[Circl8r]

Greetings colleagues:

Just taking a little poll of the country, here. I know the flashing of instruments goes against AORN's recommended practice, however, I am interested in answere from around the country. How often do you find it necessary to flash entire instrument trays and is it due to lack of inventory?

Do you used a closed system such as a flash-pak?

Thanks much!

[OR male nurse]

I only have 3 years of experience, but I'll add my input.

Where I work now, we flash whole trays all the time. Mostly because we only have (1) set of that particular tray. We don't use any type of special pan other than a mesh bottomed open top tray. The dirty instruments are cleaned in the scrub sink, rinsed and then flashed. The uncovered tray is carried into the OR and used. It's pretty gross but that's how they do it. Many of the RN's I work with don't know how to do a biological test and think I am from another planet when I bring up how gross it is to flash our trays this way and try to enlighten them about doing a biological test on the weekend when you might have to do a back to back ORIF of an ankle or similar and reuse a small frag tray. The attitude is "that's how we've always done it."

At the last hospital I worked at, we used special flashing trays that were covered, ran biological tests, and only flashed a tray if we absolutely had to. All of the RN's knew how to do a biological, would never carry an flashed pan without being covered with a sterile towel, etc. We had more inventory of trays also.

It just goes to show how different an OR can be. I went from one extreme to the next and only moved a short distance.

[shodobe]

Some facilities have the luxury and money to have multiple sets or instruments that allow them to almost never flash anything. I work part-time in one hospital like that where they never are allowed to flash and use a Steris for scopes and such. The other hospital I work at full-time doesn't have the luxury and we have alot of single-only sets and instruments. We use to have to flash our cameras and scopes for Lap Choles but now I have trays for all of them and they get gassed. We never, almost 99%, run any implantable items such as screws, plates, etc.... Unfortunately there are times where we have to flash certain items that we have only one of. Biologicals are run in the am before the day shift and we will use FlashPaks when necessary. Our sterilizers are between two rooms with a door leading into the sub-sterile room so the scrub can come in and take the items out directly. This isn't the most ideal situation but we try to limit the items that are flashed. It would be better if we all had an unlimited money source and had multiple items so flashes could be eliminated entirely.

[WitchyRN]

We will flash regular trays as a last resort but try not to flash implantable trays(small frag, etc). Thankfully we have multiples of those kind of trays. Actually, last week the surgeon postponed a case because we had used all of a particular tray we use for hemi-hips(head trials) and he wanted a sterile processed tray, not a flashed one. I see his point too-our Ortho dept. has an extremely low infection rate and we're trying to keep it that way. Granted, the trial heads don't stay in, but why tempt fate?

[umakemesmile]

We all know that flashing is a no-no. But one that just can't be helped.
We try not to run full sets, but pull out the neccesary items and complete the set with peel packed stuff. Lowering the amount of flashing items. Don't know how good that is but that's what we do. We do add a catagory 5 strip to whatever we flash.

One of a kind ortho sets like small frags, hip pans etc. get a biological and we are suppose to wait till it can be read. If a surgeon can't wait, we have a form he has to sign off on stating that he knows the set set will be used before the test is back.

We still use open pans with mesh bottoms. We put contents and inital the sterilzer tape,so it can be traced backed if there is a problem.

[MamaCheese]

The majority of time we're flashing entire trays due to holes in wrappers. So very frustrating when you're struggling to keep turnover times down. We're in the process of converting to a closed system.