Franks Autoclaves

6/11/2020 Frank's Autoclaves
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Anaesthesia
Autoclaves
Equipment
Autoclaves by Frank Weithöner
Background
User Manuals
All surgical instruments that are in touch with open wounds or enter the body of a patient must
Service Manuals
be sterile. Therefore, all surgical instruments and materials have to be sterilised before surgery.
Automated Analyzer The machine which does the sterilisation is called autoclave or steriliser. If sterilisation does
Centrifuges not happen or happens insufficiently, life-threatening infections are the result. For this reason
the autoclave is one of the most important pieces of equipment in a hospital.
Defibrillators
The medical steam autoclave is a device that uses pressurised, high temperature steam to
Dental Units sterilise medical instruments. Although there are still other methods of sterilisation e.g. dry
Dialysis Units heat, gas (Ethylene Oxide) or gamma radiation, the sterilisation with hot steam is the most
common method. The usage is simple, rapid, cost effective and environment friendly. The
ECG
following article refers to the steam autoclave.
Electrosurgery
Electrotherapy
Endoscopy Sterilisation
Fluid Warmer Sterilisation is the elimination of all transmissible micro organism, bacteria, viruses and fungi
Hospital Beds from the surface of an instrument. This is different from disinfection, where only organisms are
removed by a disinfectant and are not completely eliminated.
Incinerators
In general, any instrument that enters the body must be sterilised. This includes all surgical
Infant Incubators instruments, implants, catheters, syringes, needles, dressings and others.
Infusion Pumps Proper sterilisation of instruments is crucial in preventing HIV transmission.
Laboratory Equipment Sterilisation is possible with hot air, chemicals or radiation, but the most common method is the
use of hot steam, which kills all organisms. This method is easy and cheap to realise.
Light
For a steam sterilisation temperatures above 110°C are needed, which requires the steam to be
Medical Gas Supply applied in a pressure chamber. The sterilisation time depends on the temperature. The higher
Microscopes the temperature the faster the instruments get sterile.
Microtomes
Operating Tables
Types of autoclaves
Ophthalmology
All steam autoclaves have a metal chamber to withstand the high pressure and the
Oxygen Concentrators
temperature. A massive door or lid which is locked during operation keeps the chamber closed.
Patient Warmer The chamber is heated by an electric heating element. In places without electricity supply
Photometer & Analyzer autoclaves heated up by gas or fuel are common.
To ensure that an autoclave works correctly, the machine has a temperature and/or a pressure
Physiotherapy
gauge and often an integrated timer.
Pulse Oximeter Modern autoclaves are all electronically controlled. The control unit controls temperature,
Sphygmomanometer pressure and time and monitors all safety functions.
Hospital autoclaves are available with chamber capacities from 5 l to 900 l. The smallest and
Spirometry
simplest ones work manually and are heated up by a normal electric or gas stove. The big
Suction Pumps stationary autoclaves are fully automatically controlled and need three-phase-power supply and
Surgical Instruments a water supply installation.
Thermometer
Ultrasonographs
Pressure cooker type
Ventilators
www.frankshospitalworkshop.com/equipment/autoclaves_equipment.html 1/24
Weighing Scales The simplest autoclave with a capacity of 5-25 l is the

pressure cooker type. It is the small and portable version
X-Ray
of a vertical autoclave. Usually it is heated by an
integrated electric heating element but sometimes it
Various Equipment comes without a heater. This version is heated like a
pressure cooker on a gas stove. It is made for remote
Workshop Equipment
areas without electricity.
The pressure cooker type autoclave has a safety valve, a
release valve, a pressure gauge and a thermometer. The
simplest and cheapest ones come even without a rubber
gasket in the lid. The sterilisation process has to be
controlled manually by the user. This type is simple,
reliable and almost indestructible and very common in
small hospitals and small health centres.
Vertical
The vertical autoclave is a stationary top-loader with a
capacity of 60 l - 100 l. The construction is simple and
robust. The vertical autoclave is often double walled with
pressure gauges, thermometer, water level inspection
tube and a mechanical timer. Bigger vertical autoclaves
need 3-phase electrical installation.
Table-top
Table top autoclaves have a capacity of 20-80 l. Although it has just small capacity, the table-
top is the most common autoclave. It is found where surgical instruments are needed: E.g. in
maternity wards, laboratories and at the dentist.
Modern table-top autoclaves are a fully automatically controlled, and often come with a vacuum
pump and a drying program for drying the goods after sterilisation.
Table-tops are designed for front loading use and provide different trays for surgical
instruments. They also have a safety lock for the door and a water reservoir.
Stationary
Stationary autoclaves are big,
automated or semi-automated
machines, built for all sorts of
purposes: Instruments, liquids,
clothes and even for waste
sterilisation. They are available with
capacities up to 800 l. Stationary
autoclaves are normally located in the
sterile processing department (SPD)
of a hospital. Often the autoclaves
have two doors, a front and a rear door and are positioned between two rooms, a sterile and a
non-sterile area.
Stationary autoclaves require plumbing and 3-phase electrical installation.
The principle of steam
sterilisation
The boiling point of water is 100°C (212°F).
This means that water cannot be heated
above 100°C. Further heating does create
steam but does not raise the temperature of
the water. Only when water is heated in a
closed vessel is it possible to reach higher
temperatures. Then the water steam creates
a pressure in the vessel. With increasing
pressure the boiling point of the water also increases. The temperature gets higher than 100°C
and can then be used for sterilisation.
Temperature and time

For sterilisation a minimum temperature of 110°C (230°F) is needed. The higher the
temperature, the shorter is the needed time to get things sterile. In practice 121°C (250°F)
and 134°C (273°C) are defined as the standard sterilisation temperatures for hospital
autoclaves.
Important: Water and steam temperatures of 121°C or 134°C can only be reached
under pressure.
Sterilisation depends on
temperature and time. The
higher the temperature, the
shorter the sterilisation time.
Gauge pressure and absolute pressure
It is confusing. The air pressure at sea level is by definition 1 bar (1013 mbar). This is the true
or absolute pressure. The perfect vacuum is according to this definition 0 bar.
But our pressure gauges for technical applications always show 0 bar at ambient air pressure.
We use a different definition, the so-called technical pressure or gauge pressure. Our zero-
point is the normal air pressure at sea level. That means, that 0 bar gauge pressure is equal to
1 bar absolute pressure. That is why we have to be careful and make a clear distinction
between absolute pressure and gauge pressure.
Example: 0 bar of a pressure gauge shows us that a vessel is not under pressure. But the
absolute pressure is 1 bar. A reading of 2 bar showing on a pressure gauge of an autoclave
corresponds to an absolute pressure of 3 bar.
But in practice this fact is not really relevant to us because we are only interested in the gauge
pressure or in the change of pressure. We want to know the pressure difference of a pressure-
less vessel and a vessel under pressure.
Note: We technicians talk about the gauge pressure, the technical pressure.
Pressure and temperature

In a closed vessel, pressure and temperature rise when the vessel is heated up. When the
temperature reaches the boiling point (100°C), steam starts to be generated. This steam
creates a pressure. The higher the pressure, the higher the temperature gets in the vessel
gets. Pressure and temperature are interdependent. It is not possible that one value increases
without the other.
At 121°C the pressure is always 1 bar and if the pressure reaches 2 bar the temperature is
always 134°C. Thus, it would be enough to look only at one meter to know if the autoclave
works correctly, the pressure gauge or the temperature. But in practice most of the autoclaves
have both, a pressure gauge and a thermometer.
Pressure at high altitude

The atmospheric pressure changes with the altitude. At sea level it is 1013 mbar (absolute
pressure) but it decreases in higher altitudes. That also means that in higher altitude water
reaches the boiling point earlier. It boils at a lower temperature than at 100°C.
This also has consequences for an autoclave when the autoclave is pressure controlled and not
temperature controlled. When a pressure controlled autoclave at high altitude reaches the 1 bar
(gauge pressure) setting and switches off, the temperature has not reached 121°C. The
instruments in the steriliser will not get sterile.
For pressure controlled sterilisers we have to increase the pressure limit in order to reach the
needed sterilisation temperature. If this is not possible, the sterilisation time has to be longer.
Altitude and pressure

When the autoclave is pressure controlled and the pressure valve cannot be adjusted then it
should be done according to the following table.
Altitude Absolute air Temperature Pressure Temperature Pressure

pressure at 1 bar compensation at 2 bar compensation
0m 1.0 bar 121°C +0.0 bar 134°C +0.0 bar
1,000 m 0.9 bar 118°C +0.2 bar 132°C +0.1 bar
2,000 m 0.8 bar 117°C +0.4 bar 131°C +0.2 bar
3,000 m 0.7 bar 115°C +0.6 bar 130°C +0.3 bar
4,000 m 0.6 bar 114°C +0.7 bar 129°C +0.4 bar
Altitude and time

When the autoclave is pressure controlled and the pressure valve can not be adjusted then the
sterilisation time has to be extended according to the following table.
Altitude Temperature at Sterlisation Time Temperature at Sterilisation Time

1 bar 2 bar
0m 121°C 20 min 134°C 3 min
500 m 120°C 25 min 133°C 10 min
1,000 m 119°C 25 min 132°C 10 min
1,500 m 118°C 30 min 132°C 10 min
2,000 m 117°C 35 min 131°C 10 min
2,500 m 116°C 40 min 131°C 10 min
3,000 m 115°C 45 min 130°C 10 min
3,500 m 114°C 50 min 129°C 10 min
4,000 m 114°C 50 min 129C 10 min
Example 1: In Arusha, Tanzania the altitude is 1,500 m above sea level. A pressure controlled
autoclave would reach the 1 bar setting (121°C) already at 117.5°C. If the user would run the
normal 121°C-program, the instruments would not be sterile. Either the technician has to
adjust the pressure valve to 1.3 bar or if this is not possible, the user has to extent the
sterilisation time to 30 min.
Example 2: In La Paz, Bolivia the altitude is 4,000 m. Here we only get a temperature of 114°C
when a pressure controlled autoclave switches off the heating element. In order to get the
instruments sterile, the '121°C-cycle' has to last 50 minutes instead of 20 minutes or the
technician adjusts the pressure valve to 1.7 bar.
Working principle
The working principle of steam autoclaves is always the same. The difference is the control.
Manual autoclaves are simple and robust but the user has always to be present. Fully electronic
controlled autoclaves are easy to use but more difficult to repair.
Working principle of a simple autoclave (pressure type, vertical)

Water is heated up in the chamber. At 100°C steam develops and after a short time the
pressure increases, the boiling point of the water rises and so does the temperature (heating
phase).
When the predefined pressure or temperature is reached the heating element is switched off,
either by a thermostat or a pressure switch. In electronic controlled autoclaves a pressure or a
temperature sensor delivers a signal to the control board.
At this point the sterilisation phase begins. Then the temperature drops a bit and the heating
element is switched on again. In this way the temperature is kept stable. At the same time a
timer gets started and after the set time the autoclave switches off completely. The sterilisation
process is now completed (drying phase), the outlet valve opens and releases the steam. The
sterilisation goods remain a little longer in the chamber and the radiant heat from the chamber
dries the items.
Important: The sterilisation time begins only when the sterilisation temperature
(121°C or 134°C) is reached.
Vacuum pump
Unfortunately the sterilisation process is not that easy. In practice the items to be sterilised are
not packed separately but in packages wrapped in clothes. When the packages are packed too
tight, the steam cannot penetrate everywhere. Zones of colder air come into being and the
items do not get sterile.
Furthermore some surgical instruments consist of individual parts. In the joints and spaces
between the parts little air bubbles with cool air remain and prevent the hot steam to penetrate
(e.g. the joints of scissors) and the items will not get sterile.
Simple autoclaves which just use the steam to press the cold air out of the chamber (gravity
displacement) have problems to reach the cold air zones in the packs between the instruments.
Here an additional vacuum pump helps. Before the sterilisation process begins, the vacuum
pump sucks the air out of the packs and the insulating air bubbles disappear (pre-vacuum).
Then the sterilisation process is started by the control unit.
Later when the autoclave has finish the sterilisation, the vacuum pump is used again to suck
out the steam before the door can be opened (post-vacuum). In this way the packages get
perfectly dry.
Working principle of an automated vacuum autoclave

After switching on the steriliser, the vacuum pump sucks the air out of the closed chamber. A
vacuum develops, the pressure in the chamber is negative (air removal phase). Then the
pump stops, the inlet valve opens and filtered air gets into the chamber as well as distilled
water from the reservoir.
The pressure again is 0 bar. The valve closes and the water heater starts heating. The
temperature in the closed chamber rises slowly. In the meantime the vacuum pump creates
some more vacuums (air removal phase) which suck the trapped air out of the sterilisation
packs. After some minutes the boiling point of the water is reached and the vacuum pump
switches off completely. Now steam is created. The steam gets more and creates a pressure.
Under pressure the boiling point start to shift and the temperature rises (heating phase). After
some more minutes the pre-set temperature or pressure is reached and the heater is switched
off.
Now the sterilisation period begins and the timer starts. The pre-set time which is related to
the temperature (20 minutes at 121° or 3 minutes at 134°) is counted down. A temperature or
pressure sensor controls the whole process and lets the heater restart when the temperature
drops (sterilisation phase).
When the sterilisation process is finished an outlet valve opens and steam is released from the
chamber, condenses in a special condenser and the hot water gets back into the reservoir. The
temperature in the chamber decreases. Now the vacuum pump supports the drying process by
sucking the steam out of the chamber (drying phase).
Sometimes a special chamber heater is switched on additionally in order to improve the drying
process.
Water quality
The water quality is very important for the usage of autoclaves. In principle only distilled water
or de-mineralised water should be used because the water has to be pure and free of any
minerals.
But often normal tap water is use, which causes serious problems. The tap water leaves
deposits on the components of the autoclave and the sterilisation items. Surfaces of surgical
instruments get destroyed after some time and valves and the tubing in the autoclave get
blocked or damaged. On heating elements a layer of lime is formed which gets thicker and
thicker. One day the heating element cannot conduct the heat sufficiently and the heating
element will burn out.
In order to prevent all these problems only distilled water has to be used. The hospital
technician should ensure that only distilled water is used and should check the water quality
from time to time. The instrument needed for such a water test is the conductivity meter. It is
also sold as aquarium accessory and is not expensive.
When distilled water is not available, sometimes drinking water is an alternative when it does
not contain minerals. In some places drinking water is processed by reverse osmosis plants. In
this case you can also take this drinking water. But also here, you should test the water first
with a conductivity meter.
Another alternative is filtered rain water. Rain water is in principle free of minerals and thus
perfect for an autoclave.
Using the autoclave

The user has to be trained in the correct usage of

the autoclave. They have to know how to run the
different sterilisation programs and how to clean the
autoclave after usage. This instruction in the
operation of an autoclave should be given by the
hospital technician with the help of the user manual.
But beside the correct usage of the machine the
preparation of the sterilisation goods is even more
important. The cleaning and packing has to follow
strict international guidelines and has to be carried
out by qualified personnel only. To perform such a
user training is however not the task of the hospital
technician.
Precautions for usage and service

Be very careful while operating and servicing an autoclave. Autoclaves generate extreme heat
and high pressure. Simple autoclaves only have little or no heat shielding around the chamber.
Do not place paper, cardboard, plastic or flammable liquids next to an autoclave.
The operation has to follow exactly the user manual of the manufacturer.
In addition, always consider the following safety precautions:
1. Make sure that the chamber is filled up with enough water.

2. Check if the door gasket is in place and the door is locked firmly before starting the
autoclave.
3. After sterilisation make sure the autoclave is switched off.
4. Make sure that the chamber is pressure-less and cooled down before opening the door.
5. Open the door slowly, keeping head, face, and hands away from the opening.
6. Wait at least 30 seconds after opening the door before reaching or looking into the
autoclave.
7. Remove solutions from the autoclave slowly and gently. Some solutions can boil over
when moved.
8. Clean up any spills immediately.
9. Hospital staff should report any malfunctions or accidents immediately.
User manual
The usage of the autoclave has to be followed strictly according the user manual. One copy of
the user manual has to present in the department where the autoclave is operating and one
should be available in the workshop.
It is also a good idea to create a 'Quick User Chart', a one-page to-do-table with the most
important information for the operator. Additionally, the phone number of the hospital
technician should not be missing. This instruction can be laminated in plastic and hang up close
to the autoclave.
Using a vertical autoclave

The following is an example for the usage of a standard vertical autoclave. Every single step
has influence on the quality of the sterilisation. Any mistake results in unsterile or wet
packages.
1. Fill the autoclave with the right amount of distilled water.

2. Place a Bowie-Dick indicator strip in the centre of the load. (see ↓Bowie-Dick-test)
3. Load the autoclave with the packs. Do not overload. Packs must not touch the chamber
wall.
4. Close the lid tightly.
5. Open the air outlet valve so that the air can escape when heating up the autoclave.
6. Heat up the autoclave.
7. After water is boiling and all cold air is escaped, close the air outlet valve.
8. After some minutes when the pressure reached 1 bar (15 psi) reduce the heat and start
the timer. The sterilisation time is shown in table ↑Temperature and time.
9. When sterilisation time is over, turn off the autoclave or the gas supply and let the
autoclave cool down. At 80°C the vent valve can be opened and after this the lid. This
step may differ from one manufacturer to another.
10. It is a good idea to keep the packs in the warm autoclave for a while so that the
packs can better dry.
Cleaning by the user

An autoclave has to be perfectly clean at all times. It is the operators who are responsible for
the condition of the autoclaves. Together with the hospital technician they should think about
an appropriate procedure and schedule. This plan should be adapted to the situation on site. If
the water quality is not perfect and the cleaning technique of the user also not sufficient, then
the autoclave has to be cleaned more often.
A typical procedure for cleaning is the following:
Daily (by the user)

1. Remove and clean the outlet sieve under running water.
2. Clean the chamber using a cloth. Do not use abrasive cleansers or steel wool, as these
will scratch the surface and increase corrosion.
3. Clean the trays or baskets with multi-purpose cleaner and a cloth.
4. Clean the door or lid gaskets with a cloth and check for defects.
5. Do a performance test by using indicator strips (see ↓Bowie-Dick-test).
Weekly (by the user)

1. Flush the chamber drain to keep it free of residues.
2. Remove the outlet sieve. Pour 1 litre of multi-purpose cleaner and hot water down the
drain with a funnel. Rinse drain with 1 litre of hot water. Clean the sieve with multi-
purpose cleaner and put it back into place.
3. Do a performance test by using indicator strips.
Bowie-Dick-test
We technicians check the temperature and the sterilisation time to ensure that the autoclave
meets the technical conditions for the sterilisation process.
A performance test does more, it shows if the whole sterilisation process was successful, if
the packages were packed correctly and the autoclave not overfilled.
Such a test is performed with indicator strips or tape and is called Bowie-Dick-test.
According to the international standards Bowie-Dick-test has to be done every day by the
autoclave operator.
For this purpose a test strip is placed in the centre of the load and the sterilisation cycle is
started. After sterilisation a colour change indicates whether the steriliser works correctly or
not. A failed test can be the result of a defect autoclave or, and this is more likely, of an
overfilled or wrongly packed autoclave.
When a Bowie-Dick-test fails and the operator does not find a packing problem, the hospital
technician has to come to do a technical check. Then the sterilisation temperature and the time
have to be measured.
To do a Bowie-Dick-test in the workshop after maintenance or repair is pointless because we
run the autoclave empty and a Bowie-Dick-test would always pass.
In addition to the daily Bowie-Dick-test, a more precise test with biological indicators should be
done twice a year. These indicators have to be sent for analysing to a certified laboratory.
Validation
An autoclave validation goes even further. A validation monitors the whole sterilisation process
from the cleaning and packing to the sterilisation process and unpacking. It also covers
technical issues like measuring the sterilisation temperature but mainly the organisational
aspects.
For validation national or international standards apply.
Common problems during usage

During the sterilisation process some problems can occur. Here are the most common ones:
Wet material after sterilisation

This is probably not a technical problem. It is more likely that the autoclave is overloaded, the
air-release valve was not opened completely, the door was not briefly opened after sterilisation,
or the packs are too close to the wall, etc. However, the only correct way to achieve the best
drying result is described in the user manual and the operator should follow these instructions.
Basically, the wet steam has to be released out of the chamber after the sterilisation. If this
does not happen the steam will condense, becomes water and the sterilisation goods become
wet. A typical procedure to improve the drying is that the user opens the door briefly after
sterilisation so that the steam can escape and then leave the door ajar.
But this is only one possibility. There is no general perfect method. Every autoclave is different.
So please read the user manual!
Door locked after power outage

After a power failure many electronically controlled autoclaves are reset and are not able to
continue the sterilisation cycle. The chamber is under pressure, contains hot steam and hot
water and the door is locked by the safety lock mechanism. The user manual explains how to
open the door in this case. But be careful, hot steam and hot water will escape when opening
the door.
Here are some more suggestions to prevent problems during usage:
Use only distilled water. Never use tap water.

Use towels to separate instruments and absorb moisture if needed.
Hinged instruments must be autoclaved in the open position.
No sharp instruments should be allowed to touch other instruments.
Do not over-pack the autoclave. Otherwise, steam does not get everywhere.
Make a daily performance test.
Steam-pulsing
Pressure cooker types and vertical autoclaves without a vacuum pump have problems to
remove the air of porous sterilisation goods. In this case some experts suggest to use the
steam-pulsing technique in order to improve the sterilisation result.
Therefore, the air-removal valve is opened and closed briefly for a few times at the beginning
of the sterilisation phase. These pressure pulses flushes out the trapped air in the porous
sterilisation goods. The sterilisation phase has of course to be extended by a few minutes.
This method really works fine for sterilisation of porous sterilisation goods. But to make it clear:
It is an improvement for an otherwise functioning procedure.
The steam-pulsing method is no solution for wrong usage and it cannot replace the procedure
described in the user manual. Instead of implementing another (complicated) procedure, make
sure that the operator first follows the instructions in the user manual.
Construction of a vertical autoclave
The typical vertical autoclave is manually controlled and very common in smaller hospitals. The
components are simple and can be repaired and replaced easily.
Such an autoclave consists of the following parts:
Pressure control valve

The pressure control valve opens when the working pressure (and thus the temperature) is
reached. It works with a counter weight or a spring and can be adjusted manually.
Air-removal valve
Is opened manually when the sterilisation process is finished. It releases the steam out of the
chamber. This can be done by opening a mechanical valve or by a solenoid when pushing a
switch.
Thermometer or temperature gauge

The thermometer shows the temperature inside the chamber and thus indicates to the user
when the sterilisation temperature is reached and the sterilisation process can be started.
Safety valve
The safety valve opens and releases the pressure out of the vessel if the pressure control valve
fails and the pressure gets too high.
With pulling the safety valve also the steam pulse can be applied (↑Steam-pulsing)
Pressure gauge
The pressure gauge shows the pressure in the vessel but is not really needed when a
thermometer is built in.
Lid and lid gasket

A heavy lid closes the vessel airtight. The lid is sealed with a silicon gasket. The gasket has to
be checked and cleaned frequently. A leaking gasket allows hot steam to escape and can create
serious burns.
Pressure vessel
The high pressure chamber is made out of stainless steel. It contains the sterilisation goods.
Heating element
The heating element (sometimes three elements for a three-phases power supply) heats up the
water. It is important that it is always covered with water. A dry heating element will burn out
within seconds.
Drain valve
It is used to drain remaining water from the chamber after sterilisation and during cleaning.
Variations
Some vertical autoclaves are double walled where the sterilisation goods are not placed
directly over the heated water in the upstream steam but in another chamber. This inner
chamber is placed in such a way, that the steam can only enter from above. That helps to
achieve a more homogeneous and safer sterilisation result.
Because the water level is no more visible in a double walled autoclave, this type has a gauge
glass that shows the water level inside the outer chamber.
Most of the autoclaves have an integrated timer. The timer starts when the sterilisation
temperature is reached and switches off the heating elements when the sterilisation time is
over. The timer is often a mechanical one, driven by a little motor. In modern autoclaves the
timer is a small electronic circuit.
Circuit diagram of a semi-automated vertical autoclave

Here a circuit diagram of a typical vertical autoclave with some interesting features such as a
timer and a low-water protection.
The circuit diagram consists of two parts: On the left the three-phase power circuit with the
heating elements and on the right side the single phase control circuit.
At the top left we find the mains power supply input. The contactor K1 is connected to the
mains power supply and switches the two triple heating elements (in parallel) on and off.
The coil of the contactor K1 we find in the right part of the diagram. This part runs on single
phase (via the main switch, fuse F1 to L1). The common reference point is N (neutral) which
also comes from the mains.
The solenoid is activated when the thermostat S5 is not closed, the pressure sensor S4 below
the release point, the timer A1 is wound up, the water level is sufficient (S2) and the autoclave
is switched on by S1.
When winding up the timer, the switch A1 closes, the heater can be started but the timer itself
does not run because the timer part of S5 is open. The switch will only close when the
sterilisation temperature is reached. Then the other part of the switch opens the contactor part.
Tricky also the low-water detector. This detector consists of two parts, the micro heating
element E3 and the temperature sensor S2. This sensor has nothing to do with the sterilisation
temperature. In fact the release temperature is clearly higher than the sterilisation
temperature. This thermostat is mounted directly to the micro heating element next to the
main heating elements in the water. If everything is OK, the thermostat does not get hotter
than the sterilisation temperature. But if the water level is too low, the micro heating element
cannot emit the heat to the water, gets much hotter and the thermostat switches off the whole
system.
Construction of a table top autoclave

The general function sequence of a table top autoclave is the same as for a manual vertical
autoclave. The only difference is, that a table top autoclave runs semi- or fully automatically.
After the door has been closed, the autoclave can be started.
The valve 2 opens and water runs from the reservoir 1 through a filter 3 into the chamber 4.
When the water level reaches the level sensor 6 the valve closes and the heater switches on.
After a while, steam is generated. The steam rises and pushes the cooler air through valve 9
and the condenser 10 out of the chamber. When the temperature reaches the boiling point
(measured by the temperature sensor 7), the outlet valve 9 closes. Then the pressure in the
chamber rises (shown by the pressure gauge 8) as well as the temperature. When the
sterilisation temperature is reached (sensor 7), the heating element switches off. If the
temperature control fails and the pressure gets too high, the pressure is released by safety
valve 11. For cleaning and servicing, the water can be drained by the manual valve 12.
In addition, modern table top autoclaves provide more safety features like a door lock and an
internal water tester and most of all a suction pump. Mechanical sensors and meters are
replaced by electronic ones. An electronic board or a microprocessor controls and monitors the
sterilisation process.
1 Heating element
2 Water inlet
3 Level sensor
4 Steam to reservoir
5 Test port for external
thermometer
6 Safety valve
7 Sensor for thermometer
8 Pressure meter
9 Sensor for temperature
control
Door lock / door switch

Only after closing and locking
the door properly can the
steriliser be switched on. A
micro switch at the door
mechanism gives the
information to the electronic
board and a solenoid blocks
or releases the door mechanism.
Level switch for water inlet

A certain amount of distilled water is let into the chamber automatically. The water intake is
either time or level controlled. In the second case a water sensor in the chamber is needed. It
is usually just a piece of metal that works as a sensor together with a little electronic circuit.
This circuit measures the electrical resistance between the sensor and the chamber. When
water reaches the sensor the resistance becomes low and the electronics switches off the inlet
valve or the water pump.
Temperature sensor
The actual temperature in the chamber is measured by a temperature sensor. The sensor
delivers the measurement to the control unit. Here the actual and the pre-set temperature are
compared and a control voltage for switching the heating elements is created.
Chamber heating / thermal fuse

Often the outside of the chamber is also heated. This heating supports the drying process after
sterilisation.
This chamber heating is usually protected against over-heating by a thermal fuse.
Steam valve
After the sterilisation phase, the release valve (outlet valve) opens. Steam gets out of the
chamber, flows through a condenser and gets back as hot water into the reservoir.
Safety valve
The safety valve is designed to release steam in case the chamber pressure is increasing
beyond the normal range due to a fault in the control elements. Without safety valve the
chamber would burst with catastrophic consequences.
Variations
Modern table top autoclaves always provide a vacuum pump. Whenever a vacuum pump is
used, an additional ventilation valve with a bacterial filter is needed.
Often table top autoclaves also have an internal water quality tester. Before the distilled
water is led into the chamber, the water conductivity is automatically tested. When the quality
is not good enough, the autoclave cannot be started.
Construction of a stationary autoclave

Large stationary autoclaves, especially when they consist of several sterilisation chambers are
run by steam from an external water boiler. The advantage is that hot steam is available
immediately, the pressure in the chamber builds up faster and the overall sterilisation time gets
shorter. When the sterilisation of one batch is finished, the next batch can already be loaded
and started.
Additionally, each chamber is surrounded by an outer shell, the jacket. Here hot steam
circulates and pre-heats the chamber before it is used.
Also the chamber is post-heated that way when the steam is released out of the chamber after
sterilisation. This prevents water condensation and ensures a dry sterilisation result.
When the inlet valve 1 is open, hot steam

from the external boiler enters the jacket 2
of the autoclave. The chamber gets
preheated. The pressure gauge shows 3 the
jacket pressure. When valve 4 is opened, the
steam gets into the chamber. The colder air
escapes through the open valve 6. The valve
is a temperature controlled one-way valve.
The valve closes when the steam is hot
enough. Now the pressure rises until it is as
high as the inlet pressure. The chamber
pressure is shown by the pressure gauge 8
and the temperature by the thermometer 5.
It is placed at the bottom of the chamber,
where the lowest temperature is. When the
sterilisation time is over, the inlet valve has
to be closed and the outlet valve 7 opened.
Steam escapes through the drainage pipe.
The pressure and the temperature in the
chamber decrease but the jacket is still under hot steam pressure. This supports drying the
load. After a while the steam from the jacket can also be released by opening valve 4 or it can
be kept if another load has to be sterilised.
The safety valve 9 opens when the steam pressure is too high. In principle this valve is not
needed because the boiler already contains one and the pressure in jacket and chamber cannot
get higher than the pressure in the boiler.
Variations
Simple, manually controlled autoclaves are still widespread. They are robust and relatively easy
to repair. Spare parts can be found in every larger city. Modern stationary autoclaves are fully
electronically controlled. There are no more manual valves and also the instruments for
pressure and temperature are often digital ones.
Also in stationary autoclaves a vacuum pump provides a better sterilisation result and has
already become standard. Wherever a vacuum pump is used, an additional ventilation valve
with a bacterial filter is needed to ensure only uncontaminated air can enter the chamber when
equalizing the pressure at the end of the cycle.
Maintenance
Beside the routine checks by the user personnel, autoclaves should be maintained at least once
a year by the technicians of the hospital workshop. Many manufactures suggest even semi-
annual maintenance according to their guidelines.
The maintenance of an autoclave covers the cleaning from inside and outside, a functional
check and the control of the temperature. A calibration has to be done if the temperature check
was not successful.
Very often a service manual is needed to set the autoclave in a defined service mode and to
find the calibration points for the temperature and the display.
Note: Be very careful while doing service on an autoclave. Some older autoclaves
have only little or no heat shielding around the chamber. The chamber, tubes and valves
get very hot.
Needed tools
Beside the standard tools you need a calibrated thermometer with an external sensor. Only with
such a reference thermometer are you allowed to check and adjust the temperature. The built-
in (digital) thermometer of the autoclave cannot be taken for the temperature check. When the
display of the autoclave does not show the correct temperature you do not really know if the
temperature is wrong or the thermometer itself shows a wrong result.
For some models it is useful to have a 2 mm rod sensor which can be inserted in a special test
port.
More under ↓Calibration.
A pressure meter is not needed, even if the manufacturer recommends this. Stay with the
temperature measurement. It is safer, more practical and cheaper.
The maintenance should also include a water conductivity test. A lot of problems with
autoclaves are caused by the usage of water of poor quality.
More under ↑Distilled water.
Then, we need of course cleaning material like: A bucket, dish washing liquid, a sponge and a
stainless steel scouring pad.
Maintenance procedure
A typical annual or better semi-annual maintenance procedure is the following:
1. Fill steriliser with distilled water.

2. Place temperature sensor for external thermometer in the centre of the chamber.
3. Perform a test run at 121°C.
4. Check the temperatures inside the chamber. If it is lower than 121°C, do a calibration.
↓Temperature calibration
5. Check the display of the internal thermometer. Adjust it if necessary.
↓Temperature calibration
6. Check the function of the safety valve. Pull a few times with long pliers or a
screwdriver when the chamber is under pressure. Be careful, hot steam will come out.
7. Monitor the sterilisation time with a stop watch, your watch or your mobile phone.
8. Do a visual check for leakages from inside and outside.
Let the autoclave cool down and then continue:
9. Clean chamber, heating element and rinse the drainage (see ↓Cleaning).
10. Clean or exchange the drainage filter and the air filter.
11. Check door gasket for damages. Lubricate gaskets with silicon oil.
12. Lubricate door hinges and check the door closing mechanism.
13. Visual check for leakages: chamber, door, piping, valves, water reservoir.
14. Check electrical connections.
15. Check the electronic board for cold solder points and water damages.
16. Check contacts of relays.
17. Make a final test run at 134°C.

18. Do a calibration for the temperature display if needed.
19. Replace cover.

20. Drain the water and clean the autoclave from outside with soap water.
21. Fill out the maintenance protocol.
Cleaning by the technician

It is the task of the user to keep the chamber clean, as well as the autoclave from outside. The
user has to clean all parts which are visible and reachable on a weekly or monthly base. The
technician however must be able to demonstrate the correct cleaning to the user.
Everything that needs disassembling for cleaning is the task of the technician, which includes
cleaning of filters, valves and pipes and the heating element.
The correct cleaning of an autoclave is very important not only to achieve a satisfactory
sterilisation result but also because most of the technical problems are created by residues due
to insufficient cleaning after sterilisation.
It is advisable that the technician starts with general cleaning as described above under
↓Cleaning by the user.
Then, we can continue with our 'technical' cleaning:
1. Drain the water from the reservoir. Clean the reservoir with a sponge and distilled
water or with a soap solution if needed.
2. Remove the water filter (between reservoir and chamber). Rinse it under running water
in reverse direction.
3. Remove also the water outlet filter which is found at the bottom of the chamber. Rinse
this filter under running water.
4. The air inlet filter for ventilating the chamber after sterilisation has to be replaced once
a year.
5. Do not forget to rinse all the cleaned parts with distilled water when you are finished.
6. If the hospital uses rain water, make sure that the water is filtered before it gets used
for the autoclave. In case of a doubt, talk
with the operator and find a solution. Maybe an additional filter (e.g. a fuel filter from
a car accessory shop) can be added.
Limestone
Often the chamber and the heating element are covered with lime scale and the tubes and
valves are blocked with lime deposits.
The chamber can be cleaned by scraping of the scale with a scouring pad which is used in the
kitchen for cleaning pots and pans. Avoid steel wool, as steel wool scratches the metal surface
of the chamber.
Heating elements should be handled with care. They are made from soft copper or brass pipes
and are then coated or chrome-plated. They are less durable than the thick stainless steel of
the chamber. If you want to remove lime scale from a heating element by scratching, you will
destroy the surface of heating element. The copper tube of the element is then visible and it
will not take much time until holes appear. That is very dangerous because the intruding water
creates an electrical connection to the power supply. The whole autoclave is then under power
then, which is particularly dangerous when the electrical installation is poorly done and no
earth-leakage circuit breaker is installed in the mails supply.
The best way to remove limestone from a heating element is to remove the heating element
and put it in de-scaler which is used for water kettles and coffee machines and leave it over
night. Vinegar also works, but it takes longer. You can also try denture cleaner.
Do not forget, better than removing limestone is to prevent it. Teach the operators in
the correct cleaning and ensure that they are using distilled water only.
Temperature calibration
For the calibration you need an external calibrated (digital) thermometer. Only with such a
reference meter are you allowed to calibrate the autoclave. Never trust the internal
thermometer.
The calibration of the equipment is only as good as your measurement device. Do not use the
cheapest and keep in mind that even the expensive ones have to be calibrated after some time.
Inexpensive quality
multimeter with
thermometer adapter.
High quality multimeter

with 2 mm sensor. This
sensor fits e.g. into the
test port of Eschmann
table top autoclaves.
In principle the calibration of an autoclave consists of two

adjustments. First the calibration of the control unit and then the adjustment of the internal
thermometer. Again, never do the calibration according the internal instrument.
Insert the sensor of your reference thermometer into the chamber and close the door. The
rubber gasket prevents the cable from being damaged. Start the autoclave. The gasket might
not be perfectly sealed now and some steam will escape. Technically it does not matter as long
as more steam is created than can escape and the pressure rises. But do not burn yourself.
The calibration procedure varies from case to case. Do the calibration always according the
service manual of the manufacturer. If no manual is available, you have to do the calibration by
yourself. In a simple case you find two trimmer pots on the control board. One trimmer pot is
for 121°C and the other one for 134°C. Start with the temperature calibration.
Memorise the original settings of the trimmers. Or better make a sketch or mark them
with a pen. For adjusting a ten-turn-trimmer count the turns.
Make changes only in small steps.
Keep in mind that changes of the temperature setting need some time to take effect. Turn
the trimmer only a little and wait until the temperature is stabilised.
Cheap trimmers are not insulated. Be careful by inserting the screw driver that you do not
make a short to other metal pieces.
After the temperature is set, the thermometer can be adjusted if necessary.

There should be also a trim-pot for the thermometer close to the display where it can be
calibrated. Mechanical meters can be adjusted by turning a little screw which shifts the pointer.
With round meters the scale often can be twisted or even the whole meter housing. If all this
does not work, keep in mind it is just a meter. It has nothing to do with the function of the
equipment. Also a calibrated autoclave with an inaccurate thermometer performs a safe
sterilisation. But then you have to inform the user.
Installation
When a new autoclave has to be installed, some preparations have to be done beforehand. We
have to prepare the electrical installation, the water supply and the water drainage. Sometimes
also a tap water connection is needed when

the autoclave has an active cooling system. Or
an additional water distiller has to be installed.
The electrical installation needs a circuit
breaker for each phase and should have a
30 mA earth-leakage circuit breaker. Note the
power consumption and choose the right fuses
and wire size.
For a 230 V system up to 3.5 kW a 16 A circuit
breaker is fine and a 1.5 mm² cable can be
used. For higher currents up to 21 A, a
2.5 mm² cable has to be used.
Here an undersized main switch caused a fire
The autoclave also has to stand perfectly

horizontal. If not, the water amount which is
let in the chamber and detected by a level
sensor can be wrong.
Repair
Before starting a repair...
read the user and the service manual of your autoclave.

fill out a service record/job card with all equipment data and the fault description.
make sure that distilled water is available in your workshop when you repair a table-top
in your workshop.
Error code
In case of a fault, microprocessor controlled autoclaves show an error code in the display. With
the help of the service manual the fault can be identified easily.
Typical technical problems

Below some typical problems in connection with autoclaves:
Burnt-out heating elements

Burnt-out heating elements are the number one problem with autoclaves in hospitals with poor
maintenance service.
Pressure cooker types or vertical autoclaves are often used with too little or without water.
Then the heating elements burn out within seconds.
Or the heating elements are covered with lime scale. Then the heating elements cannot give off
the heat, get overheated and will also burn out. (Removing lime scale see ↑Lime scale.)
It is also possible that the water supply is blocked with debris or the water level sensor delivers
a wrong signal. This happens when the water sensor is dirty. Then the control unit measures a
resistance and 'thinks' that there is already enough water in the chamber and switches on the
heating elements.
Therefore it is important not only to change a burnt heating element but also to look for the
reason. Make sure that the chamber really is filling up with water. When you start a table top
autoclave, look into the water reservoir and check if the water level in the tank falls.
Heating elements are not repairable. We have to get a replacement either from the
manufacturer directly or try to find a similar one somewhere else. Universal heating elements
might be available in the repair shops in bigger town. These are spare parts for water heaters
which can also be used for autoclaves. But it is not so easy to find the right one. The mounting
and the shape of the heating element must be similar because it has to be covered with water
all the time. It is no problem if the wattage is slightly smaller or bigger. The sterilisation will
then take just more or less time.
It is advisable to have a spare heating element in stock and if you have more than one
autoclave of the same type in your hospital, it is a must.
Solid state relays

The heating elements are switched on and off by
electromechanical contactors or in modern autoclaves by
solid state relays. These relays do not contain mechanical
contacts but a so-called triac.
The function of the mechanical relays is clearly to see and to
hear but there is nothing to see and hear of a solid state
relay. Even the voltage measurement can be confusing,
because the frequency of switching can be much faster.
While mechanical relays are switched on and off every 10 to
30 seconds, the solid state relays can be triggered in
milliseconds. This switching is faster than our voltmeter and
as a result we measure an average voltage. This 'reduced
voltage' is correct and not an unwanted voltage drop.
Leaking door gasket

Rubber gaskets get hard over time and crack. A leaking gasket will not necessarily affect the
performance of the autoclave. As long as the heating element produces more steam than
escapes trough the leakage, the autoclave will work. But the escaping steam is of course
dangerous for the user and thus the gasket must be exchanged.
The gaskets should be checked and cleaned weekly and lubricated with silicon oil during the
maintenance.
After removing a silicon gasket it is sometimes difficult to put it back into the groove of the lid
or door. It seems to be too long. Do not inserting the gasket bit by bit around the lid but start
with inserting it at the 12 o'clock position, then continue at 6, 3 and then 9 o'clock.
TIP! DIY Door Gasket

The door gasket usually lays in a groove. If the gasket is damaged and no exchange
part is available, it is possible to make a gasket by filling out the groove with elastic
silicone. Once dried the silicon is elastic, durable and heat resistant. Silicon cartridges
are cheap and available in hardware stores.
Take off the door and lay it flat on the workbench. Check the thickness of the old gasket
and take it out. Clean the groove thoroughly with soap water and then with alcohol. Get
a small flat bowl with dishwashing liquid and some rugs or paper tissues. Prepare the
silicon cartridge and the pump. Fill the groove with the silicon. Now flatten the silicon
with a finger. To do this, wet the finger with dishwashing liquid glide over the silicon so
that it gets flat and even. Keep your finger always wet or the silicon will stick to your
finger and the silicon surface gets destroyed.
After finishing, the silicon has to dry. This can take a few days depending on the
thickness.
After drying, mount the door and check if the door closes properly. Make a test run and
check for leakages.
Water level sensor

Often the water level in the chamber is detected by a piece of metal and a conductivity
measurement circuit. When the sensor gets wet the resistance against the metal chamber gets
low and the connected electronics switches the water inlet valve off and the electrical heater
on. But this also happens when debris bypasses the sensor. In this case the heater starts
without water and a damaged heating element is the consequence.
Here the level sensor touches the heating element. As the

result of this short circuit to ground the control 'thought'
that already enough water was in the chamber. The water
inlet was kept closed and the heating element was started.
Some of the sterilisation goods caught fire.
The sensor has to be clean and free of debris. Check also the insulation and the mounting of
the sensor. But it is better to remove the sensor and clean the individual parts.
The autoclave also has to stand perfectly horizontal. If not, the amount of water which is let
into the chamber and detected by the sensor can be wrong.
Thermostat and mechanical Thermometer

Mechanical thermostats and thermometers are
common in simple autoclaves. Both consist of a
sensor and a pressure can. The sensor is a thin
capillary tube which leads into the pressure can (or
expansion chamber). This chamber has a moveable
metal lid or diaphragm. This closed system contains
a liquid or gas which expands when getting warmer.
The lid moves and activates a connected electrical
switch or in case of a thermometer moves the
pointer of a meter.
The thin capillary tube is often rolled up. This is
correct. Do not cut it. It is not a wire. Also avoid
bending the tube. It can get kinks and will then not
work any more.
Temperature switch or fuse

When the autoclave is heated up by a chamber
heater (a heater around the chamber), the chamber
heater is connected to a temperature switch or fuse.
This switch is mounted at the outside of the
chamber and protects the chamber heater from
over-heating in case the electronic control fails.
In case this fuse is burned or the switch is triggered
there must be a reason and you should find out.
Safety valve
Check the safety valve for correct operation when
the autoclave is in operation. Do not burn yourself.
Take pliers to pull the metal pin to release some steam. Be careful - do not burn yourself!
Pull several times. This cleans the mechanism from possible debris, which can easily block the
release mechanism.
Black or burned relay contacts

Black relay contacts can be perfectly cleaned with a
fibreglass brush. Never file contacts. This destroys
the surface of the contacts.
Wet material after sterilisation

This is unlikely to be a technical problem. See
↑Common problems during usage.
After the repair

When the autoclave is repaired, continue with a full maintenance procedure as described
under ↑Maintenance including a thorough cleaning.
Make a test run with a temperature check.
Finally, fill out your job card/service report and put a new service sticker to the autoclave
showing the next maintenance date.
Before returning it to the laboratory, make sure the autoclave is complete with all trays
and baskets.
Service manual
Service manuals are hard to come by. Some manufacturers are helpful and send a copy on
request, but most of the manufacturers do not.
If you need a manual you can also check here.
Spare parts
It is advisable to have a spare heating element in stock and if you have more than one
autoclave of the same type in your hospital, it is a must.
The same applies to door gasket. It is only a matter of time when a door gasket will leak. Put
one in stock.
Filters should also be kept in stock, especially bacterial filters which are disposable and cannot
be cleaned.
Alternatives for steam sterilisation

Some products such as plastics, paper and liquids cannot be exposed to high temperatures or
humid air and sterilisation has to be done in different way.
Alternatives are dry heat provided by hot air ovens or sterilisation using specific gas through
gas sterilisers.
Hot air ovens

Dry heat can also be used to sterilise products but is less efficient than the sterilisation with
steam. The process takes longer and the temperature has to be higher. Dry heat is used for the
sterilisation of some plastics, papers, special liquids and powders which cannot be sterilised
with steam.
One advantage of dry heat is, that it does not cause rusting of steel products.
The hot air can be applied without high pressure.
The standard setting for a hot air oven is:
160°C (320°F) for 120 minutes

190°C (374°F) for 12 minutes
Note: Hot steam at 134 °C can achieve in 3 minutes the same sterility as hot air at
160°C in two hours.
Gas steriliser
Some specific types of gas can also be used for sterilisation. Ethylene oxide is such a gas which
is used in special gas steriliser. It is a chemical agent that kills micro-organisms, including
spores.
Because a mixture of ethylene oxide in air is explosive and toxic, the gas technology is complex
and expensive and is only used where steam sterilisation cannot be used.
The sterilisation process with gas depends on the gas concentration, temperature and humidity
but generally it takes much longer than the sterilisation by steam. A typical sterilisation by
ethylene oxide takes 16-28 hours at 50-60°C. After sterilisation, all materials have to be
ventilated at least 24 hours before contact with the skin.
Manufacturers
Important manufacturer of autoclaves are:
3M Should be avoided. Prohibited the download of service manuals.

AJC
ASP Sterrad Should be avoided. Prohibited the download of service manuals.
Belimed
Getinge
Eschmann
LTE
Matachana
Melag
Midmark
Pelton & Crane
Reimers
Reverberi
Steris Should be avoided. Prohibited the download of service manuals.
SciSan
Tuttnauer
Links and sources

Here are some Wikipedia Medical Equipment articles:
Autoclave
Autoclave tape
Sterilisation
Pressure
Pressure measurement
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6/11/2020 Frank's Autoclaves

Home Equipment Teaching & Learning Electronics Organisation Contact

Weighing Scales The simplest autoclave with a capacity of 5-25 l is the

The principle of steam

Temperature and time

Gauge pressure and absolute pressure

Pressure and temperature

Pressure at high altitude

Altitude and pressure

Altitude Absolute air Temperature Pressure Temperature Pressure

Altitude and time

Altitude Temperature at Sterlisation Time Temperature at Sterilisation Time

Working principle of a simple autoclave (pressure type, vertical)

Working principle of an automated vacuum autoclave

Using the autoclave

The user has to be trained in the correct usage of

Precautions for usage and service

1. Make sure that the chamber is filled up with enough water.

Using a vertical autoclave

1. Fill the autoclave with the right amount of distilled water.

Cleaning by the user

Daily (by the user)

Weekly (by the user)

Common problems during usage

Wet material after sterilisation

Door locked after power outage

Here are some more suggestions to prevent problems during usage:

Use only distilled water. Never use tap water.

Construction of a vertical autoclave

Pressure control valve

Thermometer or temperature gauge

Lid and lid gasket

Circuit diagram of a semi-automated vertical autoclave

Construction of a table top autoclave

Door lock / door switch

Level switch for water inlet

Chamber heating / thermal fuse

Construction of a stationary autoclave

When the inlet valve 1 is open, hot steam

1. Fill steriliser with distilled water.

Let the autoclave cool down and then continue:

17. Make a final test run at 134°C.

19. Replace cover.

Cleaning by the technician

High quality multimeter

In principle the calibration of an autoclave consists of two

After the temperature is set, the thermometer can be adjusted if necessary.

also a tap water connection is needed when

Here an undersized main switch caused a fire

The autoclave also has to stand perfectly

read the user and the service manual of your autoclave.

Typical technical problems

Burnt-out heating elements

Solid state relays

Leaking door gasket

TIP! DIY Door Gasket

Water level sensor

Here the level sensor touches the heating element. As the

Thermostat and mechanical Thermometer

Temperature switch or fuse

Black or burned relay contacts

Wet material after sterilisation

After the repair