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Basics of Sterilization 2
Basics of Sterilization 2
Basics of Sterilization 2
WORK TABLE
WELCOME
TO
WI
STERILE PROCESSING WA
SH
ND
ER
OW
READY
AU
FOR
T
OC
STERILIZATION
L AV
E
ORK
W L ES
TAB
WORK AREA
INCU
BAT
OR
OBSOLETE
EQUIP / INST COUNT SHEETS
Steam Sterilization
Moist Heat
Most economical & efficient
Rapid processing time allows frequent
availability
Items must be able to tolerate high temps
& moisture
Works with time, temperature & moisture
Steam Sterilization
Time, Temperature, Moisture
Steam circulates within the jacket space surrounding
chamber
Steam enters the chamber & displaces all the air
Air and steam do not mix
As pressure increases, saturated steam contacts all
surfaces , penetrates packages, & forces air out through
a drain at the bottom of sterilizer
Sterilization is initiated once all air is removed
High temp of saturated steam causes microbial
destruction
Proper loading is crucial to allow the steam to freely
circulate
Steam Sterilization Con’t
Temperature affects the time of exposure
in that the higher the temperature, the
less exposure time is required.
As pressure ↑ in a closed chamber, so does the
temperature
If these parameters are not represented in
a cycle, sterilization will not occur
Cycle Phases
Conditioning
Air removal
Exposure
Load is heated to sterilization temp
Exhaust
Bottom drain opens and steam is exhaused
Drying
Dry heat revaporizes existing moisture & removes
from the load
Proper Loading & Unloading
Proper Loading
Prevents formation of air pockets & obstructions to
the circulation of steam
Proper Unloading
Hot packages are allowed to cool before being
handled
Moisture will form upon contact and cause
contamination
Called strike through
Do not place hot items on cool surfaces
Sterilization Process Monitors
Chemical Monitors (Indicators)
Monitor one or more process parameters of a
sterilization cycle
Detects failures in packaging, loading or sterilizer
function
Consist of a sensitive chemical or ink dye that develops a
visual change after the exposure to certain physical
process conditions (temp & humidity)
Placed on the outside of every package
Need to be examined after sterilization & before use
Chemical Monitors Con’t
Internal monitors placed in the area of greatest
challenge within the package
Visible once package is opened
Both internal l& external indicators reflect
exposure of an item to one or more sterilization
parameters
Do not guarantee sterility
If questionable, item is not considered sterile
Biologic Monitors
Standardized preparation of known
microorganisms highly resistant to a
specific mode of sterilization.
Their purpose is to reveal evidence of the
efficacy of a sterilization cycle by utilizing
a high number or resistant spores to
challenge the function of the sterilizer.
Most reliable monitors
Biologic Monitors Con’t
After cycle is complete put in incubator to
observe microbial growth
Negative biologic monitors contain no growth &
indicates that conditions necessary for
sterilization & microbial kill were met
If growth detected:
Notify supervisor immediately
Further test & evaluate to determine viability of
organisms & efficacy of the cycle
Biologic Monitors Con’t
Bacillus stearothermophilus
Steam sterilization
Bacillus subtilis
Gas sterilization
Impregnated on paper strips or capsules
and placed within the chamber
Special test packs or
Wrapped in items
Biologic Monitors Con’t
A control biologic monitor, which has the
same lot number, as the test and has not
bee exposed to a cycle is also incubated
and examined for growth
Routine Biologic Monitoring
Frequency of Use:
During installation of sterilizer or after major
repairs
Daily in steam autoclaves
Gas-with each load
Any load with implants
Routine Biologic Monitoring
Placement:
Steam
In loaded chamber over drain or coolest part of sterilizer
Gas
In the middle of the loaded chamber
Incubation:
Usually 48 hours
1 hr incubation monitors available for gravity displacement
steam sterilizers
Bowie Dick Test
Daily air removal test
Insures proper function of the vaccuum
and detects any air leaks
Monitor is placed on the bottom rack over
the drain before the first load
Satisfactory test occurs when there is a
uniform color change
Bowie Dick Test
Biological Indicators
Following the autoclave
cycle, the BI is placed in
an incubator; also a
control
Length varies with the
product; rapid readout 1-3
hours, or 24 hours
Positive test = sterilization
process has failed due to
improperly processed load,
failure to meet
temperature or exposure Yellow = pus Purple = bugs
parameters, mechanical FAIL killed, PASS
Ethylene Oxide Sterilization
Used to sterilize heat-labile and/or
moisture-sensitive items
Toxic & flammable
Lengthly processing /aeration time
High cost
Environmental concerns
ETO Sterilization
Gas
Colorless, noncorrosive, highly penetrative
For items that are sensitive to high
concentrations of moisture and/or heat
Appropriate conditions of time, (105-300
min) temp, (low) EO concentration,
relative humidity (45%-74%)
Appropriate aeration is required to remove
residual EO
EO Aeration
Continuous currents warm filtered air
12 hrs = 120 degrees
8 hrs = 140 degrees
Hydrogen Peroxide Gas Plasma
Sterilization
Sterrad
Rapidly destroys microorganisms utilizing low
temperatures without toxic residue
Used for heat and moisture sensitive items
Uses radio frequency energy to vaporize
hydrogen peroxide
Takes approximately one hour
For narrow lumens that are longer than 12” or
narrower than ¼ “ , a special adaptor is needed
Chemical Sterilization
The Steris
Used on items that are heat sensitive
Delicate instruments, scopes, cameras
Uses a lower temperature & shorter cycles
Peracetic Acid
Steris
Peracetic Acid Sterilization
“Just In Time”
Peracetic Acid
Acetic acid, hydrogen peroxide, water
Adversely reacts with protein & enzymes of
microorganisms penetrating cell wall & causing
destruction
Sterilant mixes with water, which reduces
concentration of the acid
Takes about 30 minutes
Works by time, temp and concentration
Immediate Use Sterilization
Only used in special situations
Use open , perforated mesh bottom trays
Trays with lids may impede air removal &
steam penetration
Gravity displacement method
Disassemble all instruments
Flush lumens with distilled water
Flash Sterilization Con’t
Parameters
Simple instruments
Gravity displacement 270 degrees for 3 minutes
Complex instruments
Gravity displacement 270 degrees for 10 minutes
Flash Sterilization Con’t
Several like instruments can be sterilized
together
More than 1 instrument tray requires 10
min
Lumens must be flushed with water
Trays with rubber or cloth run for 10 min
Flash Log
The same tracking process as for items
put up in CS.
Review daily for compliance
Report to ICC and department of surgery
at regular intervals
Use to support additional sets
“We need to flash the hyster tray
because we only have one”
Issues
Documentation
Pt name/MR #
Items in load
User initials
Recalls
Policies and Procedures
Sterility
The loss of sterility is related to an event,
not to time.
Germs don’t have a calendar that says – “ok it
28 days, lets contaminate the Kockers”
Events –
Dampness
Loss of package integrity
Dirt
Why Expiration Dates?
Why are their expiration dates if we
believe that sterility is event related?
Commercially prepared products are tested
for sterility at time intervals (the guarantee).
At some point in time, they stop testing, and
that’s as long as the guarantee can be made.
Scopes the bane of our
existence
Which scope was used on which patient
Cross contamination
Biological
Tissue
Disinfection
Storage
Problems in Ambulatory
Infection Control
Many well-publicized outbreaks in
ambulatory centers
Two main causes:
Unsafe injection practices
Improper cleaning, disinfection,
sterilization of instruments, endoscopes
Nevada & Nebraska outbreaks resulted
in criminal charges and license
revocations
CMS IC Requirements
Must list national guidelines being used
Follow them!
CDC/HICPAC Guidelines:
Guideline for Isolation Precautions (CDC/HICPAC)
Hand hygiene (CDC/HICPAC)
Disinfection and Sterilization in Healthcare Facilities (CDC/HICPAC)
Environmental Infection Control in Healthcare Facilities
(CDC/HICPAC)
Perioperative Standards and Recommended Practices (AORN)
Guidelines issued by a specialty surgical society / organization (List)
Please specify (please print and limit to the space provided):
CMS IC Requirements
NOTE! If the ASC cannot document that it has
designated a qualified professional with training
(not necessarily certification) in infection control to
direct its infection control program, a deficiency
related to 42 CFR 416.51(b)(1) must be cited.
Lack of a designated professional responsible for