Sterilization And Disinfectant
Centre Sterilization Supply Department
Mr. Muhammad Ilyas
Lecturer
Deptt. Surgical Technology
Faculty of Allied Health Sciences
CENTRAL PROCESSING DEPARTMENT
In most large health care facilities, high volume processing takes place
in the health facility’s Central Processing (CP) department.
The personnel responsible for this are the Central Processing
technicians.
This is a skilled, certified profession that requires expertise in the
science and practice of materials management, decontamination, and
sterilization.
In smaller facilities, surgical technologists may fill the role and perform
tasks required for processing surgical equipment.
Nearly all instruments and equipment used in surgery are transferred
to Central Processing for reprocessing.
A high level of coordination is required between perioperative
personnel and the CP staff to ensure a smooth turnover of supplies.
Central Processing must make sure that equipment is safe and ready
for scheduled surgery and that thousands of instruments are organized
and processed according to strict standards.
Perioperative staff members are under pressure to deliver equipment
fully intact with no missing parts, ready for immediate use in the
surgical field.
This collaboration works when staff members from the departments
understand and respect each other’s roles. A bond of trust exists as
well.
The CP staff must handle extremely sharp and potentially dangerous
equipment that arrives directly from the operating room.
The surgical technologist has a responsibility to prepare equipment for
processing in a way that protects CP personnel from injury.
CP staff members must appreciate the need for instrument trays to be
complete and ready for use in time for a scheduled procedure.
Personnel in both departments also must understand the critical
nature of their work—disease prevention and safety for patients and
staff
QUALITY CONTROL MONITORING
Procedures and methods for reprocessing medical devices must be
monitored to ensure patient safety.
Monitoring means checking, recording, and reporting
Quality control includes monitoring the technologies (such as the
steam sterilizer, or instrument washer) used in reprocessing
As well as the human factor (is the person following the correct
procedure,
Do they understand the process, are they protecting themselves from
injury during the process?
Technology-Based Parameters
The parameters of the sterilization or disinfection method, such as a
maximum temperature, pressure, or chemical concentration, are
verified by printed data generated by the system itself or by external
testing methods.
All batches of goods processed together in a single load are identified
by batch number and date; these data are maintained to allow tracking
of items in case of an adverse event related to system or equipment
failure.
Sterilization and disinfection systems undergo regular maintenance
and inspection by biomedical engineering professionals.
Human (Personnel) Resources
Central Processing and perioperative personnel are involved in
coordinated roles and responsibilities that directly affect their safety.
Personnel are provided with the tools and methods needed to meet
the objectives of their work.
They understand how to operate disinfection and sterilization
equipment that is within their area of responsibility.
Personnel document the procedures and results of specific
reprocessing activities.
Accurate records of responsibilities and tasks are maintained for the
purpose of tracking adverse outcomes related to sterilization and
disinfection.
Staff members are offered and encouraged to participate in ongoing
training as new technologies and evidence-based practices are
introduced.
Evidence-based practice does not rely on past practices to define
current ones.
It relies on science and evidence rather than opinion or tradition.
Evidence-based practice considers only best practices based on current
research.
REPROCESSING DISPOSABLE DEVICES
The increased acceptance of single-use products has created a need
for regulations and recommendations covering reprocessing of these
items.
Single-use items are those meant to be used on one patient only.
These are manufactured under FDA approval for their intended use on
one patient.
However, many items opened for surgery are never used and
eventually discarded as waste
To cut costs and retrieve the high cost of these items, some institutions
reprocess the items.
Commercial reprocessing services are available for instruments and
equipment approved for reprocessing by the manufacturer.
However, unless the manufacturer states specifically that the item can
be reprocessed by the health care facility, the safety of a single-use
device may be compromised.
The health care facility is liable for any patient injury that occurs as a
result of malfunction of a reprocessed single-use item that is not
approved for multiple use
CLEANING AT THE POINT OF USE
The preparation of equipment and instruments for patient use begins
at the point of use in surgery.
In the perioperative environment, this means during surgery and
immediately afterward. During surgery, instruments and equipment
exposed to blood and body tissue are periodically wiped free of blood
and debris to prevent caking and drying
Dried blood and tissue debris make instruments difficult to operate
and create a film on the instruments that is difficult to remove later.
Also, dried blood and tissue must not be reintroduced into the surgical
wound.
A sponge moistened with water can be used for this purpose, or
instruments may be placed in a basin of water.
Suction tips should be periodically flushed with water.
Saline is never used for cleaning or soaking instrument because it
causes pitting, rusting, and corrosion.
Equipment that is not immersible should also be wiped down
periodically during surgery.
This includes digital or electronic cameras, light cables, pneumatic
drills, and other power equipment.
Wiping instruments during surgery reduces biofilm and prevents
buildup of organic debris
At the close of surgery, sharp instruments are separated out to prevent
injury.
Other instruments usually are placed in a separate basin with the
heaviest ones on the bottom and lighter ones on top.
The water used to soak the instruments is suctioned off before the
equipment is transported out of the surgical suite; this prevents spills
and contamination of the transport cart.
The equipment is placed on a covered or closed transportation cart for
transfer to the decontamination area.
TRANSPORT OF SOILED INSTRUMENTS
TO DECONTAMINATION AREA
Most surgical departments use a
case cart system to collect and
transport instruments and
equipment for a surgical
procedure
Sterile instruments and supplies
are loaded onto the cart before
surgery and transported to the
surgical suite.
Immediately after surgery, instrument trays,basins, and any other
soiled equipment are placed on the cart, which has closed shelving
units.
The covered cart then is transferred to the decontamination area for
processing.
If the health care facility has a cart decontamination system, basins
and trays can be placed directly on the shelves at the point of use
before transport to the decontamination area.
If no such system is available, all soiled items must be contained in
leak-proof bags to prevent gross contamination of the cart.
Instruments and equipment are transported directly to the
decontamination area by the scrubbed technologist or nurse.
DECONTAMINATION ATTIRE
All staff members who work in the
decontamination area must wear
personal protective equipment
(PPE) in compliance with
government regulations.
This is necessary in order to protect staff from potential infection from
body fluids present on the equipment.
PPE includes:
Protective eyewear (i.e., goggles with side shields)Face shield
Gloves approved for contact with chemical disinfectants (surgical or
patient care gloves are not permitted)
Full protective body suit or gown with waterproof apron and sleeves
Waterproof shoes and covers
SORTING INSTRUMENTS
The first phase of reprocessing is sorting.
This is done to prevent damage to delicate items and prevent injury
during reprocessing.
It is also important to gather the small parts of instruments (pins,
gaskets, screws) and keep them together to prevent their loss during
reprocessing.
Items are removed from the transport cart and grouped together by
category:
Nonimmersible equipment or instruments
Instruments with sharp edges or points
Small gaskets, screws, pins, and other small parts
Heavy instruments
Delicate instruments
Heat- and pressure-sensitive instruments
Instrument containers
Basins and cups
Tubing, suction tips, or other instruments with a lumen
Instruments or equipment requiring repair or replacement
Instruments and equipment must be cleaned before they are
disinfected or sterilized.
Dried blood, body fluids, and tissue debris trap microorganisms and
become contaminants.
This debris can also cause instrument damage and malfunction.
Cleaning is performed by hand, ultrasonic cleaner, and automated
washer
CLEANING INSTRUMENTS BY HAND
After the instruments have been sorted, selected instruments are
soaked and hand cleaned using cold water and enzymatic detergent.
Cold water is superior to hot water as a solvent for blood and other
body fluids.
Also, some enzymatic detergents are deactivated at temperatures over
140° F (90° C),
The instruments are submerged during cleaning to prevent the release
of contaminated airborne droplets (aerosol effect).
Areas that are difficult to clean must be scrubbed with a small brush.
Particular attention is paid to hemostats and
other clamps, orthopedic rasps, and other instruments that contain
bits of trapped soft tissue or bone.
Items with a lumen (e.g., hollow tube) are cleaned with a soft, narrow
brush.
The correct size brush must be used to be effective
Brushes that are bent or have sections of missing bristles are not
efficient in removing tissue and biofilm.
Suction tips are cleared with a stylet, a fine wire that can be passed
through the instrument to push out debris.
Instruments with channels and valves may require disassembly for
complete cleaning
Equipment and specialty instruments that are not immersible, such as
those with lenses or electronic parts, are cleaned according to the
manufacturer’s specifications.
After cleaning, instruments must be completely rinsed to remove all
traces of detergent and debris.
Some instruments require rinsing in distilled water.
In this case the manufacturer’s guidelines should be followed
ULTRASONIC CLEANING
The ultrasonic cleaner removes
debris from instruments by a
process called cavitation
High-frequency sound waves are
generated through a water bath.
Cavitation causes tiny air spaces trapped within debris to implode
(explode inwardly), and this releases the debris from the surface of the
instrument.
The ultrasonic cleaner has one or more recessed cavities that are filled
with enzymatic cleaner intended for use in the system
Instruments may be exposed to ultrasonic cleaning before entering the
automated washer-sterilizer disinfectant process or r as a stand-alone
process.
Many washer-sterilizer systems have an ultrasonic phase as part of the
cycle.
If this part of the process is a stand-alone procedure, only instruments
that are free of gross debris are processed in the ultrasonic cleaner.
Many instruments are damaged by ultrasound energy.
Manufacturers of medical devices are careful to state whether the
item can be cleaned by ultrasound.
Ultrasound alone does not decontaminate or sterilize instruments.
SPECIAL HANDLING OF
OPHTHALMIC INSTRUMENTS
Ophthalmic instruments require special handling in order to prevent
toxic anterior segment syndrome (TASS).
TASS can result in damage to the intraocular tissue and loss of vision.
This condition occurs postoperatively after cataract surgery when
various substances, including those not removed during reprocessing,
enter the eye’s anterior chamber during or after surgery
These substances include residue from detergents and lubricants used
on the instruments during the washing and decontamination process.
Other agents that may cause TASS are topical antiseptic and lubricating
agents and powder from surgical gloves.
Mitomycin C and improperly reconstituted intraocular preparations are
also implicated in TASS.
General Guidelines for Processing
for Ophthalmic Instruments to
Prevent TASS
During surgery, instruments should be wiped clean witha lint-free
sponge and water
At the end of the procedure, the instruments must be immediately
submersed in sterile water.
Single-use cannulas (fine suction tubing) should be used if possible.
If these are not available, the lumens of the
cannulas must be flushed with sterile water immediately after the
procedure.
