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Sterile Processing Case Studies Project.

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Sterile Processing Case Studies Project.

Introduction.

Decontamination principles and sterilization methods form central practices in

nursing and medicine that defend against infections and safeguard patient safety and

healthcare provider security while maintaining sterile environments. The document includes

selected topics, an overview of decontamination principles, answers to decontamination

scenario questions, sterilization methods, and their corresponding questions, and a concluding

statement with reference articles.

Topics Selected.

The topics selected were Topic 1: Decontamination Principles & Topic 2: Sterilization

Methods.

Decontamination is crucial in healthcare to prevent infection by reducing toxic

microorganisms from surfaces, instruments, and environments. Healthcare decontamination

depends on first risk evaluation before planning cleaning and disinfecting actions while

needing sterilization following standard material handling protocols, suitable storage steps,

and established sterilization procedures.

The sterilization process destroys all microorganisms, such as bacterial, viral, and

fungal agents, along with spores on medical equipment before clinical use becomes possible.

Presentation methods under the category of sterilization consist of three primary approaches:

Autoclaving and dry heat application comprise Heat Sterilization techniques, whereas

Chemical Sterilization includes ethylene oxide vapor and hydrogen peroxide vapor as well as

peracetic acid and plasma technology for radiation sterilization with Filtration Sterilization

utilizing ultraviolet equipment and Ozone Sterilization methods.

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Topic 1: Decontamination Principles.

Eight Ideas Regarding Decontamination Principles

1. Hierarchy of Decontamination: Three sequential levels of decontamination

exist, including cleaning followed by disinfection and concluding with

sterilization that delivers progressive reductions of microbial contamination

dependent on the infection risk (Garvey & Rowan, 2023).

2. Risk-Based Categorization (Spaulding Classification): A decontamination

method must be chosen based on the testing of medical instruments into

critical (entering sterile body areas), semi-critical (contacting mucous

membranes), and non-critical (contacting intact skin) category types (Soares

Mateus et al., 2021).

3. Cleaning as a Foundation: Manufacturers initiate decontamination procedures

through elevated cleaning techniques that clear away both organic substances

like blood and bodily fluids together with debris because both agents possess

the potential to deplete disinfecting agents and prevent sterilization methods

(Attrah et al., 2022).

4. Disinfection for Pathogen Reduction: Assessments to determine appropriate

decontamination methods require chemical disinfectants from specific classes

like alcohol chlorine or quaternary ammonium compounds that eradicate most

microorganisms except spores for the sanitization of semi-critical or non-

critical items.

5. Sterilization for Complete Microbial Elimination: Autoclaving with ethylene

oxide gas disinfection destroys all microorganisms, including bacterial spores

(Bernal-Chávez et al., 2021).

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6. Preventing Cross-Contamination: The successful initiative of inhibiting cross-

contamination depends on correctly processing contaminated items and

effective area separation with proper protective equipment (PPE) handling.

7. Compliance with Guidelines and Standards: Compliance with the World

Health Organization (WHO) guidelines and others ensures that

decontamination practices remain effective and standardized (Abalkhail &

Alslamah, 2022).

8. Environmental and Material Safety: The selection of decontamination

techniques aims to protect three areas: human beings in their health services

roles and environmental spaces while preventing damage to substances and

reducing residual chemicals.

Response to the Case Study Scenario Questions.

 What issue(s) have occurred, and what may cause these errors?

Issues that occurred

i. Dirty neurological instruments have been repeatedly sent to the OR.

ii. There is a decontamination, cleaning, inspection, or sterilization process

breach.

iii. Failure in quality control and oversight within the sterile processing

department (SPD).

iv. Increased risk of infection for patients undergoing neurosurgical procedures.

Causes of the issues

- Failure to thoroughly clean instruments before disinfection or sterilization, leaving

organic matter or debris.

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- Cleaning machines like ultrasonic washers or autoclaves may not function

correctly, compromising sterilization efficacy (White et al., 2021).

 What other considerations may the sterile processing tech need to take with

instruments exposed to neurological tissues?

 Prion Disease Prevention: Neurological surgical instruments are dangerous to

acquiring prion infections, including Creutzfeldt-Jakob disease (Altuna et al.,

2022). Specific decontamination procedures should use either 18 minutes of

heat sterilization at 134 degrees Celsius or sodium hydroxide or hypochlorite

solutions to successfully remove infective agents from neurological

instruments.

 Thorough Cleaning of Lumens and Micro-Instruments: Due to their fine tips,

lumens, and delicate components, neurological tools need special cleaning

equipment featuring ultrasonic cleaners and specific brushes.

 Separate Processing: Neurological instruments require dedicated processing to

avoid contaminating contaminants between surgical instruments.

 What might the sterile processing department have to do to resolve this issue?

1. After tissue exposure, instrument sets must be isolated in a quarantine zone

until they undergo entire decontamination and sterilization sequences.

2. The cleaning protocols will be executed, and inspection and sterilization

protocols will determine which steps need improvement.

3. The surgical service team, infection control personnel, and risk managers must

be notified about all equipment problems so prevention can start promptly.

4. All cleaning equipment requiring ultrasonic washers and autoclaves requires

regular maintenance checks to validate their performance abilities.

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 Thoroughly explain the decontamination process. What steps should take place in the

OR? In SPD? Why is cleaning considered the cornerstone of instrument processing

Steps that take place in Operating Room (OR)

 Immediate Action After Use: Instruments require immediate wiping or rinsing per

procedures to stop biological materials from attaching to surfaces while drying.

 Use of Manual Cleaning and Scrubbing: Scrub techs may perform minimal

instrument manual cleaning only if the OR retrieval becomes delayed under specific

and acceptable conditions to remove tissue or debris.

 Identification and Preparation: Surgical instruments of high complexity in

neurosurgical treatments get unique labeling for appropriate disposal methods just

after surgery. Instruments classified as prion high-risk demand dedicated processing

systems.

Steps that take place in the Sterile Processing Department (SPD)

 Sorting by Type and Risk Level: The selection of appropriate decontamination

techniques depends on a criticality classification system dividing medical equipment

into critical, semi-critical, and non-critical categories.

 Preparation for Cleaning: The instrument cleaning protocol starts with device

disassembly to expose all parts, leading to battery removal and liberated component

cleaning access.

 Actual cleaning: Machine scrubbing techniques work alongside manual approaches

whenever cleaning machines are unavailable. Specialized detergents, together with

brushes, destroy all detectable organic contaminants. Machine cleaning happens with

the help of ultrasonic cleaners alongside washer-decontaminators, which eliminate

contaminants from instruments with high-frequency sound waves or pressurized water

streams.
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 Sterilization: Instruments need to undergo sterilization because the process eliminates

all microorganisms, including bacterial spores. Steam sterilization (autoclaving)

operates alongside dry heat and chemical sterilization, and hydrogen peroxide vapor

sterilization is a different method.

 The drying process following sterilization must happen carefully to prevent tray wash

residues from creating contamination. Solid evidence shows that packaging

examinations confirm the total removal of moisture and materials from instruments

before they move into the packaging stage.

 Packaging and Storage: Sterile packaging systems and protective sterile wrapping

ensure instruments stay sterile from transportation to the operating area.

Why Cleaning is Considered the Cornerstone of Instrument Processing

Cleaning is considered the cornerstone of instrument processing because it is the first and

most crucial step in the decontamination chain as effective cleaning;

o Prevents organic Matter from Interfering with Sterilization: When

disinfectants and sterilization techniques encounter blood and tissue remnants

and other organic substances, these materials create protective shields

obstructing pathogen destruction.

o Ensures Sterilization Effectiveness: Proper instrument cleaning remains

essential because improper preparation can reduce a sterilization method's

effectiveness, particularly when autoclaving.

o Prevents Damage to Instruments: The cleaning process protects surgical

instrument sensors from damage formed from hardened remains or aggressive

chemical usage.

Topic 2: Sterilization Methods.

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The Eight Ideas Regarding Sterilization Methods

1. Different Methods for Different Needs: Scientific teams select sterilization techniques

for instrument characteristics alongside their composition and application criteria

(Pérez Davila et al., 2021). Steaming instruments join dry heat with chemical

solutions and radioactively-charged particles as standard sterilization methods.

2. Steam Sterilization (Autoclaving): Among all sterilization approaches, steam

sterilization holds the highest use, where high-pressure steam rises to temperatures

from 121°C to 134°C to terminate microbes (Zhang et al., 2025). The heat, along with

moisture exposure, eliminates microorganisms from instruments that resist these

conditions. Healthcare settings extensively use autoclaving as a preferred method

because of its dependable operations, affordable efficiency, and excellent performance

results.

3. Dry Heat Sterilization: Industrial applications use high-temperature dry heat, such as

temperatures between 160°C–180°C, which provides lengthy soaking periods of 1-2

hours to eliminate microorganisms. The procedure works best for instruments like

glassware, oils, and powders that cannot handle moisture exposure.

4. Chemical Sterilization (Gas Sterilization): The gas ethylene oxide (EtO) facilitates

heat-sensitive instrument sterilization of plastic electrical devices and delicate

equipment (Sherstneva et al., 2022).

5. Hydrogen Peroxide Vapor Sterilization: Low-temperature sterilization of instruments

takes place through vaporized applications of hydrogen peroxide. Endoscopes and

sensitive instruments benefit significantly from this method because they show

sensitivity to heat during sterilization.

6. Radiation Sterilization (Gamma and E-Beam): Medical supplies, including syringes,

gloves, and implants, undergo effective sterilization through Gamma radiation and
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electron beam (e-beam) radiation, according to findings by Visan et al. in 2021. Both

processes eliminate microorganisms through high-energy radiation by targeting

molecules to kill resistant spores.

7. Plasma Sterilization: The instrument sterilization process known as plasma

sterilization utilizes the sterilizing properties of ionized gas plasma to operate

effectively at temperatures below room temperature (Stryczewska & Boiko, 2022).

Surgical robots and endoscopes, among other delicate medical instruments, receive

effective, fast sterilization using this technique. Plasma sterilization provides an

environmentally safe, non-toxic treatment option that replaces older techniques but

lacks compatibility with certain materials.

8. Filtration Sterilization: The application of filtration sterilization remains concentrated

on both liquid and gaseous materials. The process requires fluid filtration by using

filters that exclude microorganisms and bacteria.

Response to the Case Study Scenario Questions.

 Define a wet pack.

A wet pack is a condition in which a sterile package or instrument, typically

wrapped in a sterilization wrap or bag, remains damp after sterilization.

 Define a wet load

A wet load is when items placed in the sterilizer (usually an autoclave) remain

damp after the sterilization cycle.

 Why might the loads be wet? Provide at least three unique causes.

o Overloading the Sterilizer: The sterilizer must remain within its capacity to

create appropriate steam circulation so equipment can dry properly without

leaving moisture traces (Koubaa, 2024.

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o Inadequate Drying Time or Temperature: Proper item drying becomes

impossible when the drying cycle duration or temperature regulation is

ineffective. Insufficient drying phase time in autoclaves leads to wet loads

because adequate moisture elimination is not achieved.

o Improper Packaging: Precise packing of items matters in sterilizing equipment

because close arrangements between products create barriers to steam flow,

resulting in poor drying. Packaging materials that fail to meet sterilization

standards will keep moisture trapped inside.

o Failure of Autoclave Cycle Settings: Incorrect setting-up of autoclave devices

due to pressure and temperature requirements during sterilization time

generates bad sterilization outcomes, which causes items to retain moisture.

 What solutions can Kristine apply to ensure the processed instrument sets aren't wet?

o Extend Drying Time: The drying cycle on the autoclave requires sufficient

duration to evaporate all moisture.

o Verify Temperature and Pressure: The sterilizer must operate between 121°C

and 134°C to complete proper sterilization while drying instruments

adequately (Chiozzi et al., 2022).

o Kristine should resist adding too many items into the sterilization device at

once.

o Choose Appropriate Packaging Materials: Kristine must select materials that

let steam dissipate efficiently while helping evaporate moisture between each

instrument for sterilization instrument packaging.

 Discuss how this issue affects the operating room and the sterile processing

department. How should Kristine handle the wet packages to ensure quality control?

Impact on the Operating Room (OR):

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o Wet packages can compromise the sterility of surgical instruments (Frizziero et

al.,2021). If moisture is present inside the sterilized packages, it may lead to microbial

growth, contaminating the instruments and thus infected.

o When wet packages are found in the OR, surgery can be delayed since the surgical

team has to wait for a new set of instruments to be sterilized and dried.

o Moisture within the packs promotes corrosion or rusting of metal instruments. Broken

sterile instruments can jeopardize the safety of personnel; plus, it might also be costly

to repair or replace them.

Impact on the Sterile Processing Department (SPD)

o Wet packages also translate to reprocessing of contaminated instrument sets by SPD

personnel, which can cause significant delays and workflow interruption.

o Handling wet packages can put additional stress on SPD personnel, causing their

workloads and even the quality of work to increase.

o Wet packages indicate something is wrong with the drying or sterilization process. If

this is not attended to on schedule, it will weaken the general quality control

mechanisms within SPD and make errors in instrument sterilization more common.

How Kristine Should Handle Wet Packages to Ensure Quality Control

o Kristine should immediately identify and segregate any wet packages, as wet

packages should not be used in the operating room or stored in sterile areas.

o The affected instrument sets should be reprocessed through the cleaning,

decontamination, and sterilization cycle.

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o Kristine should document the incident thoroughly in the quality control log.

This will help identify recurring issues, track equipment or process failures,

and provide a basis for future corrective actions.

o Kristine should inspect the autoclave or other sterilization equipment for any

malfunctions that could lead to wet packages. Regular checks should be

conducted to verify that the drying cycles are functioning correctly.

Conclusion

Ensuring proper decontamination and sterilization of surgical instruments is critical to

maintaining patient safety, preventing infections, and ensuring the smooth operation of

healthcare facilities. The issue of wet packages, whether caused by improper loading,

insufficient drying cycles, or equipment malfunction, can compromise the sterility of

instruments, placing patients at risk of healthcare-associated infections (HAIs). This problem

also disrupts workflows in the operating room (OR) and sterile processing department (SPD),

leading to surgery delays, increased workloads, and potential financial losses due to damaged

instruments and repeated processing.

Addressing these challenges requires a thorough understanding of decontamination

principles, adherence to sterilization best practices, and proactive quality control measures.

By fostering collaboration between the OR and SPD and emphasizing the importance of

sterility in infection control, healthcare facilities can safeguard patient outcomes, enhance

operational efficiency, and uphold their commitment to delivering safe, high-quality care.

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