Flashing policy... confused

[Sammy25]

Okay so I am a little confused about the whole "flashing" thing.... they tell us that is not recommended we flash instruments and that we do it only when we "need" to because of patient safety and preventing infection..... then why do we do it at all if it's "not safe?"

We have a policy in the OR that if we open a tray that has been contaminated or has a hole in the wrapping BEFORE the patient is in the room that we either have to call for a new tray or if we don't have another one... the tray has to be sent back down to be cleaned and reprocessed (which takes over an hour) and the case has to be delayed. HOWEVER if the patient is IN the room the tray can be sent down to be cleaned and then flashed. I don't really get the meaning of it.....

Recently we had a case where I was bringing the patient to the room and right as we were about to open the door they tell me to bring the patient back to admitting and had to delay the case because there was a hole in the wrapper of a tray we needed and when they called for another tray that one ALSO had a hole... so we had to call for a tray to be sent from another campus so we waited another forty minutes and when we got the tray that one ALSO had a hole in the wrapper so the patient had to wait another two hours before the case could start so we could process the tray because we had none left..... however if we had entered the room two minutes before we could have continued like usual and flashed..... aaaah! sorry if this was long and confusing.... Any input?

[linda2097]

Are you sure they're not talking about implant trays? I can understand them being obsessive compulsive about implant trays, but I don't see the problem with flashing instruments. Sterile is sterile. They should at least allow you to flash for an extra long duration.

[Sammy25]

Nope this goes for any type of tray or instrument. In this case it was a reamer tray... no implants. we spoke with our manager and head surgeon and they both wouldn't allow a flash to be done.

[linda2097]

They must have had a sentinel event. Maybe someone used unsterile instruments during a case at your facility.

[ewattsjt]

I would like to start by saying that many facilities have varying takes on flashing. The AORN recommends against flashing unless there is a real need to flash something.

Before the patient is in the room the case can be delayed without much consequence to the patient. Once the patient has been given meds, it is typically better to run the case than to recover and try again (not only because of the meds but also psychologically as well). Sometimes it is a legal issue too (if they started and aborted-some facilities consider it a new case and the patient can’t sign another consent until after 24hrs because of the meds administered).

Central’s autoclaves are set up somewhat different (some are pulse pressure) so while they do similar things, they work on a different scale and sometimes a different system.

Two types of flashes are gravity and prevacuumed and the autoclaves are either in a sterile core (where the scrub can retrieve it directly or in another area where it is transported in a pan). As you can see, the second doesn’t really make sense unless you do not want to keep the patient under for an additional 20-45 min. (depending how central’s flash is set up).

Ideally, flashes are: gravity for single items and batteries, prevac. for items with lumens or several items ran together (typically 4 or 5). Flashes like in the surgical unit are not designed for the entire set (regardless of how it is used) so full sets should be ran through central.

Implants can be ran in a flash on the unit but it has to be prevac. and biological has to be ran with it. Once again this is recommended against unless in a pinch.

This is a matter of weighing additional gas time against chance of infection.

Facilities base what they do with flashing on the entire recommendations of groups like IAHSCMM, AORN, The Joint Commission, etc.. . There are many more reasons and much more detailed explanations but what I listed is the basics.

While this didn’t really answer your question, I hope this helped you to understand that there is more though in the process than sometimes we can and other times we can’t and why it seems to vary in different facilities!

[GadgetRN71, ASN, RN]

They must have had a sentinel event. Maybe someone used unsterile instruments during a case at your facility.

Yes, I thought this too. We have been having horrible problems with some of our instruments coming down from processing, supposedly sterile, but we find tissue/bone sometimes in the lumens. We are very good about flushing the instruments through, to try to combat this. Sad that we have to do reprocessings job too but it's all for the patients good..someone has to do it.

We try to use a "fresh" tray whenever possible, and we have mutiples of most of our trays, but we do still flash on occasion.