Instrument Processing

Outlines

 Overview

 Level of disinfection or serialization required

 Introduction to chemical disinfectants

 Description of steps in processing item

 Monitoring sterilization procedure

 Safe storage and transport of sterile/ HLD Instrument

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 Session Objective

 Understand General overview of sterile services

 Describe the steps of instruments and other items processing

 List commonly used disinfectants

 Elucidate the steps of cleaning process, sterilization and HLD

 Explain how to store safely sterilized and high level disinfected

instrument and other items

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 Overview
 Instruments which are reused without being properly processed and made
safe are one of the causes of infections in developing countries.
 Healthcare workers are increasingly at risk of becoming infected with
serious blood borne viruses such as HBV, HCV and HIV.
 The basic infection prevention processes recommended to reduce disease
transmission from soiled instruments; surgical gloves and other reusable
items are by way of cleaning and either sterilization or high-level
disinfection (HLD).
 In all steps, special attention should be given to proper handling of the
instruments and other items to
 Minimize the risk of accidental injury or exposure to blood and other body
fluids of the sterile processing staff and
 To attain high quality end result.

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 Level of Disinfection or Sterilization Required

 A rational approach for processing medical devices

and surgical instruments for patient care was first
described by Earle H. Spaulding in 1968.

 It is still relevant in making decisions about the final

approach to instrument processing.

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 Spaulding’s category of potential infection risk

 Spaulding classified instruments and patient care devices

into three categories, based upon how the device is used.
Items are classified as:
Non-critical—come in contact with intact skin but not
mucous membranes
Semi-critical—come in contact with mucous
membranes or non-intact skin
Critical—come in contact with sterile areas of the body
including the vascular system

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Spaulding’s Risk Classification and Level of Processing

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Work flow for instrument processing

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Current Common practices in Ethiopian HCI

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 What is Decontamination?

 Decontamination is the process of making inanimate

objects safer to handled by staff before cleaning.
 It is done by soaking the equipment in 0.5% chlorine
solution

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 Decontamination

Principles:
 Inactivates HBV and HIV

 Makes items safer to handle

 Must be done before cleaning

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Instructions for Preparing Dilute Chlorine Solutions

 % Concentrat e  -1
Total parts (TP) (H2O) =  % Dilute 
 

 5% Concentrat e  = 9 Total parts (TP) (H2O)

Total parts (TP) (H2O) =   -1
 .5% Dilute 

To make a 0.5% chlorine solution from 5% bleach, mix 1 part

bleach to 9 parts water.

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Instructions for Preparing a Chlorine Solution from a
Powder

 % Dilute 
Gram/Liter =   X 1000
 % Concentrat e 

Gram/Liter =
 .5% Dilute  X 1000 = 14.2 Gram/Liter
 35% Concentrat e 


To make a 0.5% chlorine solution from

a 35% chlorine powder,
mix 14.2 grams of powder to 1 liter of water.

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 Examples Using 5% Bleach for 0.5% Concentration

One part bleach to 9 parts water (use the same container to measure the bleach
and water)

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 Household Bleach Safety

 Use mask, goggles, rubber gloves, waterproof apron

 Mix in well-ventilated area

 Do not use or mix with other detergents

 Use cold or room temperature water to mix

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 Decontamination Practices # 1
 Place instruments and reusable gloves in
0.5% chlorine solution after use
 Soak for 10 minutes and rinse
immediately.
 Wipe surfaces (exam tables) with chlorine
solution
 Flush syringe and needles with 0.5% chlorine
solution

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Decontamination Practices # 2

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18
 Cleaning
Principles:
Removes organic material that:
 Protects microorganisms against sterilization and
HLD
 Can inactivate disinfectants
Must be done for sterilization and HLD to be
effective
Method of mechanically reducing the number of
microorganisms, especially endospores

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 Cleaning

Practices after items are decontaminated:

 Use PPE during cleaning

 Disassemble instruments

 Wash with detergent, water, and a soft brush.

 Scrub instruments under the water surface until

visibly clean.
 Thoroughly rinse with clean water.

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 Effectiveness of Methods for Processing
Instruments
Method Effectiveness End Point
(kill or remove
microorganisms)
Decontamination Kills HBV and HIV and 10-minute soak
most microorganisms

Cleaning (water only) Up to 50% Until visibly clean

Cleaning (water and Up to 80% Until visibly clean

soap)
Sterilization 100% High-pressure steam,
dry heat, or chemical
High-Level 95% (does not inactivate Boiling, steaming, or
Disinfection some endospores) chemical for 20
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 Storage of Sterilized & HLD Instrument#1
Storage Area
All sterile items should be stored appropriately to protect them from
dust, dirt, moisture, animals and insects.
The storage area should be located next to the place of sterilization
or connected to it in a separately enclosed area with limited access that
is used just to store sterile and clean patient care supplies.

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 Storage of Sterilized & HLD Instrument#2

 Keep the storage area clean, dry, dust-free and lint-free.

 Control temperature and humidity (approximate temperature 24 0C
and relative humidity <70%) when possible.
 Packs and containers with sterile (or high-level disinfected) items
should be stored 20 to 25cm off the floor, 45 to 50cm from the
ceiling and 15 to 20cm from an outside wall.
 Do not use cardboard boxes for storage because cardboard boxes
shed dust and debris and may harbor insects.
 Date and rotate the supplies (first in/first out). This process serves
as a reminder, but does not guarantee sterility of the packs.
 Distribute sterile and high-level disinfected items from this area.

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 Shelf Life of Instruments

 The shelf life of an item (how long items can be considered sterile)
after sterilization is event-related.
 An item remains sterile until something causes the package or
container to become contaminated as time goes on since
sterilization is not the determining factor.
 An event can be a
 Tear or worn-out area in the wrapping,
 The package becoming wet or
 Anything else that will enable microorganism to enter the
package the package or container.

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 Shelf Life of Instruments…

 Quality of the wrapper or container.

 Number of times a package is handled before use.

 Number of people who have handled the package.

 Whether the package is stored on open or closed shelves.

 Condition of storage area (e.g. humidity and cleanliness).

 Frequent or improper handling or storage.

 Use of plastic dust cover and method of sealing

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Thank You!

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