According to the Association for the Advancement of Medical Instrumentation (AAMI) and the recommended practices from the Association of peri-Operative Nurses (AORN), flash sterilization is "a process designed for the steam sterilization of patient care items for immediate use."1,2 When done correctly, flash sterilization is a safe and effective process for sterilization of medical instruments intended for use during surgery or obstetrical deliveries.2

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AORN recommends that flash sterilization should only be used if there isn't enough time to process medical devices by the preferred wrapped or container method and the item is needed for immediate use. Flash sterilization shouldn't be used as a substitute for insufficient instrument inventory.

The latest AAMI standards2 state four conditions for flash sterilization:

1. Facilities need to ensure that cleaning, decontamination, inspection, and arrangement of instruments is performed correctly in recommended sterilizing trays or containers.

2. The physical layout of the work area allows direct delivery of sterilized items to the area where they're being used (sterilizer opens into area either within or directly adjacent to the procedure room).

3. Protocols are developed, followed, and audited to ensure aseptic handling and staff safety during transfer of sterilized items from the sterilizer to the point of use.

4. The item is needed for use immediately after flash sterilization.

Flash sterilization steps

Step one

Cleaning and decontamination is the first and probably the most important step of the flash sterilization process. This step reduces bioburden and removes all visible and invisible soil and blood from items before sterilization.1,3 Failures in this step have resulted in the transmission of infectious agents.1 When surgical instruments are needed immediately or the surgeon is asking for a set, it's tempting to take shortcuts or entirely skip this step. Proper cleaning and decontamination requires more than a quick rinse under the scrub sink or a swipe with a germicidal napkin. Each facility needs to have a policy describing the proper method to clean and decontaminate instrumentation, as well as a designated separate decontamination area away from areas that perform sterilization of surgical instrumentation.1 All surgical instruments should go through the same cleaning and decontamination process regardless of how they're sterilized.4 AORN has provided guidelines on how to clean and decontaminate instrumentation.

* Manufacturer's instructions should be available and followed.

* Ensure items are disassembled and thoroughly cleaned with detergent, enzymatic cleaner, and water to remove soil, blood, body fats, and other substances.

* Flush lumens with cleaning solution and rinse thoroughly.

* Don personal protective wear, such as face mask, gloves, gown, and eye protection.

Step two

Preparing medical devices for sterilization is the next step, and ensures that steam will contact all parts of the instruments placed in the sterilization container or tray. Ensure all hinged instruments are in the open position, disassemble devices with removable parts, and thoroughly flush instruments with lumens.

Flash sterilization containers house the surgical instruments during and after sterilization.5 When using containers, be sure the manufacturer of the container provides written documentation confirming their containers are compatible with flash sterilization.3 Each facility should validate that sterilization can be achieved when using the containers in their specific sterilizer.3

During flash sterilization cycles, a sterilization process monitoring device, such as a chemical indicator or integrator, should be used in each load. Routine use of monitoring devices ensures that conditions for sterilization have been met.1 Monitoring devices in flash containers or trays should be placed in areas that are the most difficult to sterilize. Be sure to follow the flash container's written instructions on placement of chemical and biological indicators.6

Step three

Flash sterilization can be performed in two different cycles: gravity displacement and dynamic air-removal cycles (prevacuum). The exposure times and temperature settings should be set according to the written instructions of the instrument and the manufacturer of the sterilizer. Either sterilization cycle can be used for flashing as long as the manufacturer's recommendations are followed (see AAMI's general guidelines on minimum exposure times).7

OR facilities need to develop policies and procedures for flash sterilizations in accordance with AAMI, AORN, and manufacturer's recommendations. Once these are established, educating staff members on flash sterilization parameters will help ensure the process is done correctly.

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Step four

The next step begins after the flash sterilization cycle is completed. Before the sterilized instrument is taken out of the sterilizer, the operator needs to ensure the parameters of time and temperature required for sterilization have been met by reviewing and initialing the sterilizer's printout.1,6 Once verified, prevent contamination of the sterile instrument during the transfer to the sterile field. If the surgical instrument was flash sterilized in a container, then, depending on the type, be sure it's closed and the sterilized instrument is protected from contamination during delivery.4 If an item isn't sterilized in a container or in an uncovered tray, wear sterile gloves, a face mask, and avoid areas where the sterilized instrument can be exposed to aerosols during the transport.1

Step five

The last step is to document each sterilization cycle into a logbook or database.1 These should be maintained for each flash sterilizer, tracking flashed items to individual patients. Documentation should include:

* sterilization cycle

* item sterilized

* time and temperature of cycle

* name of staff member flashing the item

* date and time of cycle

* results of chemical integrator/indicator or biological indicator

* name of patient receiving the item

* reason for flash sterilization.

Facility policy will dictate the length of time logbooks need to be maintained.2 Many experts suggest a minimum of 3 years.4

Staff education and training

All staff members who use flash sterilizers should be educated and trained on the process. Training should begin at the time of hire and continued periodically to ensure competency.5 Policy and procedure manuals on flash sterilizations should be written, reviewed annually, and available for reference.8 Staff members should also receive training from instrument and sterilizer manufacturers on when to use various sterilization parameters.

It's important to note that flash sterilization should be kept to a minimum. The preferred method of sterilization is still the wrapped or sealed container method, accomplished within strict AAMI sterilization parameters.

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