Healthcare Steam Quality

​​According to the CDC Guideline for the Prevention of Surgical Site Infections: “Inadequate sterilization of surgical instruments has resulted in SSI outbreaks. Surgical instruments can be sterilized by steam under pressure, dry heat, ethylene oxide or other approved methods. The importance of routinely monitoring the quality of sterilization procedures has been established.” (1)

 

Steam under pressure is the primary way to sterilize critical items. The CDC Guideline for Disinfection and Sterilization in Healthcare Facilities states:

“Critical items confer a high risk for infection if they are contaminated with any microorganism. Thus, objects that enter sterile tissue or the vascular system must be sterile because any microbial contamination could transmit disease. This category includes surgical instruments, cardiac and urinary catheters, implants, and ultrasound probes used in sterile body cavities. Most of the items in this category should be purchased as sterile or be sterilized with steam if possible.” (2)

 

STERIS Corporation is one of the largest manufacturers of healthcare steam sterilization equipment. According to STERIS:

“Perhaps the most frustrating and confounding dilemma that we face using steam sterilization is the occurrence of wet packs… Wet packs represent an economic loss to the institution because goods must be reprocessed. Unrecognized, they are a hazard to the patient." (3)

 

At the start of the working group sessions to revise the AAMI ST79 Steam Sterilization Standard it was written by the group leader:

“This effort is important on several levels. The CS/SP/OR Department represents about 5% of the steam used in hospitals but the steam quality connected to the sterilizers is mission critical for the production of sterile items for patient use… about 60% of the steam quality issues (wet packs) can be traced to the steam supplied to the sterilizers. The quality can vary during the work day. The remaining portions are the sterilizer performance and improper wrapping or loading. In my surveys, I find 90% of all CS/SP/OR Departments have experienced wet packs. We all know how frustrating and time consuming solving wet packs issues can be.” (4)

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Finally, in the American Journal of Infection Control:

"One of the most time-consuming and frustrating sterilization issues is troubleshooting wet packs and wet loads. Wet packs or wet loads are complex issues because the cause is often not obvious." (5)

 

So, this is more than just anecdotal, the view that steam is a mysterious and troublesome way to sterilize is shared by leaders in the field, manufacturers, and standard writers.

 

(1) Mangram, A., et al.: “Guideline for Prevention of Surgical Site Infection, 1999. Hospital Infection Control Practices Advisory Committee,” Infection Control and Hospital Epidemiology. 20(4):250-278, April 1999.

(2) Disinfection and Sterilization in Healthcare Facilities, CDC

(3) Preparing instruments, utensils and textiles for sterilization and wet pack solving, STERIS Inc. 2003.

(4) Moore, Chip, Memo to AAMI ST-79 Steam Quality Working Group, 2009

(5) Seavey, Rose, Troubleshooting failed sterilization loads: Process failures and wet packs/loads, 44 (5) 2016 American Journal of Infection Control,