Administrative and Professional Knowledge: Sterility Assurance, Safety, and Ethics
Surgical conscience and scope
Surgical conscience means doing the right thing when no one is watching: admitting a break in technique, discarding a contaminated item, and speaking up. Know your state's scope of practice and facility policy, and delegate only tasks within that scope.
Sterilization and disinfection
Apply the Spaulding classification: critical items (instruments entering sterile tissue) require sterilization; semicritical items (endoscopes contacting mucosa) require high-level disinfection; noncritical items (stretchers, blood pressure cuffs) require low-level disinfection. Steam sterilization commonly uses 250 degrees F (121 degrees C) gravity displacement for 15 to 30 minutes, or 270 degrees F (132 degrees C) for about 4 minutes in a pre-vacuum cycle. A biological indicator is run with every load containing implants. Sterility is event-related: an intact, dry, undamaged package remains sterile regardless of a printed date. Flash or immediate-use sterilization is for urgent situations, not routine processing.
Safety and regulation
Follow OSHA bloodborne pathogen standards, wear appropriate PPE, and report sharps injuries immediately for evaluation and post-exposure prophylaxis. Fire requires fuel, oxidizer, and ignition; allow alcohol-based preps to dry fully and keep drapes from trapping vapor. Know RACE for evacuation and PASS for extinguishers.
Documentation and risk
Chart objectively, factually, and in real time. Correct errors with a single line, initial, and date - never obliterate an entry. Incident reports go to risk management; they are not part of the medical record.
Professional growth
Engage with professional organizations, maintain certification through continuing education or re-examination per the certifying body, and use preference cards, case carts, and first-in-first-out inventory practice to control cost.
Traps: treating flash sterilization as routine; assuming a date stamp defines sterility; charting opinions rather than observations.
Rule of thumb: if you would not want the item used on yourself or your family, it is not ready.