PICNet CONFERENCE 2013 THE ORIGINAL STEAM STERILIZERS ORIGINAL STEAM STERILIZER. SCOPING THE HORIZON Penny Brawn

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1 PICNet CONFERENCE 2013 SCOPING THE HORIZON Penny Brawn THE ORIGINAL STEAM S ORIGINAL STEAM 1

2 A LITTLE HISTORY Back in 1450 BC in Moses time, writings were found in books of Leviticus involving purification of materials by fire and boiling water. In BC Hippocrates poured boiling water on surgical instruments to clean them. In Italian Biologist Lazzaro Spallanzani discovered it took 30 minutes to kill bacteria by heating them in glass flasks HISTORY Cont s Louis Pasteur also showed that once a medium is sterilized it will remain sterilized until introduced to micro organisms. Simple boiling to 100C was not totally effective because it did not kill all spores, but he learned that by increasing the pressure by 15pounds, then the water will boil at 121Deg C. This did kill all life forms in 15 minutes or less. HISTORY Cont Current design of the autoclave was largely finalized in 1880 by Charles Chamberland, a colleague of Pasteur s 1681 Denis Papin a physicist invented the steam engine but he also invented a steam pressure cooker an early version of the autoclave. 2

3 AUTOCLAVE Why is it called an Autoclave? Descibes a device that t automatically locks shut when the pressure rises. The word is French, but comes from the Greek auto for automatic and the Latin clvis for key. (as in lock and key) REPROCESSING FOR SMALL FACILITIES Rural Health Care ( clinics/diagnostic & treatment centres ) Personal Care Services ( foot care ) Dental Offices Dr s Offices Tattoo Establishments REPROCESSING Problems around reprocessing: Lack of standards Lack of training/knowledge for staff Lack of a proper reprocessing area Lack of Manufacturer s Instructions for reprocessing - instruments and sterilizer Little or no monitoring 3

4 STANDARDS FOR S What Standards? 2011 Ministry of Health, Best Practice Guidelines for Cleaning, Disinfection and Sterilization in Health Authorities CSA Standards Z Effective Sterilization in Healthcare Facilities by the Steam Process CSA Standards Z Decontamination or Reusable Medical Devices ANSI/AAMI ST55:2010 Table Top Steam Sterilizers HOSPITAL ACQUIRED INFECTIONS In Canada, 220,000 people acquire HAI s every year Over 8,000 DIE! HAI s cause needles human suffering, resulting in huge financial burden (Dr Dick Zoutman MD FRCPC Professor Microbiology & Infectious Diseases Queens University) HOSPITAL ACQUIRED INFECTIONS The cost to treat 1 individual with MRSA is estimated to be in excess of $8,000 to $10,000 Canadian 4

5 WORDS OF WISDOM Proper cleaning is the FIRST step in the sterilization process Sterilization does NOT occur by magic! It takes people, process knowledge, commitment, and technical information. REPROCESSING MEDICAL DEVICES Decontamination is the 1 st most important step Always wear PPE! Disassemble any instruments Use fresh enzymatic detergent in warm water. Allow this detergent the appropriate time to do it s job! Brush under the level of the water. REPROCESSING MEDICAL DEVICES Rinse thoroughly Lubricate if necessary with a water soluble lubricant Assemble and wrap the sets or single instruments Prepare for sterilization 5

6 /AUTOCLAVE Pressure Vessel: sealed cavity capable of withstanding internal pressure above atmospheric pressure Sterilizer Apparatus used to sterilize medical devices by direct exposure to a sterilizing agent Usually saturated steam under pressure A table top steam sterilizer is defined as: A compact steam sterilizer that has a chamber volume of not more than 2 cubic feet. Generates it s own steam when distilled or de-ionized water is added to a reservoir by the user! 6

7 Always follow manufactures instructions on how to use the sterilizer. Make sure policies and procedures are in place Staff must be trained prior to using the sterilizer Packaging: Lubricate device with a water soluble lubricant so steam will penetrate Do not assemble devices Select appropriate packaging Medical grade and seal appropriately Use an appropriate Chemical Indicator such as a class 4 inside each package Label package with a non toxic permanent marking pen on the plastic side of a peel pouch. Not paper side. Date, name of device or set, signature etc. DISPOSABLE POUCHES 7

8 DISPOSABLE WRAP CLASS 4 CHEMICAL INDICATOR Sample of the Class 4 Chemical Indicator multi variable (reacting to two critical parameters e.g. time & temp) Check the level of the water in the reservoir. Use distilled or de-ionized water List the items going into the chamber for your records Load devices according to manufacturer s recommendations stand peel pouches on their side, bowls on their side or upside down, trays should be on their side unless they have holes in 8

9 pdf NO, NO, NO, NEVER DO THIS! Position a Biological Indicator according to manufacturer s instructions (usually in the center of the load) with a Chemical Indicator Class 5 Packages should not touch the chamber walls Select the correct cycle 9

10 BIOLOGICAL INDICATOR S Program/Load Temperature Time BI Unwrapped instruments on a 270 F-274 F 3 tray or glassware (132 C-135 C) Minutes Wrapped tray of instruments or 270 F-274 F 4-5 individually wrapped (132 C-135 C) Minutes Packs, wrapped 250 F (121 C ) 30 Minutes Liquids 250 F (121 C) 15 Minutes BI in unwrapped tray BI in wrapped tray or pouch & include porous items BI in wrapped pack that is representative of the load BI suspended above a test container of the load S When cycle is complete Verify the cycle parameters Exposure Time Temperature Pressure This is found on the printout and sign it. 10

11 S Vent the steam Ensure the pressure has returned to zero Crack the door and wait for the steam to escape Leave the load in the sterilizer to cool and dry before removing the load. Verify the Chemical Indicator has turned correctly Incubate the Biological Indicator as per manufacturer s instructions No evidence of moisture is acceptable Chemical indicator must have changed colour Incubate Biological Indicator, a negative result is required. Observe packaging for burn marks and moisture spots Complete documentation as required. STEAM STERILIZATION ACHIEVED To prove you have achieved sterilization you need The print out permanent record keep for the life of the machine! The Biological Indicator Negative result The Chemical Indicator Class 3 or Class 4 to show steam has penetrated inside your bundles. 11

12 STORAGE OF STERILE PACKAGES Storage of sterile devices When packages are completely dry store in a clean environment In a closed cupboard, On a clean wire shelf in washable containers. QUESTIONS? Thank you! 12