're succeeding when we crack the door, but have wet packs when we're not that we're doing any, any harm? Obviously, that's masking a problem that needs to be dealt with, but is it dangerous? And neither of us are microbiologists. And so we're just throwing opinions at the wall here. But like, is there like how seriously do we need to take this? Or is it something that's just okay to leave alone? You know, leaving any type of moisture in the load. So if you are letting it crack and you know, your trays are coming out dry, they are still going to have moisture somewhere if there is a true sterilizer problem. Just because the outside of the load is coming out dry, it doesn't mean that something on the inside of the load isn't going to be wet. So, and that caused contamination, which is deframental to the patient, you know, having contaminated instruments. There was a few times where, you know, we would get a whole load come out of the sterilizer and everything looked to dry on the outside, the wraps were dry. And then we would touch the corners where, you know, our corner protectors were and they were damp. So, even though it appeared to be dry and, you know, they were leaving it with the crack door on the inside, there was still moisture. Even so, we would get trays off to the campuses. In the offsite world, you know, we have to transport our stuff back to the campuses. We would get calls saying, oh, we found a couple drops of water in the bottom of our containers. And we thought that load was dry. And it wasn't. So again, it impacts patient care when, you know, you're not getting down to the real problem of doing all of your sterilizer maintenance and whatnot, just following IFUs. So, that's, I mean, it's again, it's so hilarious. I have so many questions, right? Because you've been into multiple facilities. So, I'll hold the one question that I have because from a documentation standpoint, what are the standards in IFUs say about the practice, though? So, I know we touched on Amy a little bit and reading into an IFU. But have you, have you noticed being in multiple facilities, not everybody uses one vendor, right? When it comes to sterilizer. So, have you noticed different IFUs? And then as far as standards go, like what, what do we look at as far as documentation? Like, how would you now educate somebody knowing you've been at all these different facilities with different practices and different equipment? Right. So, as an educator, it is, you know, a big part of education is reading IFUs. So, when we have new texts, I do have them pull up IFUs for things. Whenever you get into equipment, you always want to read the instructions for use. I like to think of it as when I'm baking a cake, we bake the cake in the oven. And we don't crack the oven door to let it finish baking, right? We're going to just pull it right out of the oven. We're not going to set it on a solid surface either because then our cake is going to sweat and get on nasty and mushy on the bottom. We're going to put it on a cooling rack. And then it sits out at room temperature. So, even though it came from the oven, that was just, you know, set to 350 degrees in our houses that I mean down here, it's minus that at 68 year round. So, 350 to 68 degrees is a pretty huge difference for a little cake. But my cake doesn't, it doesn't ever sweat. We put it right onto the counter with our little holder and cake comes out perfect. It's the same thing with our trays as long as we're doing exactly what we're supposed to be doing. We should not have any issues. I'm learning what's wrong with the cakes that I make now. Echo. Do you don't put them on the counter? You put them up on a rack to cool down. No, it's, that's a great illustration. I use the cake analogy all the times. So, that's awesome. I always use baking and cake. You're going to have to become part of my repertoire now. Now, Echo, would we, when we ran into each other at HSPA, one of the things that you mentioned as an educator that you like to do with newer technicians who are learning the job is to assign some of the CE approved beyond clean podcasts for folks who are learning the job. So, let's make sure to speak to that audience as well. So, we've said that cracking the door is not required by IFUs. You won't find it in best practice documents. It might actually be masking a problem rather than solving a problem. Could we also break down just like what proper unload procedure looks like? What are some of the do's and don'ts of that cool down period when the cycle ends? So, speaking for my facility in particular, as soon as the load is done, we pull it right out. We let our biological sit in cool for the IFUs for 10 minutes. And during that time, we just let our loads sit there. A more not allowed to touch it. You don't want to transfer any micro organism.
on to the packaging during the cooldown time because as we know during sterilization everything kind of opens up to allow the steam to penetrate. So once it's on, we have pastor sterilizers. So once it's sitting on the cooling side, they are not to be touched. You only touch the rack, you use your, you know, your oven mitts and whatnot or your sleeve if you're in a hurry, but we're never going to touch the containers. Then we process our biological, we let our loads sit there and cool and for us, it is 75 degrees or lower before we're allowed to touch the trays and put them away. Again, just to prevent contaminating the wraps and, you know, the filters and our containers. So that 75 degrees number is something that the first department that I worked in that that had that it was both helpful and challenging. So the department I learned in Echo, we had a, I think it was a two hour time frame. Just when it came out, we don't touch it for two hours and like that was really neat and clean. So whenever the OR was asking for something, we could tell them with precision. I'm allowed to give this to you in seven more minutes, you know, hang on, but with degrees, you've got this, this infrared scanner that you're, that you're looking at, depending on which part of the tray you measure, you get a different temperature and then the OR calls and it's like 78 degrees and like, oh, it's going to be 75 and I don't know. Give me a few more minutes. I'll let you know whatever it is. How do you navigate releasing trays in a controlled, consistent way like that when you have so many human variables of what part of the tray do you measure or some trays cool faster than others or the OR wants it now and they want a time quote on how soon it's going to be 75. Degrees. Man, yeah. Again, back to education. So, you know, when we rolled out education here, that trays must be 75 degrees or cooler before we put them into a sterile storage. We have a large sterile storage area here and then we load our case cards, we do case picking here on site and then send everything off to the campuses. But the trays, we teach to scans or temperature read the biggest ones on every layer of the rack. It doesn't, we're going to check every single tray no matter what. There's no, in an offsite, we are a slower-paced facility. We don't have the OR tied to us, they're not coming in and out asking for things. So, for our facility here, we have the luxury of, yeah, we're going to scan every single tray and if one is still at, you know, 76, we're going to let that one hang out. We may pull some of the other ones off and get those moving, but overall, the staff here is very well trained to not take anything back to sterile storage unless it is read at 75 degrees for all the trays. And it's so hard to teach. I have a lot of signs all over the department. We even have on our doors, like go into sterile storage, a gigantic stop sign that says, "Are your trays at temperature just to prevent any mishaps?" So, great idea. Yeah. So, knowing that we're covering this topic and again, like Bobby said, there's so many people listening. How do we teach that method that it, "A, it was a myth." And then, you know, these people that are listening are saying, "I still don't believe it. I'm going to stand by my door cracking." It has a feeling that we could offer it. Yeah, exactly. So, what's something we can offer to everybody listening that, "No, we don't have to crack the door. We don't." Like, how, because my one question I was going to ask you is going to these facilities, you're like, "You're cracking the door, stop cracking the door. How did everybody listen?" Like, how did you get them to grab a hold of it and just say, "Okay, that makes sense." Like, how do you teach that? I'm trial and error. I was like, you know, let's just start pulling these loads out and see what happens. And, you know, for the most part, we would pull the loads out and they were dry. They were what we needed them to be towards the end. We started getting some wet loads, but that was because of our sterilizers. We did have quite a few wet loads and we were reprocessing a lot of trays. But, again, it came down to our sterilizers. We're just old, and they were just ineffective now. Since then, we've had five brand-new sterilizers installed, and those ones, we've not had any issues with us so far. We've had a couple of wet trays here and there, but it was user error, basically loading, you know, a tray, container tray, over a wrapped tray. So that's not the sterilizers fault. That's a human error. We had one. It was a very heavy tray. It was like 24.8 pounds. It was wrapped. Some of the water hit pooled in the bottom where there was a little silicone mat. I think it was like a paragon tray or something. So little one-offs here and there, but really it's trial and error. You just got to trust that the process is going to work. And then as an SPD tag, who maybe is in a facility without an educator, take that initiative to start researching this stuff on your own. There's nobody in your department who knows SPD better than yourself. You can become your own expert in this field. And it's all about having the drive to want to know and do better for our patients out in the field. Like we heard from Jake Gleason at the conference, you know, he was impacted by, you know, having surgical site infections. And it was all because of a steril processing tech who wasn't strong enough or maybe didn't feel comfortable enough to stop the line at that point. And, you know, that's something that's going to impact him for the rest of his life. So it does come down to us, you know, wanting to do more, do better for our patients. Yeah. Well said. And I'd love to circle back at some point and talk about that Jake Gleason story on Beyond Cleanks. I know there's a lot of folks who tune in who didn't make it to the show, but yeah, it was a really powerful message about the importance of what we do and how we can really make a difference for patients if we, if we stand up for, for what's right and sterile processing. Oh, this topic in particular, though I can definitely relate to and understand the perspective of the person who feels safe with their cracked sterilizer door and is maybe hesitant about changing because when you say that we didn't have wet loads for the most part, like that for the most part is what everybody's worried about is like, I don't want to be the guy responsible for making the decision that ends up causing some delays in surgery. So to your point, starting small, doing some experiments, making sure that it's safe to do so. And then if you do uncover some issues, that's just an opportunity of a learning of an equipment deficiency that you have to work on rather than continuing to mask and cover up those deficiencies. Exactly. Well, we have, we've run short on time. I'm sure there's plenty more that we could have gone even deeper down the sterilization hole. I certainly have a couple of other myths and misconceptions around this topic we could dive into. But, I go, you've done a great job uncovering this one. Hopefully we've put this to rest for folks. I suspect not. I imagine that we're going to get some additional questions come in. So if folks want to, if folks want to continue this conversation with you or fight you in the DMs, is LinkedIn the place to get to get connected with you? Absolutely. I do go by the SPD mermaid. So you can always find me on LinkedIn. I think I'll type that in in fact. So, but yeah, I'd love to connect with anybody that's got questions. I'd be shocked if anybody else came up at the top of that list if you type this, "Fedit Mermaid." Yeah. So, all right. I'm going to have to get creative. That's right. That's what horse whisperer. Know what was a robot whisperer was yours from the beginning of the season. A robot whisperer. Yeah, that's right. So, all right, you guys. Well, echo, thanks for joining us again today. Great job on the interview. Thank you so much. Yeah. And that was echo, Pondton and Steril Processing Educator for the Offsite at Lee Health. And apparently the SPD mermaid as well. Trying to disrupt the myth that cracking your sterilizer door is the only safe way to get sterile instruments after steam sterilization. Really good episode, Jamie. This is one of those myths that I was really surprised to hear. And I remember as a technician in the early days, like having kind of like top level, you know, Defcon four or five fights with other technicians about how many minutes the door needed to be cracked because we wanted to keep patients safe. And it's just one of those things that I don't even think we had it written down anywhere. It was just something that, you know, everybody had an opinion. How many inches? How many minutes? Because we got to do it right. And it turns out it wasn't. Wasn't even in the standards anyway. Oh, yeah. I remember asking why. That's my biggest thing is, well, you got to give me a why behind everything. So when I was first taught, I was like, well, why? And they're like, you just do it. But again, why? And then you can see how everybody would crack it, you know, a little bit a lot. It was just all over the place. And so then I said, as you know, you progress in your career, it's like, wait a minute. Where does that written down that you have to do that? So it's it's amazing the things you uncover, but I loved this topic. And there's I'm sure there's still a lot of people out there. They're still scratching their heads. Yeah. Yeah. This is just the start of the homework for them. They're like wait a minute. What exactly?
mean it's a myth and usually it's whenever it comes around time where you have to teach somebody these things and and so you know you're a new educator or a new manager and you look into the standard and say okay I'm gonna write our policy on it and you start looking for that okay so how many inches how many minutes and then you're like wait a minute they can't find this can't find this written down anywhere well I guess one more one more for the road before we go any other wet pack related cool down procedures you want to throw onto the pile here Jamie about how to make sure that we've got you know safe dry terminally sterile trays other than the cracked door myth or we mentioned you know the 75 degree thing yeah no it's it's it's funny you you had mentioned two hours right putting a time limit you know it's two hours but it's honestly just following the actual IFU and the guidelines that sit behind all of this work and making sure you use that temp gun I've walked into a lot of facilities they've never even what temp gun what do you mean what temperature but to your point you can aim that in any different direction of a tray and get a totally different temperature so it's it's taking the load out making sure that you inspect your load as quickly as possible you you might trial and error you might get something that's wet more a little damp but again I've always had the I don't know if you want to call it the pleasure but it's always been unfortunately human error you know how they're loading their sterilizer really matters yeah absolutely and I guess for the record I'm also in favor of using that temp gun rather than time stamp because things dry at different cool at different pace as your peelbacks obviously going to be you know cool much faster than than your big orthotraise and in some cases two hours might not even be enough it might take might take longer than that so yeah identifying a a standard way or place that we're gonna zap it are we you know looking at the filter on the top of the rigid container do we do the underneath side of the tray you know whatever it looks like in your facility just having a standard procedure as how we're gonna temp things I think can help and then we talked about signage and training you know what my favorite sign is for the temp gun it is the sticker on the handle of the temp gun like so that they don't have to go wondering or remembering what the number is it's like the 75 degrees is printed on the temp gun itself so it's right there in front of your face when you're using it that's that's my favorite spot. Well Jamie it has been a genuine pleasure and honor to have you as co-host this season I really appreciate you bringing your your insights and experience to all these conversations crack in a few jokes along the way and it's it's just been a lot of fun getting to know you a little bit better throughout the season so thanks for joining us really. Yeah no it it has been really fun and love to do it many times over it's a blast and I like I definitely like teaching people so it's it warms my heart to do things like this. Absolutely well we'll make sure that it doesn't go too terribly long before we before we have you back on the show but that's all the time we've got for today's episode and as we've wrapped up SPD fact check I'm sure we've not covered all the topics out there there is to cover if you've got a question around a knowledge gap a myth or misconception and you'd like to talk to somebody at Beyond Clean about it of course you can reach out to us at info at beyondcleanmedia.com you can go to our website and ask a question there there's even a page on the website called ask a clean freak that'll send your question to me and I'll post a video response to your question on social media lots of ways to get your questions in we'd love to hear from you but until we talk to you again next time we'll leave you as we always do here at Beyond Clean on behalf of Jamie myself and the rest of Beyond Clean team keep fighting dirty we'll see you next time thank you for listening to this week's episode of Beyond Clean as a reminder you can help support us by subscribing to Beyond Clean on your favorite podcast app or by downloading the smartphone app on iPhone or Android simply search for Beyond Clean in the app store or Google Play the best thing about downloading the smartphone app is that you can access bonus content for certain episodes and view episodes in certain categories like articles on the go and vendor spotlights are you following us on LinkedIn or Facebook yet if you are in the 11 episode or post then let your social network know about it like comment or share our posts along with your thoughts and keep the conversation going if you have any topics or guests that you would like to recommend for a future episode just send us an email to
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