One Misunderstood Guideline in Sterile Processing - The 18-inch Supply Storage Ceiling Limit

Sterile supply room with metal shelves storing sterile blue-wrapped packages and rigid sterilization containers. Bright fluorescent lights illuminate the space.

One of the most often asked questions in the sterile processing department is, "What are the requirements for storing supplies?" This inquiry, although seemingly straightforward, reveals a complex landscape of regulations and guidelines governing the storage of medical supplies and equipment. At first glance, one might assume that the answer would be simple and easily accessible; however, the reality is that the requirements can vary significantly based on multiple factors. To navigate this intricate web of regulations, one can turn to a plethora of resources that provide the necessary information regarding storage requirements. Key references include ANSI/AAMI ST79 2017, NFPA 13, ANSI/ASHRAE/ASHE Standard 170-2017, and the FGI Guidelines for Design and Construction of Hospitals and Outpatient Facilities. Each of these documents offers insights into the design, functionality, and operational standards that must be adhered to in storage areas within healthcare facilities.

Nevertheless, one critical aspect that often overshadows others is the timeline of the facility's construction and, even more importantly, the date of the last renovation of the specific area designated for the storage of supplies. Guidelines and standards are routinely updated to reflect the latest safety practices and technological advancements; therefore, it is essential to reference the documents that were applicable during the construction period of your facility. This ensures compliance with the most relevant standards at the time the building was erected or modified. Among the various guidelines, one that frequently confuses is the storage of supplies related to fire protection, commonly referred to as the "18" rule.

The 18-inch Supply Storage Guideline In Sterile Processing

Across the nation, sterile processing departments (SPDs) have devised numerous innovative strategies to adhere to the 18-inch supply storage guideline, which is officially recognized as NFPA 13 10.2.8.1. This guideline stipulates that *The clearance between the deflector and the top of storage shall be 18 in. (450 mm) or greater. In practice, many SPDs have implemented visual cues, such as painting red lines on the walls to indicate the 18-inch threshold, serving as a clear reminder to staff to keep storage below this critical height. Others have adjusted the design of their storage units to ensure that the top shelves are positioned precisely 18 inches from the sprinkler heads, thereby indicating that any items placed on the top shelf would violate the code. These methods of compliance are not only practical but also easily understood and assessed by personnel tasked with maintaining safety standards. However, it is crucial to note the presence of an asterisk (*) in the guideline, which leads to further clarifications.

The NFPA 13 2022 10.2.8.1 (*)

The NFPA 13 2022 guideline 10.2.8.2 elaborates on the initial rule, stating: The 18 in. (450 mm) dimension shall not limit the height of shelving on a wall or shelving against a wall in accordance with 10.2.8.1. Furthermore, the NFPA 13 guideline 10.2.8.2.1 specifies: Where shelving is installed on a wall and is not directly below sprinklers, the shelves, including storage thereon, shall be permitted to extend above the level of a plane located 18 in. (450 mm) below ceiling sprinkler deflectors. In conjunction with this, guideline 10.2.8.2.2 states: Shelving, and any storage thereon, directly below the sprinklers shall not extend above a plane located 18 in. (450 mm) below the ceiling sprinkler deflectors.

It is essential to conduct thorough assessments to ensure that there are no sprinkler heads directly positioned above the storage units that are arranged along the wall. If it is confirmed that no such obstructions exist, it opens up additional storage space that may currently be underutilized. However, it is imperative not to make arbitrary adjustments to other storage units, as the 18-inch rule still applies universally. The underlying rationale for these guidelines is that sprinkler heads must be able to distribute water effectively in the event of a fire, and any obstructions could impede this function. Nevertheless, in the case of shelving against a wall, the wall itself already presents a barrier to water distribution, which means that the risk is mitigated, allowing for greater flexibility in storage capabilities.

Knowing The Regulations

Recently, while collaborating with a CMS consultant in preparation for the launch of a new Sterile Processing Department, I encountered a situation that highlighted the importance of understanding these guidelines. Upon entering the supply storage area, the consultant immediately identified that the supplies were not in compliance with established codes. I took the opportunity to discuss the relevant guidelines with the consultant, referencing the NFPA standards while also engaging with a CMS inspection firm consultant for additional clarity. To my surprise, the response I received from the CMS consultant was, "We really don't like people knowing this." However, after further discussion, the consultant ultimately approved the storage area based on the guidelines presented. This experience underscores the necessity of being well-versed in the applicable guidelines and regulations, empowering professionals to navigate compliance effectively and maintain safety standards in sterile processing environments.

Conclusion

The proper storage of supplies within sterile processing departments is a multifaceted issue governed by a variety of regulations and guidelines. Understanding these requirements, such as the critical 18-inch rule established by NFPA 13, is essential for ensuring compliance and maintaining safety standards. As we prepare for the launch of new facilities or renovations, it is vital to stay informed about the most current guidelines applicable to our specific contexts, taking into account the timeline of construction and any relevant updates in safety practices. By fostering a comprehensive understanding of these regulations among staff and implementing effective visual and structural reminders, we can enhance our operational efficiency and safeguard the essential supplies that contribute to quality patient care. Adhering to these guidelines not only upholds regulatory compliance but also underscores our commitment to creating a safe environment for both patients and healthcare personnel

At Evolved Sterile Processing, our consultants have a greater focus on sterile processing. With our decades of experience, we will help you develop better processes and educational resources for your staff.