Module 6

1. Module 6 STERILIZATION

2. Instructional Objectives • Identify types of sterilizers and their components. • Identify and sequence the steps in sterilizer cycles. • Identify EtO monitoring and personal protection requirements.

3. Factors Affecting Sterilization • Number of organisms • Their resistance to the sterilizing agent • Debris on the item providing protection for organisms • Proper loading techniques • Functional efficiency of the sterilizing equipment • Achieving required sterilization parameters • Human performance • Post sterilization handling techniques

4. Types of Sterilizers • Steam • Ethylene Oxide (EtO) • Plasma • Dry heat • Chemical • Flash

5. Steam Sterilization • Very effective • Easy to produce • Relatively inexpensive • Moist heat; saturated steam under pressure

6. Factors Affecting Steam Sterilization • Surface contact • Time and Temperature • Temperature and Pressure BARRIERS, AIR BUBBLES, PLACEMENT TEMPERATURE KILL TIME HEAT UP + KILL TIME + SAFETY FACTOR = EXPOSURE • PRESSURE TEMPERATURE • Processing temperature from 250 degrees F to 275 degrees F

7. Steam Quality • The amount of moisture in the steam • Saturated = 97% dry 3% moisture ^ temperature = Super heated steam v temperature = Wet steam • Impure steam – additives • Solid • Liquid • Vapor

8. Steam Sterilizer Equipment • Many styles/models • 2 basic types • gravity displacement • prevacuum. • Basic components

9. Prevacuum Sterilizers • Conditioning • Pulse/pull sequence • Exposure • Come down • Cool down Insert FLASH animation if possible.

10. Gravity Displacement Sterilizers • Initiation • Exposure • Exhaust • Drying

11. Testing Sterilizer Function Bowie Dick Test • Tests vacuum effectiveness • Performed daily • Done in empty sterilizer • Placed on bottom near drain

12. Table Top Steam Sterilizers • Small gravity displacement units • Found in clinics/dental offices

13. EtO Sterilization • Used for heat and moisture sensitive devices • Functions through alkalization—chemical disruption of cell • Requires caution—Toxic and flammable • Expensive and time consuming • Can produce polyglycol if mixed with water

14. EtO Sterilization • Use a mixture of EtO and carrier gas • 4 Phases • Vacuum • Conditioning • Exposure • Purge

15. Loading and Unloading • Arrange items loosely with sufficient clearance • Aeration required following sterilization

16. Monitoring • OSHA requirement • Limits • PEL • STEL • Action Level • Medical exams

17. Alarm Levels LowAlarmLevel .5ppm HighAlarmLevel 1 ppm Tank and EquipmentArea 5 ppm Environmental Monitoring • EtO emergency alarm • Ventilation alarm

18. Precautions • PPE • Avoid sparks, heat or flames • Immediate response if exposed • Know location of fire extinguishers and showers

19. Storage • 100% EtO Cartridges • no more than 3 day supply • 12 or less 50 gram cartridges • EtO Gas Mixture Cylinders • temperature regulated, designated storage area, away from traffic flow • upright, secured in place

20. Annual Training • Mandatory • Should include: • •         EtO sterilizer and aerator operation and maintenance • •         work practice/precautions for safe use of EtO • •         safe handling and storage of EtO tanks • •         physical and health hazards • •         accidental spill/leak plan • •         emergency first aid procedures • •         personal protective equipment • •         professional EtO monitoring methods

21. Other Types of Sterilizer • Plasma • Dry Heat • Chemical • Flash

22. Verifying Sterility • Biological • Chemical • Mechanical

23. Special Situations • Implants • Sterilizer load requires biological indicator • 48 hour quarantine • Manufacturer’s directions • Loaner equipment • Advance notice • Count sheet

24. Knowledge Check How can you prove that something is sterile? • Examine the label • Check the chemical indicator • You can’t • Look it up on the sterilizer log

25. Knowledge Check What is the purpose of the Bowie Dick test? • Ensure sterilization occurs • Check the efficiency of the sterilizer • Ensure that effective vacuum is achieved • Check for air displacement

26. Knowledge Check What factors can affect the steam sterilization process? • time • temperature • surface contact • pressure

27. Knowledge Check Order the steps in the steam sterilization process. • conditioning • exposure • come down • drying

28. Knowledge Check Following EtO sterilization, why is aeration important? • Residual EtO can cause burns to the patient, physician, or staff • It speeds up the sterilization process • It removes excess moisture, reducing the risk of polyglycol forming • It removes all excess EtO from the items

29. Knowledge Check Order the steps in the EtO sterilization process. • Remove residual air • Inject steam and bring to required temperature and humidity • Inject EtO gas under pressure • Exhaust gas and purge chamber

30. Knowledge Check Match the term to its limit. 5 parts EtO per million parts of air in a 15 minute period STEL – Action Level – PEL – .5 ppm TWA One part EtO per million parts of air over an eight hour period

31. Knowledge Check What types of monitoring are used in the medical center sterilization process? • Chemical • Biological • Remote • Mechanical

32. Knowledge Check The cycle phases for a prevacuum sterilizer include conditioning, three ____________ ____________ and four _________ ___________, followed by exposure and then the _______________ of filtered air. steam pulses vacuum pulls exhaust

33. Knowledge Check Standard aeration times, as outlined in MP-2 Subchapter E, subpart 108-76.303(c), are: 50o Centigrade (122 degrees F) for _____ hours. 12

34. Knowledge Check Liquids must • betightly sealed before sterilization • not be mixed in sterilizer loads with other items • not be sterilized in VA facilities • carefully monitored to prevent flashback

35. Knowledge Check Steam sterilization is the best method for: • anything that is needed in a hurry • all reusable items • items that can withstand heat and moisture • plastic and rubber items

36. Knowledge Check Which form of sterilization is known to be harmful to the ozone layer? • Steam • EtO • Plasma • Flash

37. Knowledge Check Standard steam sterilization time is: • 250 degrees F for 30-45 minutes • 270 degrees F for 3-5 minutes • 130 degrees F for 1 hour and 45 minutes • 100 degrees for 4 hours

38. Knowledge Check When loading sterilizers; • Always put the larger items on top • Place items so that they overlap • Avoid allowing items to touch the sterilizer walls • Leave at least one shelf empty to prevent condensation

39. Knowledge Check Chemical indicators are used for: • ensuring that items are sterile • indicating that an item has been exposed to the sterilization process • preventing bleed through or wicking • overriding biological indicators.

40. Knowledge Check Biologic controls must be run • In every load • Once a week or more, as needed • At least once per day when the sterilizer is in use • Whenever a problem is detected or suspected

41. Knowledge Check • When can items be removed from the aerator? • Only when the aeration cycle is complete • Before the aeration cycle finishes with a signed release from the Chief of SPD • When something is needed in the O.R. • 6-8 hours after processing

42. Knowledge Check Biologic controls must be run • In every load • Once a week or more, as needed • At least once per day when the sterilizer is in use • Whenever a problem is detected or suspected

43. Knowledge Check What is the Action Level for EtO exposure? .5 ppm in 8 hour TWA

44. Knowledge Check What is STEL and what are the limits? Short Term Excursion Limit 5 ppm in 15 minute period