[Romaine Huggett]

OFFICIAL

Thanks for your replies Megan & Michael

I questioned the need for the double bagging, as other podiatry practices do not do this for their nail surgery kits. They stated it was the personal preference of the podiatrist to maintain a sterile field, with their assistant opening the outer layer for the podiatrist, with the podiatrist taking the inner layer. I don’t recall if this specific podiatrist uses sterile gloves while doing this, but other podiatry practices do wear sterile gloves for nail surgery. The packs are reasonably heavy, and could be prone to perforations, but I don’t believe this is the reason they double bag.

Kind regards,

Romaine Huggett |Public Health Officer|Infection Control Manager
romaine.huggett@act.gov.au
Health Protection Service | Population Health Division | ACT Health Directorate
25 Mulley Street, Holder ACT 2611|Locked Bag 5005, Weston Creek ACT 2611
health.act.gov.au

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Hi Romaine

I have to ask…. why are they double bagging their instruments? Is it because of tearing or perforation of packaging? There are other, more practical and less expensive, ways to prevent perforation of packaging.

The only items we double bag in our hospital are items with multiple pieces that are required to be taken with sterile gloves onto a sterile field. Is that why they are doing this?

I am not sure that double bagging appropriately (ie in a way that does not impede steam sterilisation of the contents) is an issue, but it is certainly an increased cost, and in my view, possibly unnecessary in this instance.

Cheers
Michael

Sent from my Galaxy

——– Original message ——–

OFFICIAL

Dear all,

We have recently inspected a podiatry practice that double bags their nail surgery equipment. This isn’t a common practice in ACT office based practices, so I am calling on your knowledge with advice what recommendations I can make about this practice to ensure instruments are sterilised correctly.

I believe that two different bag sizes should be used (with inner one smaller than the outer) with the paper side of the inner on the paper side of the outer and to limit any folding (if required) of the inner bag to a third.

Do you have any further recommendations?

Kind regards,

Romaine Huggett |Public Health Officer|Infection Control Manager
romaine.huggett@act.gov.au
Health Protection Service | Population Health Division | ACT Health Directorate
25 Mulley Street, Holder ACT 2611|Locked Bag 5005, Weston Creek ACT 2611
health.act.gov.au

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[Romaine Huggett]

OFFICIAL

Hi Kylie,

We consider the type of beaver blade handle you describe as Hollow load type A. We recommend the following in our inspections:

* Helix test if reusing hollow instruments i.e beaver blade handles*

* Daily (type B cycles & type S cycles for hollow load type A*)
If the beaver blade handles are only reprocessed infrequently, we accept a helix test on the day of the handles being sterilised.
Podiatry practices in the ACT tend to have Type S autoclaves, which may not have a suitable cycle for a hollow load. In that case we recommend the use of single use beaver blades & handles.

Kind regards,

Romaine Huggett |Public Health Officer|Infection Control Manager
romaine.huggett@act.gov.au
Health Protection Service | Population Health Division | ACT Health Directorate
25 Mulley Street, Holder ACT 2611|Locked Bag 5005, Weston Creek ACT 2611
health.act.gov.au

Hi Kylie,

Hollow Type A and B are still design considerations for small steam sterilisers and are relevant while AS4815 is still in play. The design and requirements of these sterilisers are covered by ISO13060, which will continue to apply as a normative standard, even if the overarching reprocessing standard in Australia were to change. With a beaver handle, the blind ended hollow is similar to a number of other challenging little nooks and crannies. There are plenty of RMDs that may not even conform to the ideal picture of lumens or hollows but have (either hidden or obvious) close mating or narrow gaps and spaces.

ISO13060 contains the definitions and diagrams of simple hollow items (from which Type A and B are derived) and how to assign them based on the ratio of length to diameter of the cavity. This was inserted verbatim into AS4815.

Annex A of ISO13060 has a further graph to illustrate the way RMD structures are defined for the purposes of testing and classifying the load contents of small steam sterilisers, which is interesting and worth a look. The axes are the diameter and length of the RMD’s feature, and lines representing the length:diameter ratios that define Type A and B Hollow items are used to describe three plot areas into which you could place your RMD – these being non-hollow, simple hollow and narrow lumen areas. The l:d of double ended and single ended lumens are also differentiated in this. I haven’t measured up the screw hole of a beaver handle but it looks like it would come under “narrow lumen” field on that chart.

S Type sterilisers include cycles for which the manufacturer has specified the load type and limitations, so those cycles have to be followed according to the manufacturer’s instructions, including testing requirements. That aside, if I were considering the beaver handle as having a blind, narrow lumen then air removal testing would be warranted.

Regards,

Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South Australia
Level 13 | 25 Grenfell Street | Adelaide SA 5000
HCW infection prevention: http://www.sahealth.sa.gov.au/infectionprevention
General public: http://www.sahealth.sa.gov.au/hospitalinfections

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Hi everyone,

I wanted to ask the group about reprocessing a specific podiatry instrument.

The instrument is a beaver chuck blade/handle. This item is hollow but capped at the end and when in use the blade holder is screwed into the handle and the blade attached.
It’s getting reprocessed (handle separated from the blade holder) in a S Type benchtop steriliser in a AS/NZS4815 environment.

See attached image of the instrument.

Anyway, would this item be considered as a hollow type A or type B and is that even a thing anymore?

Essentially, I am wondering about having to conduct air removal steam penetration tests (ARSPT) for these S Type benchtop sterilisers because of these items. Looking at 4815 it says that if it’s a hollow A or B item then the steriliser needs an air removal steam penetration test anyway. I guess my question is would the ARSPT for this S Type steriliser each day be required because the item is a Type A Hollow or Type B Hollow and why. I’d like to know the rationale for decision making I suppose.

I have been reflecting on this and I think that because the item is hollow, it doesn’t make a difference whether it’s hollow A or B because it’s, well, hollow – and the Standard says if the item is hollow (A or B) then it needs an ARSPT. I just want some more insights about the A and B hollow situation for my own interest.

Thanks for considering this one. I would welcome any offline comments and, of course, through the forum.

Kylie

Kylie Robb
MHSM, GradCert InfecPrev&Cont, CICP-A, MAICD, FACIPC
ADA NSW Head of Practice Services
Advanced Credentialed Infection Control Professional (CICP-A)
Adjunct Lecturer – University of Newcastle – Oral Health School of Health Sciences
ACIPC Board Director

Australian Dental Association NSW Branch
1 Atchison Street, St Leonards NSW 2065
t: 02 8436 9936 m: 0438628664
E: kylie.robb@adansw.com.au | W: https://www.adansw.com.au

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