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5 Steps To Sterilizing Instruments For The Operating Room

As you know, having sterile instruments for surgery is non-negotiable. When you follow the proper procedures, you greatly minimize the risk of patient infection. Here are the five steps to sterilizing instruments used in your operating room so your patients are much more likely to have a healthy recovery.  

1. Properly Clean

Cleaning is actually a multi-step process, and it generally starts with a manual cleaning cycle. This involves briefly soaking the instruments in warm water with an enzymatic detergent to soften and loosen the contaminants. Next, a soft-bristle brush should be used to gently scrub the instruments. This should be done beneath the water's surface to help prevent particles of dirty water from spraying into the air.

After that, the instruments should be placed inside an ultrasonic cleaner. These machines work by releasing tiny bubbles that burst when they come in contact with the instrument. The action of the bubble bursting helps to loosen and kick away any microscopic contaminants that were missed during a manual clean. Surgical centers that need to wash a large amount of instruments can look into automatic washers, which can be likened to a dishwasher for surgical tools.

Lastly, the instruments should be thoroughly rinsed in distilled water and allowed to dry.

2. Inspect

Following the cleaning cycle, surgical instruments should be closely examined and inspected for any remaining dirt or contamination. Staff should also be looking for any damage present. If dirty instruments are found, they should never be cleaned in the inspection area but rather returned to the cleaning department.

3. Package for Sterilization

After all instruments have been cleaned and passed inspection, they can be sent for packaging. This is the final step before the actual sterilization procedure. There are three different ways to package.

Pouches: These are see-through sleeves made of plastic and paper that typically house singular surgical supplies. One side has an adhesive flap that folds over and keeps air out. Sterilization indicators that change color when sterile should be placed inside the pouches with the instruments. This allows the technician to clearly see if an instrument isn't sterile.

Wraps: Instruments that are too big or bulky for the plastic pouches should be double-wrapped in a non-woven material that provides a barrier to liquid and germs. Wraps should also contain a sterilization indicator inside and be taped closed with sterilization tape that works as an external indicator.

Containers: These are usually made of metal, and they're beneficial in that they can hold multiple instruments for specialty surgeries. Surgical tools are placed inside the container along with sterilization indicators, wrapped with a cloth or non-woven barrier, and secured with sterilization tape.

4. Sterilize

Autoclaves use steam sterilization, and according to the CDC, this is the more popular method of getting heat-resistant instruments sterilized and ready for use. Steam sterilization is also safe and fast and generally the most cost-effective procedure for most health care facilities.

The time and temperature for adequate sterilization will depend on the type of sterilizing equipment you have. For instance, if you use a gravity-displacement sterilizer, you'll need to heat the instruments to 121 degrees C for 30 minutes. But if you use a prevacuum sterilizer, only 4 minutes is required at 132 degrees C.

Other methods of sterilization include ozone, dry autoclave, ethylene oxide, vaporized hydrogen peroxide, and chemicals. The method employed largely depends upon the instrument manufacturer's recommendations.

5. Store

Properly storing the instruments where they are least likely to be re-contaminated is vital to keeping them sterile. This involves storing them in an area that is clean and dry, free of dust and exposure to insects and rodents, out of direct sunlight, and where traffic is kept to a minimum. All instruments should be above floor level and a minimum of 400 mm from any ceiling fixtures.

When instruments are sent to storage, they should be handled with care so that the package does not accidentally get opened or otherwise become compromised. Additionally, the integrity of all sterilized packages should be checked before storing, before transport to the operating room, and right before use during surgery. 


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