The Sterilization of Instruments

Over the course of this project I have had the opportunity to study cutting edge medical instrument sterilization methods, as well as methods that are the industry standard for thwarting environmental factors' role on infectious diseases (Rutala & Weber, 2001). The family practice that I focused my study on, Valley Wide Health Systems, uses the autoclave method, which sterilizes using high temperature steam or pressure (Patel, 2003). This type of sterilization is extremely cost effective and efficient, though it can only be used on instruments that can handle high heat (Sabnis, Bhattu & Vijaykumar, 2014). The process of using an autoclave to sterilize your instruments is very straight forward, requiring only a few simple steps: selecting the proper container for your instruments, preparing all of the materials to ensure proper sterilization and to prevent spills or melting, selecting the proper cycle for the material you are sterilizing, selecting time, and then removing your materials (Douglass, 2014). While these steps seem very straight forward, they require that one is knowledgeable on materials that can be autoclaved, amount of fluid needed, time needed, and proper removal of the instrumentation when sterilization is completed. I focused my field research on the knowledge of the autoclave sterilization methods on the nursing staff at the Valley Wide Health Systems practices. My initial objectives for this project were as follows:

1. To gather data about sterilization knowledge and processes with the current nursing staff of Valley Wide Health Systems through the medium of a questionnaire.

2. To compile the data and analyze it, in order to identify points of weakness in the nursing staff’s current knowledge.

3. To meet with the nursing staff, the Director of Nursing, and to study the current policy and procedures manual in order to further identify weaknesses in the dissemination and retention of knowledge regarding sterilization practices.

4. To complete a thorough evaluation of the current sterilization orientation course materials.

5. Then, based on the information that I would have gathered, I would then present suggestions for improvement and encourage open discussion and feedback between the Director of Nursing, the nursing staff, and myself in order to improve the state of sterilization of instrumentation at Valley Wide Health Systems.

I chose to analyze the sterilization of instruments—in a family practice setting—specifically because it would allow for the utilization of multiple lessons learned over the course of my nursing education. Accurate data collection was a very important concept that I engaged with frequently while working on this project. One of my project goals was to create a questionnaire that would be able to properly assess the base knowledge level of the nursing staff on the topic of instrument sterilization. It was more challenging than I had anticipated. Being able to create a concise series of questions that would cover all of the necessary points on the issue of sterilization required much more “work shopping” than I initially anticipated.

After collecting the data—which ended up being another challenge as the nursing staff had much more pressing issues to tend to than taking a college student’s quiz—I compiled it for easier analyzing. I then proceeded to work through the written material the practice had on hand in order to fully understand the questionnaire results and the teaching materials that were available to this nursing staff.

Another concept that I was able to take from the classroom to the workplace was effective communication skills. In the classroom, we had discussed the importance of proper interactions with the patient, having focused on things like respect, body language, and how to ask the right questions (Lloyd, 2007). This was a skill I really got the opportunity to exercise. It was also a skill set I had not actively anticipated using. Rarely, does one think about how their body language, and the way they phrase a request or a question, can translate into a yes or no answer from the individual that they are addressing. I found that it was important for me to remain open and nonjudgmental when engaging with the nursing staff, because I was essentially questioning the way they performed. It could have been very easy for my questions to hold an air of disapproval or questioning their judgment. I was also taking precious time away from their work, and so it was important that they felt that the time they spent with me was worthwhile, and that I respected their contribution.

I initially anticipated the execution of this project to be pretty straightforward. It became apparent, almost immediately, that this was going to require a lot more brain power and time than initially allotted. As previously stated, the questionnaire required quite a bit of time to come up with the right questions. I wanted to make sure that I included all of the important aspects of the sterilization techniques they used at this particular practice. As stated previously, while the autoclaving process requires only four or so steps, it also varies depending on type of instrument one is planning on sterilizing, the fluid level they put in the autoclave, as well as the proper amount of time required to completely sterilize the instrument. It was important to me that the questionnaire felt personalized to this facility. I also spent a fair amount of time studying to make sure that I was up to date on current sterilization methods and practices.

One of the main questions I had at the beginning was whether or not the nursing staff had that basic knowledge of sterilization in their minds, and also if they executed the sterilization of the instrumentation properly. I was anticipating the nursing staff to perform much more poorly than they actually did. I was pleasantly surprised to discover how meticulous they were. I think that I assumed they would do poorly on this task because I’ve found that people often tend to cut corners when a task becomes too familiar, or it begins to feel like “second nature,” but I found that the nurses did particularly well at this practice. This was very encouraging, because proper sterilization, and cleanliness in general, is incredibly important to the health of both the patient and the hospital or medical practice.

One of the main things that I learned about myself over the course of this project was that I really appreciate interacting with people, especially fellow nurses. I became very passionate about this project after I began my initial research, it is such an important and necessary skill that every nurse should have, the skill to properly sterilize their instruments. Along with proper hand sanitation practices, it is vital to both the health of the patient, and the health of the practice. It was really wonderful engaging with veteran nurses on this topic, hearing their opinions, observing the way they practice their craft, and getting the opportunity to soak up their knowledge.

Another piece of knowledge I gained about myself was that I especially loved being in the family practice setting. Getting to play a role in an individual’s health, long term, is a really incredible responsibility. I was able to observe excellent examples of nurse-patient interaction. It was truly wonderful to have a patient tell me that they loved their nurse, and that the nurses at Valley Wide Health Systems really cared about them and were good at their job. That sort of appreciation for the staff was great to experience. I also loved the wide variety of patients that would come in, everybody from small children to the elderly. The wide variety of ailments and levels of health was very interesting as well.

It occurred to me that if Valley Wide Health Systems were to spend some time and resources to focus on continual education for their nursing staff, that it has potential to be a very effective way to work towards the elimination of knowledge disparities regarding the sterilization of instruments. One way that this could be achieved would be to require the nursing staff to take a questionnaire—similar to the one that I created—once or twice a year to gauge level of knowledge. If a nurse were to fail the test then they would have to work through the learning materials again as a refresher, and potentially be asked to perform some sterilization techniques while another nurse observes to make sure that they fully comprehend all of the procedures. This would create a sense of mutual responsibility between members of the nursing staff. While this may seem like a convoluted and time-consuming way to ensure proper technique, I do feel that this type of program can be streamlined. One way to encourage that would be to enlist the help of an individual who could put this all on the Internet. It would be wonderful if the staff could access this information remotely, if the questionnaire were automated, this would eliminate the need for manual testing and grading. Fortunately, it really would not take that much time, or require too much of the budget to create a program like this, as there are multiple free resources available on the Internet.

While this site felt very comprehensive to me, and I was able to get a solid grasp on the nursing staff and their abilities, one way in which my learning experience could have been enhanced, would have been for me to visit other types of facilities. It would have been interesting to see if the nursing staff in a faster paced environment—for instance, a high-volume emergency room—or in a specialized practice would handle instrument sterilization with a higher or lower level of importance than the family practice I studied. I wonder too, if I were to have studied medical practices that deal with populations with vastly different income disparities, if that would have made a difference in the way they emphasis certain techniques or methods over others.

One way in which I might have enhanced my own learning experiences, would have been to explore multiple sterilization techniques in depth. The practice that I studied only used one technique, the autoclave. While I did spend some time researching other sterilization methods, I would have loved to spend more time exploring current techniques and cutting-edge technologies in instrument sterilization. Another interesting topic, that could have enhanced my learning experience would have been an exploration into the statistics of diseases that occur because of the hospital setting and how sterilization—and even over sterilization—could potentially contribute to this issue.

Another way that could have enhanced my learning experience would have been to explore that particular medical facilities history of instrument sterilization, as well as to ask more questions that were personal to this facility and engaged a bit more with the history of Valley Wide Health Systems. Have they always used the autoclave? Does this type of equipment require regular maintenance? What is this particular facilities level of facility born disease that occurs in their patients? Is it at all related to the manner in which they sterilize their medical equipment?

If I were to sum up my final thoughts on this particular project, I would have to say that I felt it was a success. I was able to utilize multiple skills that had been taught to me over the course of my nursing studies, everything from proper data collection and analysis to an effective and caring bedside manner. I gained ample amounts of new knowledge on the ever important and relevant topic of instrument sterilization, current techniques, history of the autoclave, and where this technology is headed.

This topic in particular gave me a refreshed appreciation for proper procedure in the medical environment. I was able to learn how important it is to continually revisit procedures and techniques in order to maintain proper knowledge or technique. I also was able to work and learn in an environment I discovered that I really enjoy—the family practice setting. Being able to observe talented, veteran nurses engage with their patients was very eye opening and exiting. The family practice setting really allows a health care professional to observe and help a wide range of patient ages, levels of health, and living situations. It was a very interesting situation to observe, and this project gave me the opportunity to explore this particular type of practice in depth.

One of the most interesting and important parts of my study had been having the opportunity to observe a variety of different medical environments. By getting the opportunity to study medicine and nursing in an assortment of health care centers and medical environments, it has allowed me to gain an increasingly full, and richer grasp of the medical and nursing world, and has also allowed me to figure out what type of environment I would eventually like to work in, and where I would be most effective. After this project, the family practice environment is one that I would like to explore in greater depth. I felt very comfortable there and appreciated the atmosphere and variety of patients that one get to serve.

Finally, the opportunity to encourage healthy instrument sterilization habits among the nursing staff at Valley Wide Health Systems was a wonderful experience. This was actually one of the most exciting aspects about this final project. It was very encouraging to see that I had the potential to make a positive change in this practice, one that would benefit both the nursing staff and the patients, even while still in school. It was very encouraging to see that I could be effective at stimulating change, regardless of my level of seniority or experience.

References

Douglass, G. (2014). Autoclaving procedures. In Environmental Safety. Retrieved from https://www.des.umd.edu/biosafety/auto/autoclave.html

Lloyd, C. (2007). A guide to taking a patient's history. Nursing Standard, 22(12), 42-48.

Patel, M. (2003). Medical sterilization methods. (White paper) Retrieved from http://www.lemo.de/downloads/misc/P_series_whitepaper.pdf

Rutala, W., & Weber, D. (2001). New disinfection and sterilization methods. Emerging Infectious Diseases, 7(2), 348-353. Retrieved from http://wwwnc.cdc.gov/eid/article/7/2/pdfs/70-0348.pdf

Sabnis, R., Bhattu, A., & Vijaykumar, M. (2014). Sterilization of endoscopic instruments. Current Opinion Urology, 24(2), 195-202. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24451088