We all know the AAMI standard for running Biological Indicators…”weekly, preferably daily (every day the sterilizer is in use) and with all implant loads”. So, how frequently are you running a BI in your steam sterilizers? Have you heard of and considered ELM? And that’s not a reference to a tree that historically experienced near-blight conditions in earlier decades!

ELM is, of course, Every Load Monitoring. So why would you consider biologically monitoring each one of your hundreds and thousands of steam loads? If AAMI indicates it can be done weekly, how many of us are actually doing that? I would suspect very few. If we ever had a positive BI and had to initiate a recall due to a failed BI, none of us want to go back seven days, recover each item that was sterilized in our five steam sterilizers, notify Infection Control about the nasty bug growth event, then explain to surgeons, Nurse Managers, Department Managers, and Risk Management that we experienced a problem. I would guess that most of us are at the “preferably daily” and all “implant loads” stage in our managing steam sterilization monitoring. But why stop here?

Busy Sterile Processing Departments can run up to a couple hundred steam loads per day, and in general, many of those loads might already contain an implant, so we are already running multiple BI’s during the course of a busy day. Why not go the next step and do ELM? “A BI in every load leads to more stringent quality assurance that the instruments processed in the SPD are sterile.” BI recall or otherwise failed loads require the department to go back to the last negative BI run in that sterilizer. If we are doing ELM, we have so greatly reduced the risk of releasing something that could be questionable and at the same time we have so greatly increased the quality outcome of sterility for each and every one of our patients. This is especially true, given the fact that if we are using the 3M products and using fluorescence to detect growth, we will know if we have a problem with a steam load BEFORE the load is even cooled, let alone released, for use.

Every Load Monitoring is truly the Gold Standard, Best Practice for steam BI monitoring and ultimately the best service and assurance level we can provide to our customers and to our patients. It’s not just a lot of hype or a money making scheme. Ethically, it is the most important thing we could do.

Author: Dave Craige