1. Preparation of Supplies for Sterilization

2. Objectives Explain the steps involved in cleaning, disinfecting, wrapping, and packaging sterile packs and instrument trays. Identify the principles and procedures related to disinfection and sterilization. Demonstrate competency in the procedures related to disinfection and sterilization.

3. Key Terms Cleaning – Physical removal of bioburden from an inanimate object. Disinfection – Destruction of pathogens by exposure to chemical or physical agents. –Low, Intermediate, High Sterilization – Destruction of all microorganisms by steam, chemicals, or radiation.

4. Instrument Processing Constant “circle” of events: –Cleaning (Decontaminating) –Disinfecting (Terminal Disinfection) –Sorting –Assembling –Wrapping –Sterilizing –Storing

5. Cleaning/Decontaminating

6. After the surgical procedure is complete, the STSR should remove any gross contaminates from the instruments. –Soaked in a detergent based solution. –Spray disinfectant. The instruments are then placed in the case cart and transported to the decontamination room.

7. Decontamination Room Separate “dirty area”, usually in close proximity to the clean processing area. Negative air pressure is maintained. Minimum of 10 air exchanges per hour. Temp/Humidity = 64-70 F / 35%-72%

8. Cleaning/Decontaminating

9. Decontamination is the first step in prevention of transmission of microbes from instrument to patient or instrument to personnel. Gross debris is removed, as instruments are rinsed clean. Enzymatic or detergents may be used.

10. Ultrasonic Washer Machine that uses high-frequency sound waves in a solution to help clean the hard to reach areas of the instrument. –Box locks, ratchets, lumens. Sound waves are converted to vibrations in the solution.

11. Ultrasonic Washer

12. Washer-Decontaminator Machine used to terminally disinfect instruments before reassembly. Similar to washer-sterilizer but without the sterilization phase. –Pre-rinse cycle –Cleaning cycle –Final rinse –Dry phase

13. Washer-Sterilizer Machine used to terminally sterilize instruments before reassembly. –Pre-rinse cycle –Automatic detergent injection –Fill phase –Wash phase –Post rinse –Sterilization phase –Lubrication (milking) –Dry phase

14. Washer-Sterilizer Two types: –Tunnel like chamber Has door at both ends and rotating sprayer arms. –Horizontal/Cabinet Has one or two doors. Chamber injected with water and detergent using a turbulent action.

15. Washer-Sterilizer

16. Instrument Decontamination Decontamination tips: –Instruments must be placed in a mesh tray to allow for proper cleaning. –Heavier instruments are placed on the bottom. Delicate on top. –Hinges and box locks are left open. –Instruments are disassembled.

17. Hand Washing Instruments Perform on delicate instruments or if washer- sterilizers unavailable. Wear proper PPE Each instrument is individually cleaned with a soft bristle brush. Keep brush and instrument submerged while cleaning. Pay attention to jaws, ratchets, and box locks. Lumens may be cleaned with pipe cleaners.

18. Hand Washing Instruments Three sink arrangement is ideal: –First sink – Wash sink with water and detergent. –Second sink – 1 st rinse with distilled water. –Third sink – Final rinse with distilled water.

19. Special Care Instruments Rigid endoscopes Flexible endoscopes Powered instruments –Saws –Drills –Dermatomes

20. Instrument Prep for Wrapping and Sterilization First must be terminally disinfected or terminally sterilized. Instruments are: –Inspected –Reassembled –Prepared These functions take place in the clean processing area.

21. Clean Instrument Room

22. Inspection and Functional Testing Scissors and trocar points should be sharp with no burs on cutting edge. Check for sprung instruments. Jaw/Tip approximation. Self retaining retractors. Proper powered instrument care. –Manufacturers recommendations.

23. Instrument Sets Placed in a wire mesh basket with absorbent towel lining the bottom. –Do not use disposable wrapper. Ringed instruments are placed on a “string” and ratchets left unlocked. Loose instruments arranged so that movement is minimized. –Bible wrapped

24. Instrument Sets Heavy instruments are placed on the bottom, delicate instruments on top. Metal to metal contact is limited by separating layers with a absorbent towel. Recommended not to exceed 16 pounds.

25. Preparation of Supplies for Sterilization QUESTIONS?