Autoclaves Nadina Wiórkiewicz (2011), Small benchtop laboratory autoclave [photograph]. Retrieved from https://commons.wikimedia.org/wiki/File:Laboratory_autoclave.jpg

Learning Objectives What materials can be autoclaved? What Personal Protective Equipment (PPE) is necessary for autoclave use? How does one properly load the autoclave? What steps assist in efficient decontamination of biohazardous waste? How does one verify autoclave performance for decontamination of biohazardous waste? Skeet, M., & Fear, D. (1995). Care and safe use of hospital equipment (p. 90). London: VSO.

Importance of Proper Autoclave Use Tremendous pressure from steam in chamber provides explosive potential High temperatures and presence of extremely hot water creates potential for burns and scalding Inadequate decontamination allows for the potential of biological hazards and personnel and environmental contamination Note: burning is the most common form of biowaste disposal in the developing world

What can be autoclaved? Surgical Instruments Glassware Plastic tubes and pipette tips Solutions and water Animal food and bedding Waste آرمین (2012), Surgical instruments [photograph]. Retrieved from https://commons.wikimedia.org/wiki/File:Surgical_instruments_02.JPG Pocar19 (012), Gilson Pipette Tip [photograph]. Retrieved from https://en.wikipedia.org/wiki/File:Gilson_pipette_tip.jpg Lilly_M (2011), Glass beakers [photographs]. Retrieved from https://commons.wikimedia.org/wiki/File:Glass_beakers-set.jpg

Types of waste Waste Type Container What You Need To Do Biological Infectious Waste Orange or clear autoclave bag Autoclave Medical Waste Biological Infectious Waste which cannot be autoclaved Red incineration bag in red waste container Medical Center- close and place by trash in lab for pick-up, Outside Medical Center- contact Environmental Management for pick-up Sharps- All needles, syringes, scalpels, blades, and all other sharp medical waste Sharps container Animal Carcasses- no biological, chemical, or radiological hazard Opaque bag Return to appropriate DLAR location Animal Carcasses- intentionally infected Red incineration bag Incinerate (Medical Center or call Environmental Management pick-up) Used Biological Culture Media Glass or plastic Disinfect with bleach or autoclave

Principles of Autoclave Operation Steam penetrates objects in the autoclave 121 °C (249°F) Condensation creates negative pressure and draws in additional steam Moist heat kills microorganisms via coagulation of proteins Two types of autoclaves Gravity Displacement Vacuum Assisted

Gravity Displacement Snelling, Guy. “Autoclave Validation-What is Really Required?.” Retrieved from: http://www.frankshospitalworkshop.com/equipment/documents/ autoclaves/background/Autoclave_validation_-_what_is_really_required.pdf

Autoclave Use Basics Personal Protective Equipment (PPE) Packaging Loading Operating User logs Maintenance logs Unloading Improper Autoclave Practices Nadina Wiórkiewicz (2011), Small benchtop laboratory autoclave [photograph]. Retrieved from https://commons.wikimedia.org/wiki/File:Laboratory_autoclave.jpg

PPE for Autoclave Users Eye Protection Lab Coat, Buttoned Closed-toed Shoes Heat-resistant Gloves Lilly_M (2011) Laboratory protection goggles [photograph]. Retrieved from https://commons.wikimedia.org/wiki/File:Laboratory_protection_goggles-blue.jpg Public Domain Pictures (2014), Retrieved from Pixabay

Packaging for Autoclaving Be sure the material should be autoclaved No volatile chemicals, sharps, red bag waste, radioactivity Utilize containers and autoclave bags appropriate for autoclaving Clear or orange bags UK Stores 6532-0046    Do not overfill containers Tom Beatty (2012), Autoclaves [photograph]. Retrieved from https://www.flickr.com/photos/northcoastoutfitters/8291521701

Packaging for Autoclaving Carefully add water to autoclave bags Add approximately 1 liter of water to 24” x 30” bag Aids in reaching appropriate temperature quickly Creates steam in the autoclave bag to replace cold air Prepare packaging to allow steam penetration Check that all containers including bags are vented Loosely close autoclave bags Vent lids on bottles containing solutions Place packaged material in a secondary container Stainless steel tray or autoclavable polypropylene bin

Loading the Autoclave Load material to allow efficient steam penetration Autoclave clean items and waste separately Do not allow material to be autoclaved to touch the sides or top of the chamber Nadina Wiórkiewicz (2011) Laboratory autoclave [photograph]. Retrieved from: https://commons.wikimedia.org/wiki/File:Laboratory_autoclave.jpg

Operating the Autoclave Be sure the autoclave is functioning properly before use Record information in User Log Close door properly and securely Choose the correct conditions for your material For decontamination: Temperatures between 121-124°C Total processing time 60-120 minutes Exposure time greater than 20 minutes Pressure minimum 15 PSI Select liquid cycle or slow exhaust cycle ONLY use destined water!!! Clean with vinegar every day

Autoclave User Log Complete User Log with Every Use Maintain User Logs for Two Years Complete User Log with Every Use

Autoclave Maintenance Log Maintain Maintenance Logs for Five Years Complete Maintenance Log for Every Repair Maintain records of Yearly Calibration

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 Allow contents to cool before removal Carefully remove items Be especially careful with fluids and plastic bins

Improper Autoclave Practices MFERMION (2014), Biomedical Waste [photograph]. Retrieved from https://commons.wikimedia.org/wiki/File:Biomedical_waste.jpg

Common Problems Build up of a scale due to the use of non-distilled water Scale may cause the air release valve and the over-pressure relief valve to be clogged Soaking them for several days in pure distilled water should dissolve any deposits Hissing noise due a leak in the pressure vessel or valve Leaky door seal Thermostat

Autoclave Verification Program Program will ensure that all potentially hazardous biological waste is properly decontaminated prior to deposition in landfill Program requires testing of the ability of campus autoclaves to kill microorganisms There are over 50 autoclaves on campus which require this verification program

Autoclave Verification Each Load of Biohazardous Waste Autoclaves with automatic documentation Review the printed report If conditions were met, initial, date, and place User Log number on printed report If conditions were not met, do not remove the load, repeat autoclave cycle. If conditions are not met again, autoclave must be labeled out of order. Contact responsible individual posted on autoclave. Responsible individual contacts service company to schedule repairs.

Autoclave Verification Each Load of Biohazardous Waste Autoclaves without automatic documentation A Chemical Integrator Test Pack (CITP) must be incorporated in each load. Based on color change the performance of the autoclave will be evaluated. Tape the autoclaved CITP strip in the appropriate section of the User Log for your load.

Autoclave Verification Monthly Verification for Biological Waste Autoclaves Biological Indicator Test Checks all conditions of autoclave cycle, time, temperature, and pressure Verifies ability of autoclave to kill a microorganism Utilize the 3M Attest Biological Indicator Monitoring Kit Record results in Biological Indicator Results Log

Biological Indicator Results Log Maintain Results Logs for Five Years Complete Results Log with Every Monthly Test

Chemical Indicators These indicators change color after being exposed to specific temperatures. There are two types of chemical indicators, temperature sensitive tape (autoclave tape) and integrated chemical indicator strips. Autoclave tape can only attest to the temperature attained and not to exposure time and hence success of sterilization. Integrated chemical indicator strips however, provide a limited validation of temperature and time, though this is not as accurate as a Biological Indicator, and so it cannot be used as a replacement.

Biological Indicator Test Procedure Label Attest package containing biological indicator vial with date, autoclave ID, and load number from user log Place the indicator vial package in the autoclave with the biohazard waste load Run the autoclave cycle as usual Using proper unloading procedures, remove the indicator package from the autoclave

Biological Indicator Test Procedure Label the indicator vial with all information from package Check indicator vial label for color change from rose to brown Place the biological indicator vial into the 56°C incubator for 24-48 hours

Biological Indicator Test Procedure Place a non-autoclaved, labeled control tube in the incubator Examine the indicator tube at 8, 12, 24, and 48 hours for any color change Yellow color change indicates bacterial growth Compare to non-autoclaved control at each time point Record 48 hour test results in Results Log

Learning Objectives Review What materials can be autoclaved? Surgical Instruments Glassware Plastic tubes and pipette tips Solutions and water Animal food and bedding Waste

Learning Objectives Review What Personal Protective Equipment (PPE) is necessary for autoclave use? Lilly_M (2011) Laboratory protection goggles [photograph]. Retrieved from https://commons.wikimedia.org/wiki/File:Laboratory_protection_goggles-blue.jpg Public Domain Pictures (2014), Retrieved from Pixabay

Learning Objectives Review How does one properly load the autoclave? Load material to allow efficient steam penetration Autoclave clean items and waste separately Do not allow material to be autoclaved to touch the sides or top of the chamber

Learning Objectives Review What steps assist in efficient decontamination of biohazardous waste? Add approximately 1 liter of water to 24” x 30” bag Loosely close autoclave bags Place packaged material in an approved 2° container

Learning Objectives Review How does one verify autoclave performance for decontamination of biohazardous waste? Each Load Verify cycle conditions via autoclave printout CITP indicator use Monthly Utilize Attest Biological Indicator Vial