Lecture 7 - Sterilization

2015‐02‐10
STERILLIZATION
©2014 – The Hospital for Sick Children, Toronto, Canada. All Rights
Reserved. Used under a limited licensing agreement.
Learning Objectives
At the end of this session, you will be able
to:
 Differentiate between levels of disinfection versus
sterilization
 Apply an understanding of the sterilization process to
assess that instruments and supplies are free from
pathogens.
© 2014 ‐ The Hospital for Sick Children, Toronto, Canada. All Rights Reserved. 2
Agenda
 Disinfection versus antisepsis
 Sterilization and classification
 Cleaning and packaging
 Different sterilization methods
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Disinfection versus Antisepsis
 Disinfectants are used on inanimate objects (surfaces,
equipment).
 Antiseptics are used on living tissue (patients).
Disinfection
 The process that kills microorganisms, except high #s of
spores
 Low‐level : kills vegetative forms of bacteria, some viruses
and some fungi.
 Intermediate level: kills vegetative bacteria, viruses and fungi,
but not spores.
 High‐level: as above plus kills some spores.
Critical Classification of Items
 Requires sterilization
 Medical equipment/devices must be thoroughly cleaned
prior to sterilization.
(Public Health Ontario, 2013)
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Semi–Critical Classification of Items
 Requires high level of disinfection
 Medical equipment/devices must be thoroughly cleaned
prior to high‐level disinfection.
(Public Health Ontario, 2013)
Non‐critical Classification of Items
 Requires intermediate or low‐level disinfection.
 Comes into contact with intact skin only.
(AORN, 2013)
Pre‐Sterilzation Decontamination
 Keep instruments as free as possible from gross debris during
procedure.
 Bacteria and fungi stick to each other (forming biofilms) or to
medical devices (especially lumens)
 Irrigate lumens with sterile water
 Disassemble instruments with parts
 Open box locks fully
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Sterilization
 Sterilization – Sterilization is a process that kills all
microorganisms including, bacteria, viruses, fungi, and
spores
 Different Types
◦ Steam Sterilization
◦ Chemical Sterilization
◦ Dry Heat Sterilization
© 2014 ‐ The Hospital for Sick Children, Toronto, Canada. All Rights Reserved.
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Operating Room Equipment:
From Dirty to Clean
 Before instruments can be re‐sterilized they must be
repackaged
 What are some important characteristics of sterile
packaging?
•Allows steam to penetrate and air to be removed
• Microbial barrier
•Tear and puncture resistant
•Proven seal integrity
•Allows aseptic delivery
•Cost effective
•Low lint
© 2014 ‐ The Hospital for Sick Children,
Toronto, Canada. All Rights Reserved.
11
Operating Room Equipment:
From Dirty to Clean
Chemical indicators should be placed within each
package and an external chemical indicator should
be attached to the outside of all packages being
sterilized.
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Packaging Sterile Equipment
“Packaging systems should ensure the
integrity of the sterilized item until opened
for use and should permit aseptic delivery
of the contents to the sterile field”
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Packaging: Rigid Containers
 Benefits
◦ Simple to package and store
◦ Low to no risk of puncture or abrasion
◦ Cost effective
◦ Can accommodate heavy items
© 2014 ‐ The Hospital for Sick Children,
Toronto, Canada. All Rights Reserved.
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 Using Rigid Containers
◦ Circulating nurse checks for evidence of integrity and
sterility
 Break away tabs
OR
 Sterile indicating tape
◦ Circulating nurse carefully lifts lid off container
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 Scrub nurse examines indicator and removes inner
basket carefully
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Packaging: Textiles
 Cloth or disposable wrap textile
 Benefits
◦ Low cost
◦ Fairly Low risk of puncture or abrasion
◦ Can accommodate awkward shaped items
Packaging: Textiles
 Check for holes or tears prior to use
 Item being wrapped must not exceed 12 lb
 A 2 layer barrier should be used
 Should be wrapped using envelope technique
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Packaging: Textiles
 Using Textiles
◦ Circulating nurse
 Checks wrap for evidence of tampering, tearing or puncture.
 Checks external indicator for evidence of sterilization
 Opens wrap using aseptic technique and presents item to
scrub nurse
◦ Scrub nurse
 Checks indicator and accepts item onto sterile field
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Packaging: Sterilization Pouch
 Usually a combination of paper and plastic
 Benefits
◦ Can visualize the item wrapped
◦ Good for small items
 Double wrap method is generally used
Packaging: Sterilization Pouch
 Circulating Nurse inspects package for damage and checks
chemical indicator.
◦ Opens using aseptic technique, presents to scrub nurse
 Scrub nurse checks chemical indicator and accepts package
onto sterile field
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Steam Sterilization
 Oldest, safest and most cost‐effective method
 Microorganisms can be destroyed with high
temperature
◦ Moist heat destroys at a lower temperature than dry heat
◦ Items can be heated more rapidly with steam than dry heat
(Rothrock, 2011)
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Steam Sterilization
 Not appropriate for items that will not tolerate high
heat
 Does not eliminate pyrogens
 Cannot be used for oils or powders
(WHO, 2009; Rothrock, 2011)
Steam Sterilization
 3 factors required to achieve steam sterilization:
1. Time
2. Temperature + +
3. Moisture
 When steam cycle is compete items must be dried,
cooled, and stored
(Rothrock, 2011)
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Chemical Sterilization
 Referred to as ‘low‐temperature sterilization’
 Suitable for items that are sensitive to high temperatures and
or moisture
 Penetrates certain plastics
 Easy to operate
◦ Example: Ethylene Oxide
 Instruments must be placed loosely in containers and lumens
should be in the open position so that the gas can circulate
effectively
(Rothrock, 2011, WHO, 2009)
Chemical Sterilization ‐ Disadvantages
 Long exposure and aeration time
 Not effective for Prions
 Toxic to humans
 Toxic to environment
Dry Heat Sterilization
 Should only be used when items cannot be sterilized
by any other method
 Electric heat is used to achieve high temperature
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Dry Heat Sterilization
 Long exposure
 Not suitable for items that don’t tolerate high heat
 High cost
 Not suitable for items of fabric or rubber‐ will be degraded by
the high temperatures
 Not effective against Prions
Activity
 Group Discussion
 Apply ‘Best practices’ to confirm sterility of package
Take Home Messages
 Assess whether items used in Theatre are critical,
semi‐critical, or non‐critical, and choose appropriate
levels of disinfection
 Assess appropriateness of sterilization process for
surgical items.
 Use critical thinking skills to assess if surgical
instruments and supplies are sterile
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Break Time
Photo Author: furtwangl
References
 Association of periOperative Registered Nurses(AORN). (2013).
Perioperative standards and recommended practices, 2013 Edition.
Denver, CO: p. 451‐540
 World Health Organization. (2009). WHO guidelines for Safe
Surgery 2009: safe surgery saves lives. (pp. 57‐62). Geneva,
World Health Organization. Accessed January 15, 2014 at
http://apps.who.int/iris/bitstream/10665/70126/1/WHO_IER
_PSP_2009.07_eng.pdf
 Ontario Agency for Health Protection and Promotion (Public Health
Ontario). (May 2013). Provincial Infectious Diseases Advisory
Committee. Best practices for cleaning, disinfection and
sterilization of medical equipment/devices. 3rd ed. Toronto, ON:
Queen’s Printer for Ontario. Accessed February 20, 2014 at
http://www.publichealthontario.ca/en/eRepository/PIDAC_Cl
eaning_Disinfection_and_Sterilization_2013.pdf
 Rothrock, J. C. (Ed.). (2011). Alexander’s care of the patient in surgery.
(14th ed.). St. Louis: Elsevier,.
References
 AORN Recommended Practices for Hand Hygiene in
the Perioperatve setting
 AORN Recommended Practices for Surgical Attire p.
51
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Debrief
 What was most valuable to you?
 What did you enjoy the most?
 What would you have liked to cover that was not?
THANK YOU
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