1. Chemical Indicators: Class 5 Integrating Indicators

2. Presented by SPSmedical
Largest sterilizer testing Lab in North America with over 50 sterilizers
Develop and market sterility assurance products that offer advanced technologies
Provide full day sterilization Seminars and on-site Facility audits for compliance with best practices
Corporate member: CSA and AAMI, serving on numerous sterilization working groups

3. Meets in Washington, DC throughout
Association for the Advancement of Medical Instrumentation
Meets in Washington, DC throughout
each year and establishes guidelines
for sterility assurance which become
our American National standards.
Membership includes:
Healthcare facilities
Healthcare organizations
Government agencies
Medical device manufacturers
Testing Labs and Consultants

4. Objectives At the end of this program, participants will be able to…
Identify the different classes of chemical indicators,
Discuss the appropriate application for each chemical indicator,
Review proper placement of internal chemical indicators based on packaging and contents of each item,
Discuss new ISO requirements for Class 5 indicators.

5. Chemical Indicators
AAMI ST79:2006 recognizes five classes: Class 1 – Process Indicators Class 2 – Specific Test Indicators Class 3 – Single parameter Indicators Class 4 – Multi-parameter Indicators Class 5 – Integrating Indicators Class 6 – Emulating Indicators

6. Quality Control Class 1 Process Indicators are intended for use as
an external indicator to
distinguish between
processed and
unprocessed items.

7. Quality Control Class 2 Specific Test Indicators are Bowie-Dick type
indicators for use with
air removal testing.
Two Options:
Buy a commercial test pack (single use or reusable),
Make your own test pack using freshly laundered towels (10x10x11-12”) with an indicator sheet placed in the center and single wrapped.

8. Quality Control
Pre-vacuum type Steam sterilizers should be tested daily with a Bowie-Dick type test.
This is usually done in the morning, before the first processed load.

9. Quality Control
The Bowie-Dick test is placed over the drain in empty chamber and run at 273°F for mins.
The indicator inside the test pack should show a uniform color change to pass.
*For test packs other than the Lantor Cube, a cart should be used.
Processed - PASS

10. Chemical Indicators
Chemical indicators should be used externally and internally for each item processed.
AAMI Says…
Internal CIs should be Class 3, 4 or 5 and chosen based upon how many critical process variables are to be monitored and how much information is desired about the sterilization process.

11. Chemical Indicators
The chemical indicator should be placed in that area of the package, tray, or container considered least accessible to sterilizing agent penetration. This area may or may not be at the center of the package, tray, or container and may or may not be at the center of the sterilizer chamber.

12. Chemical Indicators
Where would you place your CI in this tray? What classification CI would you choose?

13. Chemical Indicators
Chemical indicators are intended to provide information about local conditions within the sterilizing chamber and thus to alert the user to potential sterilization process failures. The basic performance descriptor of any chemical indicator is its “endpoint” response, which is the observable change as specified by the manufacturer that occurs after the indicator has been exposed to certain predefined process conditions.

14. Chemical Indicators
This observable change generally involves either the melting of a chemical substance or a chemical reaction resulting in a color change.

15. Indicator melts when reaching a specific temperature, e.g. 270°F
Quality Control
Class 3
Single Parameter
Chemical Indicators
These are designed to react to one parameter of the sterilization process, to indicate exposure
at a stated value.
Indicator melts when reaching a specific temperature, e.g. 270°F

16. Quality Control Class 4 Multi-Parameter indicators
are designed to react to
two (2) or more critical parameters, to indicate exposure at stated values.

17. Chemical Indicators
The majority of internal chemical indicators in use today
for Steam and/or EO gas are multi-parameter “color
change” indicators designed to react to two or more of the
critical parameters of sterilization. Other low temperature
processes are monitored with single parameter chemical
indicators.

18. Chemical Indicators
As discussed, different classes of CI’s have been developed to suit different monitoring needs. Some types are sensitive to certain specific problems, such as a temperature deficiency, while others can be less sensitive to an individual parameter but can simultaneously test the overall process. Even chemical indicators of the same basic type can differ in response characteristics, means of detecting exposure conditions, and reliability.

19. Class 5 Indicators (commonly referred to as Integrators)
Integrating indicators react to all critical parameters
of the sterilization process over a specified range of
sterilization cycles and their performance correlates
to BI performance as stated on their labeling.

20. Class 5 Indicators AAMI says… “the results of Class 5
integrating indicators may serve as
the basis for the release of processed
items, including implants if you can
not wait for BI results.
For monitoring wrapped loads,
these integrating indicators must
be used within an appropriate
challenge test pack.”

21. Class 5 Indicators
AAMI standards also state “chemical indicators should clearly differentiate between adequately and inadequately processed items.” For this reason, the endpoint response should be appropriate and unambiguous. Examples of adequate and inadequate exposures should be available from the manufacturer and clearly understood by the user.

22. Class 5 Chemical Indicator
ANSI/AAMI/ISO :2005 outlines more rigid
criteria for a device to be labeled as a Class 5
Integrating Indicator.
▬ Class 5 integrating indicators are the only class of CI’s that must have a response correlated to a BI
▬ Stated values must correlate to the results of the BI at 250ºF, 275ºF and a minimum of one point between
▬ Must now have a stated value at 250ºF that is greater than 16.5 minutes
▬ Pass dry heat test showing the CI does not reach it’s endpoint in 30 minutes at 280ºF

23. Benefits of ANSI/AAMI ISO Class 5
Integrating Indicator:
▬ Stated values are equivalent to or exceed the performance requirements of BI’s
▬ Ensures the Class 5 CI does not change inappropriately or too quickly at significantly lower temperatures
▬ Class 5 Integrator can be used for ALL steam cycles
▬ Class 5 Integrator passes only if the BI is killed
SPSmedical C5 meets these new more stringent requirements.
Check with your supplier for documentation.

24. Class 5 Indicators
Chemical integrators are tested in resistometer vessels. A resistometer is a special sterilizer that is designed for very rapid attainment of the particular critical parameters of the sterilization process. These parameters are very closely controlled during the sterilization exposure.
SPSmedical chemical indicator evaluator resistomer manufactured by Joslyn Valve Co.

25. Class 5 Indicators
Because standard sterilizers do not have enough accuracy of exposure conditions as found in resistometers, it is nearly impossible for a user to replicate mfg’s label claims.

26. Class 5 Indicators
Often, the stated goal of the integrator manufacturer is to design a product that will provide as much information as a biological indicator.

27. Class 5 Indicators
The assumption is that if we know the process conditions that provide kill to the biological indicator, and the chemical integrator can be prevented from reaching its’ endpoint until those conditions have been met, reaching the endpoint gives a level of assurance similar or equal to that of a biological indicator.

28. Class 6 Emulators Cycle specific indicators
Multiple sterilization cycles require separate C6 indicators to monitor each time and temperature.
Can NOT be used in all steam cycles
Neither AAMI nor AORN provide end users with recommendations on their appropriate use
Correlates to the BI at (1) time/temperature whereas ISO compliant C5s correlate at 3 time/temps.

29. SUMMARY
Due to the vast complexity of cleaning, packaging and sterilization of instruments today, no single element of a sterility assurance program, can be relied upon, by itself, to assure sterility.

30. SUMMARY
However, the careful selection and use of Class 5 indicators, along with attention to all aspects of sterilizer performance, processes, and compliance with industry standards… certainly provides the highest level of sterility assurance possible!

31. THANK YOU! SPSmedical Supply Corp. Sterilization Products & Services
6789 W. Henrietta Road
Rush, NY USA
Fax: (585)
Ph: (800)
Website:
© SPSmedical Supply Corp.
Chemical Indicators and Integrators
Certificate is available after viewing by calling SPSmedical or ing

32. Purchasing AAMI Standards
If your organization is not a member of AAMI, you may purchase the Standards directly from SPSmedical at our member discount. The member discount saves you 40-50% depending on the document.
For example:
ORDER CODE: AAMI ST:79
List Price: $220
Member Price: $110

33. References & Resources
Association for the Advancement of Medical Instrumentation
1110 North Glebe Road, Suite 220, Arlington, VA
Fax:
Association of periOperative Registered Nurses
2170 South Parker Road, Suite 300 Denver, CO
Canadian Standards Association
5060 Spectrum Way Mississauga, Ontario L4W 5N6 CANADA
Fax: (416)
Certification Board for Sterile Processing & Distribution
2 Industrial Park, Suite 3 Alpha, NJ 08865
International Assoc. of Healthcare Central Service Materiel Management
213 W. Institute Place, Suite Chicago, IL 60610
Fax: