Presentation on

Outline
Introduction
Prevention on Personal Hygiene
Disinfectant
Assembling and Packaging
Autoclave Safety
Sterilization
Summary
References
Q&A
 Introduction
Sterilization and disinfection are the basic components of hospital
infection control activities. Every day, a number of hospitals are
performing various surgical procedures. Even more number of
invasive procedures are being performed in different health care
facilities. The medical device or the surgical instrument that comes in
contact with the sterile tissue or the mucus membrane of the patient
during the various processes is associated with increased risk of
introduction of pathogens into the patient's body.
 Introduction Cont’d
Moreover, there is chance of transmission of infection from patient
to patient; from patient or to health care personnel, and vice versa;
or from the environment to the patient through the improper
sterilized or disinfected devices. Hence, medical personnel,
laboratory people and the health care providers should have better
knowledge regarding these techniques to prevent the spread of
these pathogens.
PREVENTION ON PERSONAL HYGIENE
HAND HYGIENE: is a term that means either hand washing or using an
approved antiseptic hand rub. This hand hygiene is considered the most
single factor in reducing infection.

Hand washing procedure:

1. Remove all jewelry.
2. Wet hands and apply liquid soap.
3. Scrub hands for at least 20 seconds.
4. Keep hands at lower angle than elbows
to prevent dirty water from running back to arms.
5. Dry hands with clean towel.
PREVENTION BY WEARING ATTIRE
ATTIRE
SC professionals must wear attire specific for
the area in which they work. This protects the
employee and other staff members, patient
and the public.
 DISINFECTANT
DISINFECTANT: is widely used to control
infections, it kills microorganisms such as
bacteria, viruses, and fungi using chemicals
called biocides. Disinfectants are used to kill
germs on nonliving surfaces but does not kill
all spores.
Below are some examples of Chemical
Disinfectants:
Alcohol, Chlorine and chlorine compounds,
Formaldehyde, Glutaraldehyde, Hydrogen
peroxide, Iodophors and hypo.
DISINFECTION
Disinfection describes a process that
eliminates many or all pathogenic
microorganisms, except bacterial
spores, on inanimate objects.
LOW- LEVEL DISINFECTION
Low-level disinfection means that disinfection which
kills most vegetative bacteria, fungi, and lipid viruses
and does not kill spores and non-lipid viruses. Low-
level disinfection is sometimes less active against
some of the gram-negative rods (Pseudomonas) and
Mycobacterium (TB). But not bacterial spores, e.g
isopropyl alcohol and chlorine.
INTERMEDIATE-LEVEL DISINFECTION
INTERMEDIATE-LEVEL DISINFECTION: the
destruction of viruses, mycobacteria, fungi
[but not bacterial spores]. Such as hypo
and phenolic.
HIGH-LEVEL DISINFECTION
• HIGH-LEVEL DISINFECTION: The destruction of
all vegetative micro organisms,
mycobacterium, small or non lipid viruses eg
hydrogen peroxide, iodophores,
glutaraldehyde.
HLD Procedure
• Prepare disinfectant solution

• Submerge item in solution

• Soak/contact time 12-30 minutes

• Minimum contact time is 12 minutes for HLD

• Rinse thoroughly with water prior to use

• Monitor anesthesia blades for possibility of metal alloy

reaction especially with gold plated blades.
Purpose of HLD
• Disinfect semi-critical items, which are those
that come into contact with non-intact skin and
mucous membranes.

• Kill all bacteria, fungi, viruses and TB on hard,

non-porous surfaces.

• Does not kill spores

• Intended to disinfect anesthesia scope blades.

Is HLD Sterilization?

HLD is NOT Sterilization

High Level Disinfection (HLD)
• Process of destroying or inhibiting growth of
pathogenic microorganisms on inanimate
objects.

• Reduces the risk of microbial contamination

but does not provide the same level of
assurance as sterilization because all spores are
not killed.
Packaging
Instrument packaging should be done in a clean and low contamination
area, using FDA approved products:
•Sterilization wrap
•Sterilization container
 Instrument wrap
• Usually supplied by hospital

• Should be square wrap with a 6 inch border

around each side of the pan.
• Alternative wrap: 140-thread count, 100%
cotton muslin.
• Wrap must be laundered between uses
• Disposable wrap must be specific for
instrument wrap. It allows for steam
penetration and faster drying time.
 Assembly
• Assembly area is a clean area where instrument
inspection, assembly and packaging are performed.
 Definition
An autoclave is a machine that uses
steam under pressure to kill harmful
bacteria, viruses, fungi, and spores on
items that are placed inside a pressure
vessel. The items are heated to an
appropriate sterilization temperature
for a given amount of time.
Loading the Autoclave
• Load material to allow efficient
steam penetration (do not
overfill the chamber)
• Do not allow material to touch
the sides or top of the
chamber
• Autoclave clean items and
waste separately
 Proper Autoclave Use

• Proper temperature and exposure time are critical in

ensuring the reliability of the autoclaving process.
• These factors are dependent upon steam penetration to
every part of the waste load.
• If all the air is not allowed to escape from the waste
during the autoclave cycle, then steam will not replace
the air.
• The autoclave user must be mindful to prevent the
entrapment of air. (i.e. leaving the biowaste bag open
inside the autoclave, removing the lid on sharps
containers inside the autoclave.)
 PPE for Autoclave Users
• Eye Protection

• Lab Coat, Buttoned

• Closed-toed Shoes

• Heat-resistant Gloves
 Operating the Autoclave
• Be sure the autoclave is functioning properly
before use
• Record information in User Log
• Check strainer and remove any debris
• Close door properly and securely
• Choose the correct conditions for your
material
 Make sure door to autoclave room remains closed as this
prevents the loss of negative air pressure, therefore
preventing the release of odors.
Hazards Associated with Autoclaves
• How to prevent hazards associated with autoclave use:
• Read the owners manual as manufacturer recommendations
vary.
• Make sure autoclave doors and gaskets are firmly locked into
place before operating the autoclave.
• These interlocking mechanisms help to prevent a sudden
release of high pressure steam.
• If the autoclave does not have interlocking mechanisms, take
additional precautions to ensure the door is closed.
 Unloading the Autoclave
• Put on Personal Protective Equipment
• Allow the autoclave to completely finish cycle
• Pressure gauge must read zero
• Verify cycle conditions were met
• Open door slightly to allow steam to escape
• While slowly opening the autoclave door, make sure to keep
head, face, and hands away from the opening.
• Verify that heat sensitive tape has changed color or word
“autoclaved” has appeared.
• Allow contents to cool before removal
• When removing biohazard bags, always pick up from the
top, taped area of the bag. Never handle biohazard bags by
grabbing from the sides or bottom.
Autoclave Waste Decontamination Procedures

• Autoclaves are to be operated at

121°C (250°F) or higher for a
minimum of 60 minutes.
• Some biohazard waste may be
required to be autoclaved for a
different set amount of time.
Sterilization
• Freeing of an environment from all living microorganisms
includes bacteria and their spores, fungi, parasites and
viruses.
• Sterilization means germ free objects.
• Sterilization occurs by:
• Physical methods.
• Chemical methods.
Sterilization by Physical methods
Physical methods
• Heat:
• Exposure of the objects to heat will kills microbes by
coagulation of protein, denaturation of enzymes and
oxidation.
• Filtration:
• Sterilization through removing of microbes from fluids by
exposing to small size filter. Used for heat sensitive fluids
like serum, antibiotic, sugar and urea.
• Radiation:
• Exposure to irradiation causes denaturation of proteins
and enzymes.
Medical Policy Sterilization
1. All critical items such as instruments, supplies and
equipment used during surgical procedures must be sterile.

a. Critical items are those that enter sterile tissue or the vascular
system.

b. This includes surgical instruments utilized in cleft lip and cleft

palate surgery, craniofacial surgery, microsurgery, orthopedic
surgery, burns and dental procedures.
 Policy - 2
2. Items are considered sterile that have undergone one of
several sterilization methods including steam sterilization,
gamma radiation or ethylene oxide.
a. Manufactured items must have sterility status printed on the
package and the outer packing must be dry and intact to be
considered sterile.

b. Items that have been processed within the facility must have a
positive external and internal chemical indicator reading denoting
adequate exposure to sterilization processes.
 Policy - 3

3. All facility processed re-useable critical items will

be considered unsterile after being packed and
moved to another location.
Hospital sterilization
At the end of day instruments sets are cleaned, assembled and wrapped,
then taken to be sterilized overnight in hospital autoclaves.

What if packs come back wet?

 Wet packs?

If the exterior wrap is damp or wet

or if condensate/water droplets
are found inside of the pack it
must be considered unsterile.
Pack should be opened and
instruments for the first case should
be flash sterilized in the Operation
Smile autoclaves. Additional loads
should be done as time allows.
CS - Summary
The Central service [CS] professional plays a significant role in the
prevention of surgical site and healthcare-associated infections [HAIs].
When the importance of this role is understood , technicians recognize
that their work practices can mean the difference between a patients
successful surgery or hospital stay, and a negative outcome that could
lead to infection or possibly death.
Resources
Central Service Technical Manual 8th Edition, by International Association of Healthcare Central Materiel
Management 2016.

Alexander’s Care of the Patient in Surgery, Jane C. Rothrock, 15th edition, Mosby Elsevier, 2015.

Berry & Kohn’s Operating Room Technique, Nancymarie Phillips, 12th edition, Mosby Elsevier, 2012.

Essentials of Perioperative Nursing, Goodman and Spry, 5th edition, Jones and Bartlett Learning, 2014.

Perioperative Standards and Recommended Practice, Association of Perioperative Registered Nurses

(AORN), 2014 edition.

Surgical Technology for the Surgical Technologist: A Positive Care Approach, American Association of Surgical
Technologist (AST), 4th edition, Delmar, 2012.
My Certificate