1. Sterilization Methods CTVT pages 1158-1168
Objectives:
Understand aseptic technique and it’s importance in surgery.
Learn how to properly sterilize instruments and equipment.

2. Asepsis- condition of sterility where no living organisms are present
Aseptic technique- all steps taken to prevent contamination of surgical site by infectious agents
Goal: to maintain asepsis and watch for “breaks” in aseptic technique

3. Ways to Maintain Aseptic Technique
Disinfection - destruction of pathogens on inanimate objects (Kennel Care, Accel)
Doesn’t effect bacteria spores
Sanitization - acceptable level of contaminants present
Antiseptic – inhibits growth of infectious agents on living tissue (Chlorhexidine)
Sterilization - complete destruction or elimination of all living organisms
Including viruses and bacterial spores
Always inorganic material

4. When does aseptic technique begin?
It’s always happening!
Cleaning of instruments (see Instrument Guide)
Surgery suite sanitation/disinfection
Patient prep
Surgical team scrub
Surgical suite etiquette
Contamination cannot always be avoided
Skin abscess, wounds, organ rupture, dental disease

5. Methods of Sterilization
Physical Sterilization
Filtration
Radiation
Heat
2. Chemical Sterilization
Liquid
Gas

6. 1. Filtration SterilizationP
1. Filtration Sterilization
Microorganisms separated from liquid
Utilized by pharmaceutical companies
Filter can be placed on IV line or syringe

7. 2. Radiation SterilizationP
2. Radiation Sterilization
Destruction of microorganism without significant increase in temperature
Ex. Gloves and suture material
*Filtration and radiation are typically performed by the manufacturer before shipments
- anything that comes pre-sterilized
- a lot of “one time use” products
- items which cannot be heat sterilized

8. P 3. Heat Sterilization Most common sterilization technique
Destroys bacteria by denaturing their proteins
Two options:
a. Dry Heat Sterilization
High temperatures for a long period of time
b. Wet Heat Sterilization
Creating steam under pressure at high temperatures

9. a. Dry Heat SterilizationP
a. Dry Heat Sterilization
Used for instruments sensitive to moisture
Advantage: no rust or corrosion
Disadvantages:
Takes longer than wet heat
Requires _______________ temperatures
Not for items that can burn
Ex. setting= 300°f for 2 ½ hours

10. b. Wet Heat SterilizationP
b. Wet Heat Sterilization
Pack must be able to withstand
heat AND moisture!
Pre-vacuum sterilizer
A pump evacuates the air before the steam enters
More even penetration of steam
Shorter duration
Gravity Displacement Sterilizer
Steam enters the top and forces air to bottom
Most commonly used type

11. Autoclave Sterilization (Gravity Displacement)
Used most commonly for “packs”
Heat = _______ °F minimum
Pressure = ______ PSI
Time = _____ minutes at temp (exposure time)
Total cycle =Heat-up + exposure + dry time
Usually minute cycle total
Always use _____________ water!
*Every machine is different, refer to the operator's manual

12. Proper placement of packs in the autoclave:
Steam should be allowed to flow around every surface of each pack
Use multiple racks if sterilizing a lot of packs

15. Pack Preparation
1. Instruments must be clean and dry 2. All locking instruments should be _________________ 3. Should be labeled appropriately 4. Sharp edges should be protected 5. Should contain a ______________ _______________
muslin

16. Pack Materials Wrap materials must be steam permeable
1. Woven = double thickness _____________
Reusable
2. Non-woven = crepe paper
One time use …mostly
3. Laminate packs/peel pouches
clear pouches made of plastic and paper
**According to AAHA practices, all packs should be double wrapped

17. Pouch Preparation Instrument is placed into pouch with
the handles toward the ____________ end
Pre-cut sizes or on rolls
Self-sealing or heat sealed
Plastic side should face down in autoclave

18. Labeling of Packs
Three requirements: 1. _______________________ 2. _______________________ 3. _______________________ *VTI- which patient it is for

19. Sterility Indicators
Autoclave Tape –specific part of the pack was exposed to steam
Commonly used on the outside of packs
Use sharpie to write information directly on tape
Tape should NOT be used to keep the pack closed

20. Sterility Indicators
2. Chemical Indicator Strips- change color when exposed to steam for adequate time
Examples:
Peel packs – indicator on the outside of the paper
OK Strip - can be placed in the center of the pack
Chemical sticker- can be placed anywhere (mostly for gas)

21. Sterility Indicators
3. Pellet glass – glass ampule containing a temperature sensitive pellet that melts around 250 °F
4. Biological/Culture tests – contain a spore population of bacteria (usually Bacillus sp.)
Confirms that microorganisms were in fact killed if the sample does not grow anything after incubation
Disadvantage:
Most effective method for testing machine functionality- not individual packs

22. Autoclave Quality Control
Performed by the technicians to ensure proper sterilization technique is being used
1. Sterility Indicators
Must be used in combination, as not just one will cover all requirements
2. Autoclave maintenance
Ex. Speed-Clean – liquid is mixed into water
Ex. Chamber Brite – powder is sprinkled on the bottom of cold chamber; cycle is ran without drying
*Both require a “rinse” cycle to be ran after use

23. After the Autoclave Cycle
Let the dry cycle finish completely!
Packs must cool slowly to prevent condensation which could: 1. 2. 3.
Door should be cracked to vent first
Open door with caution!

24. Maintaining Sterile Packs
The outside is not sterile
Storage: dust free, dry, well-ventilated, away from contaminated areas
Ex. A closed cabinet is safer than an open area
Broken sterility = dropped on floor, wet, broken outer wrap (ex. instrument penetrates paper)
Never assume sterility - autoclave again if pack is in question
Monitor dates for expired sterility
(follow clinic protocol)

25. Length of Sterility Table on page 1163 in CTVT
1. Date related practice: Which one lasts longer?
Double vs. single wrapped
Non-woven vs. Woven
Closed vs. open cabinet
Heat sealed vs. Self-sealed
2. Event related practice: item is sterile until an event in which the sterility is broken

26. Flash Sterilization
Instruments are placed __________________________ in a perforated metal tray
________ for _____ minute exposure time
Removed with detachable metal handles and carried straight to surgery (or use oven mitt or huck towel)
Instruments must cool before use
Some machines have a preset button