PICNet CONFERENCE 2013 S COPING THE HORIZON Penny Brawn THE - - PowerPoint PPT Presentation

PICNet CONFERENCE 2013

S COPING THE HORIZON

Penny Brawn

THE ORIGINAL STEAM STERILIZERS

ORIGINAL STEAM STERILIZER

A LITTLE HISTORY

 Back in 1450 BC in Moses time, writings were

found in books of Leviticus involving purification

• f materials by fire and boiling water.

 In 460 –

377BC Hippocrates poured boiling water

• n surgical instruments to clean them.

 In 1729 –

1799 Italian Biologist Lazzaro S pallanzani discovered it took 30 minutes to kill bacteria by heating them in glass flasks

HISTORY

Cont… ..

 1880’ s Louis Pasteur also showed that once a

medium is sterilized it will remain sterilized until introduced to micro organisms. S imple 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

• f the autoclave.

AUTOCLAVE

 Why is it called an

Autoclave?

Descibes a device that 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/ diagnost ic &

treatment centres )

 Personal Care S

ervices ( foot care )

 Dental Offices  Dr’ s Offices  Tattoo Establishment s

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

STANDARDS FOR TABLE TOP STERILIZERS

What S tandards?

 2011 Ministry of Health, Best Practice

Guidelines for Cleaning, Disinfection and S terilization in Health Authorities

 CS

A S tandards Z314.3-09 Effective S terilization in Healthcare Facilities by the S team Process

 CS

A S tandards Z314.8-08 Decontamination or Reusable Medical Devices

 ANS

I/ AAMI S T55:2010 Table Top S team S terilizers

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 MRS A is estimated to be in excess of $8,000 to $10,000 Canadian

WORDS OF WISDOM

 Proper cleaning is the

FIRS T step in the sterilization process

 S

terilization does NOT occur by magic!

 It takes people,

process knowledge, commitment, and technical information.

REPROCESSING MEDICAL DEVICES

 Decontaminat ion is the 1st 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 j ob!

 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

TABLE TOP STERILIZER/AUTOCLAVE Pressure Vessel :

sealed cavity capable of withstanding internal pressure above atmospheric pressure

TABLE TOP STERILIZER

 S

terilizer

 Apparatus used to sterilize medical devices by

direct exposure to a sterilizing agent

 Usually saturated steam under pressure

TABLE TOP STERILIZER

 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!

TABLE TOP STERILIZER

 Always follow manufactures instructions

• n how to use the sterilizer.

 Make sure policies and procedures are in

place

 S

taff must be trained prior to using the sterilizer

TABLE TOP STERILIZER

 Packaging:

– Lubricate device with a water soluble lubricant so

steam will penetrate

– Do not assemble devices – S

elect 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

• n the plastic side of a peel pouch. Not paper side.

– Date, name of device or set, signature etc.

DISPOSABLE POUCHES

DISPOSABLE WRAP

CLASS 4 CHEMICAL INDICATOR

 S

ample of the Class 4 Chemical Indicator multi variable (reacting to two critical parameters e.g. time & temp)

TABLE TOP STERILIZER

 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

TABLE TOP STERILIZER NO, NO, NO,… … NEVER DO THIS !

TABLE TOP STERILIZER

 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

 S

elect the correct cycle

BIOLOGICAL INDICATOR

TABLE TOP STERILIZERS

Program/Load Temperature

Time BI

Unwrapped inst rument s on a t ray or glassware 270° F-274°F (132° C-135° C) 3 Minut es BI in unwrapped t ray Wrapped t ray of inst rument s or individually wrapped 270° F-274°F (132° C-135° C) 4-5 Minut es BI in wrapped t ray or pouch & include porous it ems Packs, wrapped 250° F (121°C ) 30 Minut es BI in wrapped pack t hat is representat ive

• f t he load

Liquids 250° F (121°C ) 15 Minut es BI suspended above a t est cont ainer of t he load

TABLE TOP STERILIZERS

 When cycle is complete

– Verify the cycle parameters

 Exposure Time  Temperature  Pressure

This is found on the printout and sign it.

TABLE TOP STERILIZERS

 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

TABLE TOP STERILIZER

 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 documentat ion 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.

STORAGE OF STERILE PACKAGES

 S

torage 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.

TABLE TOP STERILIZER

QUES TIONS ? Thank you!