Sterilization and Aseptic Techniques in Operating Room Setup
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To acquire knowledge and
understanding on the different methods of
sterilization as well as the sterilization
processes.
To know & get familiarized with the
principles of aseptic techniques & apply
them in the clinical areas & Operating
Room.
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Physical Methods
Cool Chemical Methods
Liquid Chemicals
Other Methods
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Preparation of items before sterilization
Steam Sterilization Process
Testing the Effectiveness of the Autoclave
Storage of Sterile Packages
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The prevention of infection in health
care areas is
largely
dependent on
the following:
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:
Surgical instruments, devices & heat sensitive
items are sterilized by the method recommended
by the manufacturer.
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.
Sterilizing agent should be in contact with every
part / surface of the item to be sterilized at specific
period of time & temperature.
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:
1. Dry Heat-Hot air ovens, infra red ovens.
2
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.
Minimum exposure time required for sterilizing
instruments is 50 minutes at 131ºC or 60
minutes at 136ºC.
T
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.
Steam penetrates the load & very rapid
sterilization of dressings, instruments, raytec
swabs, lap sponges, other surgical items &
packs is possible in 30 to 40 minutes at 134ºC.
(Available in KKUH)
N
e
w
S
t
e
r
i
s
A
u
t
o
c
l
a
v
e
P
r
e
p
a
r
a
t
i
o
n
O
f
I
t
e
m
s
B
e
f
o
r
e
S
T
E
R
I
L
I
Z
A
T
I
O
N
1.
Decontamination
2.
Disassembly
3.
Washing
4.
Drying
5.
Packing
6.
Loading in sterilizer
U
l
t
r
a
s
o
n
i
c
W
a
s
h
e
r
A
u
t
o
m
a
t
e
d
W
a
s
h
e
r
T
H
E
S
T
E
A
M
S
T
E
R
I
L
I
Z
A
T
I
O
N
P
R
O
C
E
S
S
–
F
I
V
E
D
I
S
T
I
N
C
T
P
H
A
S
E
S
:
P
H
A
S
E
I
-
L
o
a
d
i
n
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p
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a
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e
-
i
n
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t
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o
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l
o
a
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d
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r
i
l
i
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e
r
.
P
H
A
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E
I
I
-
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e
a
t
i
n
g
p
h
a
s
e
-
i
n
w
h
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c
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t
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a
m
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t
t
o
p
r
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p
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m
p
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r
a
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&
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l
l
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d
t
o
p
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n
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t
r
a
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t
h
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r
.
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A
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I
I
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-
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s
t
r
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y
i
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p
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a
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n
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c
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d
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&
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d
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n
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f
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d
a
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d
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d
&
p
a
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s
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m
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d
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t
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d
.
P
H
A
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E
V
-
T
e
s
t
i
n
g
p
h
a
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e
-
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n
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t
i
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n
p
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o
c
e
s
s
i
s
c
h
e
c
k
e
d
.
A
l
l
m
e
c
h
a
n
i
c
a
l
p
a
r
t
s
o
f
s
t
e
r
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l
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e
r
s
,
i
n
c
l
u
d
i
n
g
g
a
u
g
e
s
,
s
t
e
a
m
l
i
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e
s
&
d
r
a
i
n
s
s
h
o
u
l
d
b
e
p
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r
i
o
d
i
c
a
l
l
y
c
h
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c
k
e
d
b
y
a
c
o
m
p
e
t
e
n
t
b
i
o
m
e
d
e
n
g
i
n
e
e
r
.
L
o
a
d
i
n
g
P
r
o
c
e
d
u
r
e
M
A
K
I
N
G
O
F
S
T
E
R
I
L
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P
A
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K
S
S
h
o
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l
d
h
a
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t
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f
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t
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l
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d
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c
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y
h
a
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n
p
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s
s
e
d
:
A
u
t
o
c
l
a
v
e
t
a
p
e
s
s
h
o
w
a
p
a
c
k
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a
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a
s
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n
t
h
r
o
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h
a
s
t
e
r
i
l
i
z
a
t
i
o
n
c
y
c
l
e
&
s
h
o
u
l
d
b
e
v
i
s
i
b
l
e
o
u
t
s
i
d
e
e
v
e
r
y
p
a
c
k
s
t
e
r
i
l
i
z
e
d
.
A
u
t
o
c
l
a
v
e
t
a
p
e
i
s
d
e
s
i
g
n
e
d
b
l
a
c
k
w
h
e
n
s
p
e
c
i
f
i
e
d
t
e
m
p
e
r
a
t
u
r
e
i
s
r
e
a
c
h
e
d
.
Must be
labeled as to its contents
with the
processing date, autoclave used & load number
.
This assists locating processed items in case of
recall
.
S
T
O
R
A
G
E
O
F
S
T
E
R
I
L
E
P
A
C
K
S
Sterile packs / sets should be left
untouched & allowed to be cooled before
storage to avoid condensation inside.
Must be handled as little as possible to
reduce the risk of contamination.
S
T
O
R
A
G
E
O
F
S
T
E
R
I
L
E
P
A
C
K
S
Sterile packages should be stored on open
shelves.
T
h
e
l
o
w
e
s
t
s
h
e
l
f
s
h
o
u
l
d
b
e
8
t
o
1
0
i
n
c
h
e
s
o
f
f
t
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e
f
l
o
o
r
.
T
h
e
h
i
g
h
e
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t
s
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l
f
s
h
o
u
l
d
b
e
1
8
i
n
c
h
e
s
f
r
o
m
t
h
e
c
e
i
l
i
n
g
.
A
l
l
s
h
e
l
v
e
s
s
h
o
u
l
d
b
e
a
t
l
e
a
s
t
2
i
n
c
h
e
s
f
r
o
m
t
h
e
w
a
l
l
s
.
K
K
U
H
-
C
S
S
D
S
t
o
r
a
g
e
R
o
o
m
S
T
O
R
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E
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F
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T
E
R
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A
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E
i
t
h
e
r
g
o
o
d
f
o
r
3
0
d
a
y
s
o
r
6
m
o
n
t
h
s
t
o
o
n
e
y
e
a
r
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e
p
e
n
d
i
n
g
o
n
h
o
w
t
h
e
p
a
c
k
a
g
e
s
a
r
e
w
r
a
p
p
e
d
&
w
h
a
t
t
y
p
e
o
f
w
r
a
p
p
e
r
s
u
s
e
d
.
S
h
e
l
f
l
i
f
e
-
r
e
f
e
r
s
t
o
t
h
e
l
e
n
g
t
h
o
f
t
i
m
e
a
p
a
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k
a
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e
m
a
y
b
e
c
o
n
s
i
d
e
r
e
d
s
t
e
r
i
l
e
.
Sterile packages must be stored and issued in
correct order.
Traceability (Tracking System)
S
T
O
R
A
G
E
O
F
S
T
E
R
I
L
E
P
A
C
K
S
S
t
o
r
a
g
e
r
o
o
m
-
s
u
b
j
e
c
t
e
d
t
o
r
e
g
u
l
a
r
a
d
e
q
u
a
t
e
p
e
s
t
c
o
n
t
r
o
l
t
o
p
r
e
v
e
n
t
c
o
n
t
a
m
i
n
a
t
i
o
n
f
r
o
m
r
o
d
e
n
t
s
,
a
n
t
s
&
c
o
c
k
r
o
a
c
h
e
s
.
Traffic is restricted to CSSD personnel &
trainees only.
One flow
C
a
u
s
e
s
o
f
f
a
i
l
u
r
e
t
o
p
r
o
d
u
c
e
a
s
t
e
r
i
l
e
l
o
a
d
Faults & errors in the autoclave
Poor quality steam
Way it is operated
Failure to remove air & condensate
Faulty gauges & timings
Leaking door seals
Inadequate air filter
Excessive layers of wrapping materials
Large packs, torn & wet packs
Methods of Testing the
Effectiveness of Autoclaves:
M
e
c
h
a
n
i
c
a
l
-
c
h
a
r
t
&
g
a
u
g
e
s
u
s
u
a
l
l
y
c
a
r
r
i
e
d
o
u
t
b
y
B
i
o
m
e
d
E
n
g
i
n
e
e
r
.
C
h
e
m
i
c
a
l
-
b
y
t
h
e
u
s
e
o
f
a
u
t
o
c
l
a
v
e
t
a
p
e
s
,
s
t
r
i
p
s
a
n
d
c
a
r
d
.
A
d
a
i
l
y
t
e
s
t
i
n
a
n
e
m
p
t
y
c
h
a
m
b
e
r
u
s
i
n
g
a
h
e
a
t
s
e
n
s
i
t
i
v
e
t
a
p
e
.
T
h
i
s
i
s
f
o
r
h
i
g
h
v
a
c
u
u
m
/
h
i
g
h
p
r
e
s
s
u
r
e
a
u
t
o
c
l
a
v
e
s
.
E
x
.
B
o
w
i
e
D
i
c
k
T
e
s
t
P
a
c
k
-
a
p
a
c
k
w
i
t
h
a
c
h
e
m
i
c
a
l
i
n
d
i
c
a
t
o
r
b
o
t
h
o
u
t
s
i
d
e
&
i
n
s
i
d
e
t
o
v
e
r
i
f
y
t
h
a
t
s
t
e
a
m
h
a
s
p
e
n
e
t
r
a
t
e
d
t
h
e
p
a
c
k
&
t
o
t
e
s
t
a
i
r
l
e
a
k
s
.
B
i
o
l
o
g
i
c
a
l
B
i
o
l
o
g
i
c
a
l
I
n
d
i
c
a
t
o
r
-
B
i
o
l
o
g
i
c
a
l
S
p
o
r
e
T
e
s
t
i
n
g
To test autoclaves regularly with
Geobacillus
stearothermophilus, which is one of the most
heat tolerant species of bacteria.
If sterilization in an autoclave does not destroy
the Geobacilus spores, the autoclave is not
working properly.
Testing the Effectiveness of
Steam Autoclave:
F
i
r
s
t
-
R
u
n
i
t
e
m
p
t
y
f
o
r
o
n
e
c
y
c
l
e
.
(
D
u
m
m
y
R
u
n
)
–
t
o
w
a
r
m
u
p
t
h
e
m
a
c
h
i
n
e
.
S
e
c
o
n
d
-
P
u
t
i
n
s
i
d
e
i
n
t
h
e
m
i
d
d
l
e
o
f
t
h
e
c
h
a
m
b
e
r
,
t
h
e
B
o
w
i
e
D
i
c
k
T
e
s
t
P
a
c
k
a
n
d
r
u
n
i
t
a
g
a
i
n
a
n
d
f
i
n
i
s
h
t
h
e
w
h
o
l
e
c
y
c
l
e
.
O
h
h
i
g
h
p
r
e
s
s
u
r
e
-
t
o
t
e
s
t
l
e
a
k
s
a
n
d
p
r
e
s
e
n
c
e
o
f
a
i
r
.
(
Y
e
l
l
o
w
t
u
r
n
s
b
l
a
c
k
)
T
h
i
r
d
-
L
o
a
d
t
h
e
i
t
e
m
s
&
t
r
a
y
s
f
o
r
s
t
e
r
i
l
i
z
a
t
i
o
n
(
l
i
t
t
l
e
b
i
t
l
o
w
e
r
p
r
e
s
s
u
r
e
)
.
I
t
i
s
d
o
n
e
o
n
c
e
d
a
i
l
y
.
F
o
u
r
t
h
-
L
i
v
e
O
r
g
a
n
i
s
m
-
d
o
n
e
o
n
c
e
i
n
e
v
e
r
y
S
u
n
d
a
y
m
o
r
n
i
n
g
i
n
C
S
S
D
,
K
K
U
H
.
C
O
L
D
M
E
T
H
O
D
-
C
h
e
m
i
c
a
l
s
E
t
h
y
l
e
n
e
O
x
i
d
e
(
E
O
)
-
*
W
e
l
l
e
s
t
a
b
l
i
s
h
e
d
t
e
c
h
n
i
q
u
e
f
o
r
s
t
e
r
i
l
i
z
i
n
g
h
e
a
t
s
e
n
s
i
t
i
v
e
a
r
t
i
c
l
e
s
.
*
C
o
l
o
r
l
e
s
s
g
a
s
*
E
x
p
o
s
u
r
e
p
e
r
i
o
d
o
f
5
t
o
7
h
o
u
r
s
i
s
n
e
c
e
s
s
a
r
y
f
o
r
c
o
m
p
l
e
t
e
E
.
O
.
s
t
e
r
i
l
i
z
a
t
i
o
n
.
*
Temperature for sterilizing is 21º C to 60º C
(70º F to 140º F).
E
.
O
.
S
t
e
r
i
l
i
z
e
r
Used for sterilizing vascular & bone grafts,
delicate instruments, plastic articles such as
disposable syringes,bacteriological media &
vaccines.
E
t
h
y
l
e
n
e
O
x
i
d
e
(
E
O
)
C
h
e
m
i
c
a
l
i
n
d
i
c
a
t
o
r
s
f
o
r
E
O
s
h
o
u
l
d
b
e
u
s
e
d
w
i
t
h
e
a
c
h
p
a
c
k
.
G
a
s
s
t
e
r
i
l
i
z
e
r
s
s
h
o
u
l
d
b
e
c
h
e
c
k
e
d
o
n
c
e
a
w
e
e
k
w
i
t
h
c
o
m
m
e
r
c
i
a
l
p
r
e
p
a
r
a
t
i
o
n
s
p
o
r
e
s
,
u
s
u
a
l
l
y
B
a
c
i
l
l
u
s
A
t
r
o
p
h
e
u
s
.
R
e
q
u
i
r
e
s
6
-
8
h
o
u
r
s
o
f
a
e
r
a
t
i
o
n
.
D
I
S
A
D
V
A
N
T
A
G
E
S
O
F
E
O
Lengthy process with long aeration
periods.
Expensive & more complex process.
Produce
serious burns
on exposed skin.
Insufficiently aerated materials can
cause irritation, burns of body tissues.
T
o
x
i
c
&
m
a
y
c
a
u
s
e
C
a
n
c
e
r
.
*
P
r
e
c
a
u
t
i
o
n
s
s
h
o
u
l
d
b
e
t
a
k
e
n
t
o
p
r
o
t
e
c
t
p
e
r
s
o
n
n
e
l
.
P
l
a
s
m
a
S
t
e
r
i
l
i
z
e
r
P
l
a
s
m
a
A
u
t
o
c
l
a
v
e
(
S
t
e
r
r
a
d
)
-
*
L
o
w
T
e
m
p
e
r
a
t
u
r
e
H
y
d
r
o
g
e
n
G
a
s
S
t
e
r
i
l
i
z
e
r
s
.
*
U
s
e
d
t
o
s
t
e
r
i
l
i
z
e
d
e
l
i
c
a
t
e
i
n
s
t
r
u
m
e
n
t
s
t
h
a
t
a
r
e
h
e
a
t
&
m
o
i
s
t
u
r
e
s
e
n
s
i
t
i
v
e
,
s
u
c
h
a
s
m
i
c
r
o
i
n
s
t
r
u
m
e
n
t
s
,
c
a
m
e
r
a
s
,
s
c
o
p
e
s
&
l
i
g
h
t
c
o
r
d
s
.
*
G
e
n
t
l
e
p
a
t
e
n
t
e
d
s
t
e
r
i
l
i
z
a
t
i
o
n
p
r
o
c
e
s
s
w
i
t
h
t
h
e
u
s
e
o
f
h
y
d
r
o
g
e
n
p
e
r
o
x
i
d
e
&
g
e
n
e
r
a
t
i
o
n
o
f
l
o
w
t
e
m
p
e
r
a
t
u
r
e
g
a
s
p
l
a
s
m
a
.
*
S
p
o
r
e
t
e
s
t
i
n
g
s
h
o
u
l
d
b
e
p
e
r
f
o
r
m
e
d
a
t
t
h
e
s
a
m
e
i
n
t
e
r
v
a
l
a
s
t
e
s
t
i
n
g
o
f
o
t
h
e
r
s
t
e
r
i
l
i
z
e
r
s
.
P
l
a
s
m
a
S
t
e
r
i
l
i
z
a
t
i
o
n
104°F-131°F (40°C-55°C). – 45 minutes to I
hour.
Advantages of
plasma sterilization
include
speed,
safety of use
, &
no aeration.
Five phases to the “Sterrad” Plasma
sterilization cycle: vacuum, injection, diffusion,
plasma, vent.
N
e
w
S
t
e
r
r
a
d
P
l
a
s
m
a
A
u
t
o
c
l
a
v
e
L
I
Q
U
I
D
C
H
E
M
I
C
A
L
S
T
E
R
I
L
I
Z
A
T
I
O
N
Liquid chemo sterilizers
can destroy all forms
of microbial life including bacterial, fungal
spores, tubercle bacilli & viruses.
Can be used for sterilization when steam,
gas or dry heat is not indicated or available.
C
o
m
m
o
n
L
i
q
u
i
d
C
h
e
m
i
c
a
l
s
-
C
a
p
a
b
l
e
o
f
c
a
u
s
i
n
g
D
i
s
i
n
f
e
c
t
i
o
n
/
S
t
e
r
i
l
i
z
a
t
i
o
n
.
A
q
u
e
o
u
s
F
o
r
m
a
l
d
e
h
y
d
e
-
O
l
d
e
s
t
c
h
e
m
o
s
t
e
r
i
l
i
z
e
r
s
k
n
o
w
n
t
o
d
e
s
t
r
o
y
s
p
o
r
e
s
;
r
a
r
e
l
y
u
s
e
d
d
u
e
t
o
i
t
s
p
u
n
g
e
n
t
o
d
o
r
.
A
q
u
e
o
u
s
G
l
u
t
a
r
a
l
d
e
h
y
d
e
-
C
o
l
o
r
l
e
s
s
l
i
q
u
i
d
c
h
e
m
i
c
a
l
w
i
t
h
p
u
n
g
e
n
t
o
d
o
r
.
(
C
I
D
E
X
)
*
S
h
o
r
t
s
o
a
k
i
n
g
p
e
r
i
o
d
(
2
0
m
i
n
u
t
e
s
-
3
0
m
i
n
u
t
e
s
)
o
n
l
y
p
r
o
v
i
d
e
s
d
i
s
i
n
f
e
c
t
i
o
n
o
f
i
n
s
t
r
u
m
e
n
t
s
.
*
C
o
m
p
l
e
t
e
i
m
m
e
r
s
i
o
n
i
n
a
c
t
i
v
a
t
e
d
g
l
u
t
a
r
a
l
d
e
h
y
d
e
s
o
l
u
t
i
o
n
f
o
r
1
0
h
o
u
r
s
a
c
h
i
e
v
e
s
s
t
e
r
i
l
i
z
a
t
i
o
n
.
*
A
f
t
e
r
i
m
m
e
r
s
i
o
n
,
a
l
l
s
u
r
f
a
c
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s
o
f
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h
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t
r
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m
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t
s
m
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t
b
e
r
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n
s
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d
t
h
o
r
o
u
g
h
l
y
w
i
t
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s
t
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r
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l
e
w
a
t
e
r
b
e
f
o
r
e
u
s
e
.
*
A
n
y
i
m
m
e
r
s
i
o
n
o
f
l
e
s
s
t
h
a
n
1
0
h
o
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r
s
m
u
s
t
b
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o
n
s
i
d
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r
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d
a
s
o
n
l
y
a
s
d
i
s
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n
f
e
c
t
i
o
n
(
S
p
o
r
e
s
n
o
t
k
i
l
l
e
d
.
*
T
o
x
i
c
&
c
a
n
c
a
u
s
e
n
a
s
a
l
(
r
e
s
p
i
r
a
t
o
r
y
m
u
c
o
s
a
)
,
e
y
e
&
s
k
i
n
i
r
r
i
t
a
t
i
o
n
.
C
o
m
m
o
n
L
i
q
u
i
d
C
h
e
m
i
c
a
l
D
i
s
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n
f
e
c
t
a
n
t
s
O
P
A
C
i
d
e
x
-
(
0
.
5
5
%
o
r
t
h
o
-
p
h
t
h
a
l
a
l
d
e
h
y
d
e
)
-
C
l
e
a
r
,
p
a
l
e
-
b
l
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e
l
i
q
u
i
d
(
p
H
,
7
.
5
)
,
c
o
n
t
a
i
n
s
0
.
5
5
%
t
h
e
n
o
n
-
g
l
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t
a
r
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d
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l
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t
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d
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s
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t
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o
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i
b
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n
d
o
s
c
o
p
e
s
a
n
d
o
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d
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v
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s
.
A
l
c
o
h
o
l
-
7
0
%
E
t
h
y
l
A
l
c
o
h
o
l
&
7
0
%
I
s
o
p
r
o
p
y
l
A
l
c
o
h
o
l
-
E
f
f
e
c
t
i
v
e
&
r
a
p
i
d
l
y
a
c
t
i
n
g
d
i
s
i
n
f
e
c
t
a
n
t
s
.
*
A
l
c
o
h
o
l
g
e
l
p
r
e
p
a
r
a
t
i
o
n
s
t
o
d
a
y
h
a
v
e
b
e
e
n
i
n
t
r
o
d
u
c
e
d
&
l
o
n
g
s
t
a
n
d
i
n
g
e
f
f
e
c
t
,
f
a
s
t
i
n
a
c
t
i
o
n
&
m
o
r
e
u
s
e
r
s
f
r
i
e
n
d
l
y
.
(
H
a
n
d
A
n
t
i
s
e
p
t
i
c
s
)
C
h
l
o
r
e
x
i
d
i
n
e
-
S
k
i
n
a
n
t
i
s
e
p
t
i
c
&
h
i
g
h
l
y
a
c
t
i
v
e
a
g
a
i
n
s
t
v
e
g
e
t
a
t
i
v
e
b
a
c
t
e
r
i
a
.
H
y
p
o
c
h
l
o
r
i
t
e
-
B
r
o
a
d
s
p
e
c
t
r
u
m
c
h
l
o
r
i
n
e
d
i
s
i
n
f
e
c
t
a
n
t
e
f
f
e
c
t
i
v
e
a
g
a
i
n
s
t
v
i
r
u
s
e
s
,
f
u
n
g
i
,
b
a
c
t
e
r
i
a
&
s
p
o
r
e
s
.
*
D
i
s
i
n
f
e
c
t
a
n
t
o
f
c
h
o
i
c
e
a
g
a
i
n
s
t
h
e
p
a
t
i
t
i
s
B
v
i
r
u
s
.
O
t
h
e
r
M
e
t
h
o
d
s
o
f
S
t
e
r
i
l
i
z
a
t
i
o
n
:
G
a
m
m
a
R
a
d
i
a
t
i
o
n
G
a
m
m
a
R
a
d
i
a
t
i
o
n
-
R
a
d
i
o
a
c
t
i
v
e
m
a
t
e
r
i
a
l
,
s
u
c
h
a
s
a
C
o
b
a
l
t
-
6
0
s
o
u
r
c
e
,
e
m
i
t
s
r
a
d
i
a
t
i
o
n
(
g
a
m
m
a
r
a
y
s
)
.
Gamma Radiation
effectively
kills microorganisms.
Used on
commercial basis
for the sterilization of a
wide variety of pre-packaged hospital items and
devices.
Total sterilizing time is measured in
days
.
F
l
a
s
h
S
t
e
r
i
l
i
z
a
t
i
o
n
“
F
l
a
s
h
s
t
e
r
i
l
i
z
a
t
i
o
n
”
s
h
o
u
l
d
b
e
u
s
e
d
i
n
s
e
l
e
c
t
e
d
c
l
i
n
i
c
a
l
s
i
t
u
a
t
i
o
n
s
&
i
n
a
c
o
n
t
r
o
l
l
e
d
m
a
n
n
e
r
.
*
U
s
e
o
f
f
l
a
s
h
s
t
e
r
i
l
i
z
e
r
s
h
o
u
l
d
b
e
k
e
p
t
t
o
a
m
i
n
i
m
u
m
&
o
n
l
y
f
o
r
e
m
e
r
g
e
n
c
y
u
s
e
.
Flash sterilization should not be used as a substitute for
proper sterilization methods.
Flash sterilization should not be used for
implantable
devices.
P
r
i
n
c
i
p
l
e
s
o
f
A
s
e
p
t
i
c
T
e
c
h
n
i
q
u
e
s
B
y
:
M
s
.
N
i
d
a
J
.
S
a
l
c
e
d
o
A
D
O
N
-
O
.
R
.
For O.R. Set Up
(Sterile Field)
Aseptic techniques are sets of practices
performed under careful, controlled
conditions in order to prevent
contaminations of pathogens.
Most strictly applied in the O.R.
because of
direct & extensive disruption of skin &
underlying tissues.
Practices that ensure safe & effective ways in
establishing & maintaining sterile field in which
surgery can be performed safely.
Aseptic techniques help to prevent surgical site
infection.
•
A
l
l
i
t
e
m
s
u
s
e
d
w
i
t
h
i
n
t
h
e
s
t
e
r
i
l
e
f
i
e
l
d
m
u
s
t
b
e
s
t
e
r
i
l
e
.
Point of emphasis:
Sterile items presented to the sterile field
must be checked for:
* Package Integrity
* Expiration Date
* Chemical Process Indicator
Tears in barriers & expired sterilization dates
are considered breaks in sterility.
Use of unsterile
items
contaminate
the
sterile field.
Sterile field is created as well as sterile
packages are
opened as close as possible to
time of actual use.
Moist areas
are considered sterile.
•
S
c
r
u
b
b
e
d
p
e
r
s
o
n
n
e
l
s
h
o
u
l
d
f
u
n
c
t
i
o
n
w
i
t
h
i
n
a
s
t
e
r
i
l
e
f
i
e
l
d
.
S
u
r
g
i
c
a
l
t
e
a
m
i
s
m
a
d
e
u
p
o
f
:
*
S
t
e
r
i
l
e
m
e
m
b
e
r
s
o
r
s
c
r
u
b
b
e
d
p
e
r
s
o
n
n
e
l
-
work directly in the surgical field.
Ex. Surgeons, Scrub nurse, O.R. Technician
*
N
o
n
-
s
t
e
r
i
l
e
m
e
m
b
e
r
s
o
r
u
n
s
c
r
u
b
b
e
d
personnel
.
Ex. Anesthetists, Circulating nurses,
Anesthesia Technicians, X-Ray Technician
Points of Emphasis:
Surgical team members must wear the scrub
suit attire, surgical cap, surgical face mask
before performing surgical hand scrub.
F
i
r
s
t
s
u
r
g
i
c
a
l
h
a
n
d
s
c
r
u
b
s
h
o
u
l
d
b
e
a
t
l
e
a
s
t
5
m
i
n
u
t
e
s
&
t
h
e
s
u
b
s
e
q
u
e
n
t
h
a
n
d
,
a
t
l
e
a
s
t
2
t
o
3
m
i
n
u
t
e
s
.
Surgical hand scrubbing to be performed prior
to donning of sterile gown & sterile gloves.
A
f
t
e
r
d
o
n
n
i
n
g
t
h
e
s
t
e
r
i
l
e
g
o
w
n
i
s
d
o
n
n
i
n
g
t
h
e
s
t
e
r
i
l
e
g
l
o
v
e
s
.
(
C
l
o
s
e
d
G
l
o
v
i
n
g
T
e
c
h
n
i
q
u
e
i
s
r
e
c
o
m
m
e
n
d
e
d
i
n
O
.
R
.
)
N
e
v
e
r
l
e
t
t
h
e
f
i
n
g
e
r
s
e
x
t
e
n
d
b
e
y
o
n
d
t
h
e
s
t
o
c
k
i
n
e
t
t
e
c
u
f
f
)
•
T
h
e
s
t
e
r
i
l
i
t
y
i
s
l
i
m
i
t
e
d
t
o
t
h
e
p
o
r
t
i
o
n
s
o
f
t
h
e
g
o
w
n
s
d
i
r
e
c
t
l
y
v
i
e
w
e
d
b
y
t
h
e
s
c
r
u
b
b
e
d
p
e
r
s
o
n
.
Gowns are considered sterile only on the:
1. Front of gown from chest to the level of the
sterile field.
2. Sleeves of gown from 2 inches above the
elbow to the cuff.
Note:
Cuff
should be considered unsterile due
to it tends to collect moisture & it is not an
effective barrier. Therefore,
cuff should always
be covered by sterile gloves.
S
c
r
u
b
b
e
d
P
e
r
s
o
n
n
e
l
A
r
e
a
s
o
f
g
o
w
n
c
o
n
s
i
d
e
r
e
d
u
n
s
t
e
r
i
l
e
a
r
e
:
1. Gown’s neckline
2. Shoulders
3. Under the arms
4. Back
N
o
t
t
o
a
l
l
o
w
t
h
e
h
a
n
d
s
o
r
a
n
y
i
t
e
m
s
t
o
f
a
l
l
b
e
l
o
w
t
h
e
l
e
v
e
l
o
f
s
t
e
r
i
l
e
f
i
e
l
d
.
No sitting nor leaning against unsterile surface
because of great contamination.
•
S
t
e
r
i
l
e
d
r
a
p
e
s
a
r
e
u
s
e
d
t
o
c
r
e
a
t
e
a
s
t
e
r
i
l
e
f
i
e
l
d
.
S
u
r
g
i
c
a
l
D
r
a
p
e
s
a
r
e
s
t
e
r
i
l
e
m
a
t
e
r
i
a
l
s
u
s
e
d
t
o
maintain the sterility of the operation field.
Surgical Drapes establish an
aseptic barrier
minimizing the passage of microorganisms from
non sterile to sterile areas.
Sterile surgical drapes should be placed on the
patient, parts of O.R. table & equipment
included in the sterile field, leaving only the
incision site exposed.
D
R
A
P
I
N
G
P
R
O
C
E
S
S
Only the scrubbed personnel should handle sterile
drapes by cuffing the draping material over the
gloved hand.
When draping, it should be compact, held higher
than the O.R. table &
draped from the prepped
incision site to the periphery.
Tables
are only
sterile at table level.
Once
the
drape is placed
, it should
not be moved
or re-arranged
& only top surface is considered
sterile.
*
A
l
l
i
t
e
m
s
s
h
o
u
l
d
b
e
d
i
s
p
e
n
s
e
d
t
o
t
h
e
s
t
e
r
i
l
e
f
i
e
l
d
b
y
m
e
t
h
o
d
s
t
h
a
t
p
r
e
s
e
r
v
e
t
h
e
s
t
e
r
i
l
i
t
y
o
f
t
h
e
i
t
e
m
s
&
i
n
t
e
g
r
i
t
y
o
f
t
h
e
s
t
e
r
i
l
e
f
i
e
l
d
.
Open the sterile items: The
unscrubbed
person
should open the wrapper flap
farthest away from him
first & the
nearest
wrapper last
to prevent contamination by
passing an unsterile arm over a sterile
item.
After a sterile pack is opened, the
edges
are
considered unsterile
.
D
i
s
p
e
n
s
i
n
g
s
o
l
u
t
i
o
n
t
o
S
t
e
r
i
l
e
F
i
e
l
d
Either entire bottle contents should be poured
into the receptacle or
remainder should be
discarded.
Edge of the bottle cap
is considered unsterile
once opened.
Solution should be
poured slowly
to avoid
splashing.
Splashing can cause
strike through
&
contamination of the sterile field.
•
A
s
t
e
r
i
l
e
f
i
e
l
d
s
h
o
u
l
d
b
e
c
o
n
s
t
a
n
t
l
y
m
a
i
n
t
a
i
n
e
d
a
n
d
m
o
n
i
t
o
r
e
d
.
Surgical team members should maintain a
vigilant watch
on the sterile field & point out
any contamination immediately.
When breach of sterility occurs, an immediate
action to correct the break in technique.
.
Contaminated item must be removed
immediately from the sterile field.
•
M
o
v
e
m
e
n
t
a
r
o
u
n
d
a
s
t
e
r
i
l
e
f
i
e
l
d
m
u
s
t
n
o
t
c
a
u
s
e
c
o
n
t
a
m
i
n
a
t
i
o
n
.
T
h
e
o
p
e
r
a
t
i
v
e
s
i
t
e
i
s
t
h
e
c
e
n
t
e
r
o
f
t
h
e
s
t
e
r
i
l
e
f
i
e
l
d
&
a
l
l
s
c
r
u
b
b
e
d
p
e
r
s
o
n
n
e
l
s
h
o
u
l
d
r
e
m
a
i
n
c
l
o
s
e
t
o
t
h
i
s
a
r
e
a
.
M
o
v
e
m
e
n
t
s
c
a
n
c
a
u
s
e
c
o
n
t
a
m
i
n
a
t
i
o
n
t
o
t
h
e
s
t
e
r
i
l
e
f
i
e
l
d
.
Surgical team should move only from sterile
areas to sterile areas.
C
h
a
n
g
e
p
o
s
i
t
i
o
n
s
–
S
h
o
u
l
d
t
u
r
n
b
a
c
k
t
o
b
a
c
k
o
r
f
a
c
e
t
o
f
a
c
e
&
m
a
i
n
t
a
i
n
a
s
a
f
e
d
i
s
t
a
n
c
e
c
l
o
s
e
t
o
t
h
e
s
t
e
r
i
l
e
f
i
e
l
d
.
P
o
i
n
t
s
o
f
E
m
p
h
a
s
i
s
-
S
c
r
u
b
b
e
d
P
e
r
s
o
n
n
e
l
Keep arms &
hands within the sterile field at all
times
to avoid any accidental contact with unsterile
areas.
Keep gloved hands in sight & kept at waist level or
above
because below the waist is contaminated.
Maintain a safe distance when approaching
unsterile objects and personnel. Identify safe
boundaries.
U
n
-
s
c
r
u
b
b
e
d
P
e
r
s
o
n
n
e
l
Remain in non-sterile area to prevent
contamination of the sterile field.
Always face the sterile field on approach and
should never walk between 2 sterile fields
.
O.R. personnel with colds & URTI should avoid
working inside the theater.
•
I
t
e
m
s
o
f
d
o
u
b
t
f
u
l
s
t
e
r
i
l
i
t
y
m
u
s
t
b
e
c
o
n
s
i
d
e
r
e
d
u
n
s
t
e
r
i
l
e
.
When a
sterile barrier is permeated
, it must be
considered contaminated.
Once set up, the sterile field should be
monitored constantly and not be left
unattended.
Non sterile items should not cross above a
sterile field.
The
margin of safety
is generally identified as a
minimum of 12 inches.
S
t
e
r
i
l
e
W
o
u
n
d
D
r
e
s
s
i
n
g
Dressing material should only
be opened during
wound dressing time.
Wound or surgical site should be cleaned &
dried before application of the dressing
material.
Applied before surgical drapes are removed
to
avoid contamination of the incision.
T
a
k
e
n
o
t
e
S
u
r
g
i
c
a
l
t
e
a
m
m
u
s
t
p
r
a
c
t
i
c
e
t
h
e
s
e
p
r
i
n
c
i
p
l
e
s
o
f
a
s
e
p
t
i
c
t
e
c
h
n
i
q
u
e
t
o
p
r
e
v
e
n
t
t
h
e
t
r
a
n
s
f
e
r
o
f
m
i
c
r
o
o
r
g
a
n
i
s
m
s
i
n
t
o
t
h
e
s
u
r
g
i
c
a
l
w
o
u
n
d
.
S
u
r
g
i
c
a
l
t
e
a
m
m
e
m
b
e
r
s
’
r
e
s
p
o
n
s
i
b
i
l
i
t
y
t
o
d
e
v
e
l
o
p
a
s
t
r
o
n
g
s
u
r
g
i
c
a
l
c
o
n
s
c
i
e
n
c
e
,
a
d
h
e
r
i
n
g
t
o
t
h
e
p
r
i
n
c
i
p
l
e
s
o
f
s
u
r
g
i
c
a
l
a
s
e
p
s
i
s
&
c
o
r
r
e
c
t
i
n
g
a
n
y
i
m
p
r
o
p
e
r
t
e
c
h
n
i
q
u
e
w
i
t
n
e
s
s
e
d
i
n
t
h
e
O
R
.
K
i
n
g
K
h
a
l
i
d
U
n
i
v
e
r
s
i
t
y
H
o
s
p
i
t
a
l
O
p
e
r
a
t
i
n
g
R
o
o
m
O
p
e
r
a
t
i
n
g
R
o
o
m
S
e
t
U
p
f
o
r
P
a
t
i
e
n
t
S
a
f
e
t
y
B
y
:
M
s
.
N
i
d
a
J
.
S
a
l
c
e
d
o
A
D
O
N
-
O
.
R
.
M
a
i
n
O
b
j
e
c
t
i
v
e
-
T
o
b
e
a
b
l
e
T
o
a
c
q
u
i
r
e
k
n
o
w
l
e
d
g
e
&
u
n
d
e
r
s
t
a
n
d
i
n
g
a
b
o
u
t
t
h
e
O
p
e
r
a
t
i
n
g
R
o
o
m
s
e
t
u
p
i
n
o
r
d
e
r
t
o
e
n
s
u
r
e
s
a
f
e
e
n
v
i
r
o
n
m
e
n
t
&
s
a
f
e
s
u
r
g
i
c
a
l
p
r
a
c
t
i
c
e
s
t
o
w
a
r
d
s
p
a
t
i
e
n
t
s
a
f
e
t
y
.
O
p
e
r
a
t
i
n
g
R
o
o
m
S
e
t
U
p
O.R. as a system
Effective flow of information &
communication.
Teamwork
Culture of Patient Safety-Safe
environment & safe surgical practices.
Just & fair culture
Environment of continuous learning
Cutting edge equipment & supplies –
advance technology.
S
e
t
t
i
n
g
u
p
a
n
O
r
g
a
n
i
z
e
d
O
p
e
r
a
t
i
n
g
R
o
o
m
-
A
s
s
i
s
t
t
h
e
S
u
r
g
i
c
a
l
T
e
a
m
To work in an efficient & timely
manner, which is critical when
performing life-saving procedures.
To focus & offer a safe environment &
quality surgical services to the surgical
patients.
P
e
r
i
o
p
e
r
a
t
i
v
e
S
t
a
g
e
s
Immediate Pre - operative Stage – O.R.
Pre-Op. Holding Area, before entering
O.R. theater.
Intra - operative Stage – Inside the
theater, during the surgery.
Immediate Post - operative – Post
Anesthesia Care Unit (PACU) – After
surgery.
O
.
R
.
Z
o
n
e
s
/
A
r
e
a
s
Unrestricted Areas
- where street
clothes are permitted. Ex. Changing
Rooms
Semi -restricted Areas
– Hallways,
corridors, O.R. offices, equipment &
instruments’ storage rooms & staff
sitting rooms.
Restricted Areas
– Sterile Storage
Room, Inside Operating theaters
.
O
.
R
.
T
h
e
a
t
e
r
P
h
y
s
i
c
a
l
B
a
s
i
c
S
e
t
U
p
Operating Room Table & accessories
Operating Room Surgical Light
Anesthesia Machine & Anesthesia Trolley for
Intubation & Anesthesia supplies
Physiological Monitor
Suction Machines
ESU (Electro Surgical Unit)
Mayo Table / Instrument Trolleys
Equipment according to specialty
P
r
o
p
e
r
S
u
r
g
i
c
a
l
A
t
t
i
r
e
i
n
t
h
e
O
.
R
.
Provides barrier between O.R. personnel &
patient
Protection of O.R. personnel against exposure
to infectious microorganism.
KKUH Policy – All O.R. personnel who enter
the semi-restricted areas & restricted areas of
O.R. must wear freshly laundered surgical
scrub suits intended only to be used within the
O.R.
S
u
r
g
i
c
a
l
A
t
t
i
r
e
-
2
p
i
e
c
e
s
c
r
u
b
s
u
i
t
,
O
.
R
.
C
a
p
/
H
o
o
d
,
O
.
R
.
C
l
o
g
s
,
S
u
r
g
i
c
a
l
F
a
c
e
M
a
s
k
&
o
t
h
e
r
P
P
E
S
c
r
u
b
S
u
i
t
If soiled or wet, must be changed.
Lab coat/cover gown is to be worn
whenever leaving the O.R.
Lab coat not to be brought inside the
O.R. semi-restricted & restricted areas.
S
u
r
g
i
c
a
l
A
t
t
i
r
e
O
.
R
.
C
a
p
/
S
u
r
g
i
c
a
l
H
o
o
d
/
S
u
r
g
i
c
a
l
M
a
s
k
Head & facial hair to be covered.
High filtration surgical mask to be used in
restricted areas.
Discard surgical mask when not in use.
Leave O.R. without surgical mask hanging
on the neck.
S
u
r
g
i
c
a
l
A
t
t
i
r
e
O
.
R
.
C
l
o
g
s
(
O
.
R
.
F
o
o
t
w
e
a
r
)
No street shoes to be worn in O.R.
Intended for O.R. use only
Shoe covers may be worn if anticipated
splashes may occur
Cleaning & disinfection of clogs to be done
when soiled.
E
f
f
e
c
t
i
v
e
C
o
m
m
u
n
i
c
a
t
i
o
n
i
n
O
.
R
.
“
Communication failure is the root cause
of sentinel events in the O.R.
”
Sophisticated instruments / state - of the
- art equipment.
Transfer of critical information.
Changing nature of patient’s condition.
Uncertainty inherent in surgery.
W
a
y
s
t
o
E
s
t
a
b
l
i
s
h
G
o
o
d
C
o
m
m
u
n
i
c
a
t
i
o
n
i
n
O
.
R
.
Eliminate hierarchy
Encourage team approach to care
(Teamwork)
SBAR as a tool / Read back
technique
Pre-operative Checklist
Surgical Safety Checklist
Time Out Procedure
C
a
u
s
e
s
o
f
W
r
o
n
g
-
S
i
t
e
,
W
r
o
n
g
-
P
r
o
c
e
d
u
r
e
,
W
r
o
n
g
-
P
e
r
s
o
n
S
u
r
g
e
r
y
Ineffective communication among members of
the surgical team.
Improper procedures for verifying operative site.
Lack of patient involvement in site marking
Inadequate patient assessment (Patient Care
Plan)
Inadequate medical record review.
Wrong patient identifiers.
Illegible handwriting
Use of abbreviations related to surgical
procedure (site or laterality)
C
a
u
s
e
s
o
f
W
r
o
n
g
-
S
i
t
e
,
W
r
o
n
g
-
P
r
o
c
e
d
u
r
e
,
W
r
o
n
g
-
P
e
r
s
o
n
S
u
r
g
e
r
y
Multiple procedures
Under time pressure
More than one surgeon
Unusual patient characteristics.
U
n
i
v
e
r
s
a
l
P
r
o
t
o
c
o
l
–
f
o
r
P
r
e
v
e
n
t
i
n
g
W
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Pre-operative verification process
Marking of the surgical site
Time-out before start of procedure
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At the time procedure is scheduled.
At pre-admission testing & assessment
At the time of admission to the floor
Anytime responsibility of care for patient is
transferred to another healthcare provider.
Before patient leaves preoperative area or
enters O.R.
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Write “ Left” or “Right” indicated in the
surgical informed consent.
Surgical site is marked with the patient
involved, awake & alert if possible.
Mark should be visible after patient has been
prepped and draped.
Do not mark any non-operative site.
Marking should be done by the one who will
perform the procedure.
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Correct patient’s identity
Correct side/site is marked
Accurate & complete signed informed surgical
consent
Agreement on procedure to be performed
Correct patient’s position
Availability of correct implants, special equipment
or requirements
Images are labeled & correctly displayed
Safety precautions based on patient’s history &
medication use
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Ensuring Fire Safety
Ensuring Infection Control
Measures – Waste Management;
Sharps Safety
Maintenance of proper Hand
Hygiene
Preventing Overbooking of O.R.
surgical lists.
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Prepare patients appropriately- Skin
preparation should be done properly.
Test equipment before use
Use equipment safely.
Maintain equipment – PPM
Laser Safety.
Control of excess oxygen in the
environment
Engage staff in fire prevention – Fire Drills
Responding to O.R. Fire
Shut down medical gases.
Pour saline into surgical site.
Remove burning material
Ventilate with air instead of oxygen
.
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Air quality & ventilation
Effective O.R. cleaning – Terminal
cleaning
Effective medical equipment
cleaning & disinfection
Effective laundry cleaning
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Maintain positive pressure ventilation
Maintain 15 air changes cycle per hour &
at least 3-4 fresh air changes
Ensure filtered air
Introduce air from ceiling & exhaust near
the floor
Keep theater doors closed always
Use proper O.R. attire in O.R. restricted
areas.
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Patient should be intubated in AIIR
(Airborne Infection Isolation Room)
Patient wears a surgical mask.
Use surgical N95 mask or respirator.
Use bacterial filter with anesthesia
equipment.
Schedule as last surgical case of the day.
Extubate & allow recovery in AIIR.
O
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Damp dusting before the first
procedure.
Proper cleaning in between cases.
Terminal cleaning once every 24 hours.
Use wet vacuum & single use mop.
General cleaning weekly.
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Antiseptics to be used in O.R.
should be a combination of 2
antiseptics with different
mechanisms of action can be
better at fighting bacteria than a
single antiseptic
.
Example: Iodine 10% & Alcohol 70%
Reducing Surgical Site Infections
Use prophylactic antibiotics
Use sterile instruments, aseptic techniques adherence
Remove hair properly through hair clipping.
Ensure glycemic control.
Prevent hypothermia.
Provide supplemental O2 during surgery.
Limit O.R. traffic – Visitor Control Policy, Visitor’s permit
Designate specific rooms and routes – Traffic Pattern
Use of disposable items – No reprocessing is allowed.
Follow manufacturer’s instructions.
Monitor staff’s health.
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Use a neutral zone.
Practice double gloving
Change surgical gloves
Be very vigilant & stay out of the
way
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Set clear rules
Consider O.R. time utilization as a
guideline
Review block time regularly
Emergency theater not to be used
for elective cases.
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Emergency surgeries
Complex procedures
Surgeries with unplanned procedures
Surgeries on off hours
Sponges used on retractors & as
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Patients with high body mass index
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Educate staff , regular update for
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Review policies & procedures on
counting.
Ensure effective communication during the
entire surgical procedure.
Minimize rush
Minimize distractions
Perform x-ray on all high-risk patients.
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Explore the methods and processes of sterilization, principles of aseptic techniques, and operating room setup for patient safety. Learn terminologies related to sterilization, asepsis, sepsis, antiseptics, and disinfection to ensure a sterile environment for medical procedures.
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STERILIZATION STERILIZATION & & Operating Room Set Operating Room Set Up Up By: Ms. Nida Jerez Salcedo ADON O.R.
Main Objectives: To be able To acquire knowledge and understanding on the different methods of sterilization as well as the sterilization processes. To know & get familiarized with the principles of aseptic techniques & apply them in the clinical areas & Operating Room.
Table of Contents: Methods of Sterilization Physical Methods Cool Chemical Methods Liquid Chemicals Other Methods Sterilization Processes Preparation of items before sterilization Steam Sterilization Process Testing the Effectiveness of the Autoclave Storage of Sterile Packages Principles of Aseptic Techniques-O.R. Set Up (Sterile Field) Operating Room Set Up for Patient Safety
Terminologies Sterilization-process by which all living microorganisms both pathogenic & non- pathogenic including spores are killed. Sterile-absence of all microorganisms including bacteria, spores and viruses. Asepsis- freedom from infection or the absence of microorganisms that cause diseases.
Terminologies Sepsis- generalized reaction to pathogenic microorganism which is evident clinically by signs of inflammation & febrile conditions Aseptic Techniques-practices that restrict microorganisms in the environment, equipment, supplies & prevention of the normal body flora from contaminating the surgical wound. (Method by which contamination with microorganisms is prevented).
Terminologies Contamination-introduction of microorganisms to a sterile field. Antiseptics-substances that renders microorganisms on living tissue inactive by preventing their growth. Used to disinfect body surfaces, skin & tissue. Inhibits the growth of endogenous bacteria. (Combat sepsis)
Terminologies Disinfection-process by which renders inanimate objects free of pathogenic bacteria. Disinfectants-agents that kill all growing or vegetative forms of microorganisms thus completely eliminating them from inanimate objects. Contamination-introduction of microorganisms to a sterile field.
The prevention of infection in health care areas is largely dependent on the following: Rigorous adherence to the principles of aseptic techniques by all personnel who performs any invasive procedures on patients. Sterility of all items directly used in such procedures. Disinfection of all surfaces & other items in the immediate environment. Other methods Prevention of SSI-Bundle of Care
Remember: There is no degree of sterility. An item is either sterile or non- sterile. It can never be relatively sterile.
Take Note: Surgical instruments, devices & heat sensitive items are sterilized by the method recommended by the manufacturer. No sterile disposable items designed for single use should be reprocessed. Sterilizing agent should be in contact with every part / surface of the item to be sterilized at specific period of time & temperature.
Methods of Sterilization: Physical Methods: 1. Dry Heat-Hot air ovens, infra red ovens. 2. Moist heat- Steam Autoclave-(Available in KKUH) Cool Chemical Methods: 1. E.O. Sterilizer 2. Plasma Sterilizer (Sterrad)- (Available in KKUH) 3. Liquid Chemicals Other Methods
Physical Method: Moist heat, at raised atmospheric pressure Steam sterilization (steam under pressure) - most inexpensive & effective method of sterilization. Steam under pressure permits permeation of moist heat to porous substances by condensation & results in destruction of all microbial life. . Ex. Steam autoclave Method used for sterilizing surgical instruments, dressing, drapes, swabs, laps sponges & culture media.
Steam Autoclave An autoclave is a closed chamber in which items or objects are subjected to steam at high pressure & temperature above 100 C.
Types of Autoclaves: Downward Displacement Autoclave- Air is removed in two stages & sterilization is effected by pure steam. Minimum exposure time required for sterilizing instruments is 50 minutes at 131 C or 60 minutes at 136 C.
Types of Autoclaves: High Vacuum / High Pressure Autoclave- Air is removed by powerful pump. Steam penetrates the load & very rapid sterilization of dressings, instruments, raytec swabs, lap sponges, other surgical items & packs is possible in 30 to 40 minutes at 134 C. (Available in KKUH)
Preparation Of Items Before STERILIZATION 1. Decontamination 2. Disassembly 3. Washing 4. Drying 5. Packing 6. Loading in sterilizer
THE STEAM STERILIZATION PROCESS FIVE DISTINCT PHASES: PHASE I - Loading phase - in which the objects or packs are loaded in the sterilizer. PHASE II - Heating phase - in which the steam is brought to proper temperature & allowed to penetrate through the objects in the chamber. PHASE III - Destroying phase or time temperature cycle - in which all microbial life is exposed to the killing effect of the steam.
THE STEAM STERILIZATION PROCESS PHASE IV - Drying and cooling phase - in which the objects are dried & cooled then, filtered air is introduced into the chamber, door is opened & packs are removed stored. PHASE V - Testing phase - in which the efficiency of the sterilization process is checked. All mechanical parts of sterilizers, including gauges, steam lines & drains should be periodically checked by a competent biomed engineer.
MAKING OF STERILE PACKS Should have the following external indications showing that they have been processed: Autoclave tapes show a pack that has been through a sterilization cycle & should be visible outside every pack sterilized. Autoclave tape is designed black when specified temperature is reached. Must be labeled as to its contents with the processing date, autoclave used & load number. This assists locating processed items in case of recall.
STORAGE OF STERILE PACKS Sterile packs / sets should be left untouched & allowed to be cooled before storage to avoid condensation inside. Must be handled as little as possible to reduce the risk of contamination.
STORAGE OF STERILE PACKS Sterile packages should be stored on open shelves. The lowest shelf should be 8 to 10 inches off the floor. The highest shelf should be 18 inches from the ceiling. All shelves should be at least 2 inches from the walls.
STORAGE OF STERILE PACKS Either good for 30 days or 6 months to one year depending on how the packages are wrapped & what type of wrappers used. Shelf life - refers to the length of time a package maybe considered sterile. Sterile packages must be stored and issued in correct order. Traceability (Tracking System)
STORAGE OF STERILE PACKS Storage room-subjected to regular adequate pest control to prevent contamination from rodents, ants & cockroaches. Traffic is restricted to CSSD personnel & trainees only. One flow
Causes of failure to produce a sterile load Faults & errors in the autoclave Poor quality steam Way it is operated Failure to remove air & condensate Faulty gauges & timings Leaking door seals Inadequate air filter Excessive layers of wrapping materials Large packs, torn & wet packs
Methods of Testing the Effectiveness of Autoclaves: Mechanical- chart & gauges usually carried out by Biomed Engineer. Chemical- by the use of autoclave tapes, strips and card. A daily test in an empty chamber using a heat sensitive tape. This is for high vacuum/high pressure autoclaves. Ex. Bowie Dick Test Pack- a pack with a chemical indicator both outside & inside to verify that steam has penetrated the pack & to test air leaks. Biological
Biological Indicator- Biological Spore Testing To test autoclaves regularly with Geobacillus stearothermophilus, which is one of the most heat tolerant species of bacteria. If sterilization in an autoclave does not destroy the Geobacilus spores, the autoclave is not working properly. http://www.atssupplies.com/__CategoryImage/5_27_2011_5_14_49_AM_297.png
Testing the Effectiveness of Steam Autoclave: First- Run it empty for one cycle. (Dummy Run) to warm up the machine. Second- Put inside in the middle of the chamber, the Bowie Dick Test Pack and run it again and finish the whole cycle. Oh high pressure- to test leaks and presence of air. (Yellow turns black) Third- Load the items & trays for sterilization ( little bit lower pressure). It is done once daily. Fourth- Live Organism- done once in every Sunday morning in CSSD, KKUH.
COLD METHOD-Chemicals Ethylene Oxide (EO)- *Well established technique for sterilizing heat sensitive articles. *Colorless gas * Exposure period of 5 to 7 hours is necessary for complete E.O. sterilization. *Temperature for sterilizing is 21 C to 60 C (70 F to 140 F).
E.O. Sterilizer Used for sterilizing vascular & bone grafts, delicate instruments, plastic articles such as disposable syringes,bacteriological media & vaccines.
Ethylene Oxide (EO) Chemical indicators for EO should be used with each pack . Gas sterilizers should be checked once a week with commercial preparation spores, usually Bacillus Atropheus. Requires 6-8 hours of aeration.
DISADVANTAGES OF EO Lengthy process with long aeration periods. Expensive & more complex process. Produce serious burns on exposed skin. Insufficiently aerated materials can cause irritation, burns of body tissues. Toxic & may cause Cancer. *Precautions should be taken to protect personnel.
Plasma Sterilizer Plasma Autoclave (Sterrad)- *Low Temperature Hydrogen Gas Sterilizers. *Used to sterilize delicate instruments that are heat & moisture sensitive, such as micro instruments, cameras, scopes & light cords. *Gentle patented sterilization process with the use of hydrogen peroxide & generation of low temperature gas plasma. *Spore testing should be performed at the same interval as testing of other sterilizers.
Plasma Sterilization 104 F-131 F (40 C-55 C). 45 minutes to I hour. Advantages of plasma sterilization include speed, safety of use, & no aeration. Five phases to the Sterrad Plasma sterilization cycle: vacuum, injection, diffusion, plasma, vent.
LIQUID CHEMICAL STERILIZATION Liquid chemo sterilizers can destroy all forms of microbial life including bacterial, fungal spores, tubercle bacilli & viruses. Can be used for sterilization when steam, gas or dry heat is not indicated or available.
Common Liquid Chemicals - Capable of causing Disinfection / Sterilization. Aqueous Formaldehyde- Oldest chemo sterilizers known to destroy spores; rarely used due to its pungent odor. Aqueous Glutaraldehyde- Colorless liquid chemical with pungent odor. (CIDEX) *Short soaking period( 20 minutes-30 minutes) only provides disinfection of instruments. *Complete immersion in activated glutaraldehyde solution for 10 hours achieves sterilization. *After immersion, all surfaces of the instruments must be rinsed thoroughly with sterile water before use. *Any immersion of less than 10 hours must be considered as only as disinfection(Spores not killed. *Toxic & can cause nasal ( respiratory mucosa), eye & skin irritation.
Common Liquid Chemical Disinfectants OPA Cidex-(0.55% ortho-phthalaldehyde)-Clear, pale-blue liquid (pH, 7.5), contains 0.55%the non-glutaraldehyde solution for disinfection of flexible endoscopes and other medical devices. Alcohol- 70 % Ethyl Alcohol & 70% Isopropyl Alcohol- Effective & rapidly acting disinfectants. *Alcohol gel preparations today have been introduced & long standing effect, fast in action & more users friendly.( Hand Antiseptics) Chlorexidine- Skin antiseptic & highly active against vegetative bacteria. Hypochlorite- Broad spectrum chlorine disinfectant effective against viruses, fungi, bacteria & spores. *Disinfectant of choice against hepatitis B virus.
Other Methods of Sterilization: Gamma Radiation Gamma Radiation-Radioactive material, such as a Cobalt-60 source, emits radiation(gamma rays). Gamma Radiation effectively kills microorganisms. Used on commercial basis for the sterilization of a wide variety of pre-packaged hospital items and devices. Total sterilizing time is measured in days.
Flash Sterilization Flash sterilization should be used in selected clinical situations & in a controlled manner. *Use of flash sterilizer should be kept to a minimum & only for emergency use. Flash sterilization should not be used as a substitute for proper sterilization methods. Flash sterilization should not be used for implantable devices.
Principles of Aseptic Techniques By: Ms. Nida J. Salcedo ADON-O.R. For O.R. Set Up (Sterile Field)
Aseptic techniques are sets of practices performed under careful, controlled conditions in order to prevent contaminations of pathogens. Most strictly applied in the O.R. because of direct & extensive disruption of skin & underlying tissues. Practices that ensure safe & effective ways in establishing & maintaining sterile field in which surgery can be performed safely. Aseptic techniques help to prevent surgical site infection.
All items used within the sterile field must be sterile. Point of emphasis: Sterile items presented to the sterile field must be checked for: * Package Integrity * Expiration Date * Chemical Process Indicator Tears in barriers & expired sterilization dates are considered breaks in sterility.
Use of unsterile items contaminate the sterile field. Sterile field is created as well as sterile packages are opened as close as possible to time of actual use. Moist areas are considered sterile.
Scrubbed personnel should function within a sterile field. Surgical team is made up of: * Sterile members or scrubbed personnel- work directly in the surgical field. Ex. Surgeons, Scrub nurse, O.R. Technician * Non-sterile members or unscrubbed personnel. Ex. Anesthetists, Circulating nurses, Anesthesia Technicians, X-Ray Technician
Points of Emphasis: Surgical team members must wear the scrub suit attire, surgical cap, surgical face mask before performing surgical hand scrub. First surgical hand scrub should be at least 5 minutes & the subsequent hand, at least 2 to 3 minutes. Surgical hand scrubbing to be performed prior to donning of sterile gown & sterile gloves.
