Republic of the Philippines Palawan State University College of Nursing and Health Sciences Puerto Princesa City

NCM 106 RLE Related Reading in Operating Room:

Methods of Sterilization

Submitted by: Mozo, Jhoana Marie O. BSN4 Group 4

Submitted to: Ms. Maria Andrealyn M. Flores, RN, MAN Clinical Instructor

June 2012

Methods of Sterilization
Methods of Sterilization are one of the questions of my pre-employment exam last week. Well, usually I am not the type of person who dwells inside the testing room when I do not know the answer. I do hate to pressure my brain cells of the stuffs they technically do not know. Of course, I know the methods of sterilization. After all, they only asked three. So what are the methods of sterilization inside the operating room?

Steam Sterilization. This is the most common method of sterilization for operating room instruments. If steam alone is used, it is not enough for sterilization. But, when it is pressurized, its temperature would rise. This moist pressurized read causes the destruction of microbes by coagulation and denaturation of protein inside the cells. The relationship between the temperature, exposure time and pressure are the contributory factors in the destruction of microbes. When steam is limited, in a closed-compartment and the pressure is increased, the temperature will also increase provided that the volume of the compartment remains the same. Items will be considered sterile if it is exposed long enough to steam at a specific temperature and pressure. Autoclave is a unit used to create this atmosphere of high temperature.

Types of Steam Sterilizers: * Gravity Displacement Sterilizer * Prevacuum Sterilizer * Flash Sterilizer

Ethylene Oxide (Gas) Sterilization. This is considered to be one of the most cost-effective methods for sterilization. Ethylene oxide is a flammable explosive liquid that when mixed with carbon dioxide or Freon becomes highly efficient. This is usually used for equipment that could not withstand the extreme temperature and pressure of the steam sterilizer. Examples of these are endoscope, plastics, power cables, cameras, etc.

How does Ethylene Oxide works? Ethylene oxide destroys microorganisms including their spores by interfering with the metabolic and reproductive processes of the cell. The process in enhance with moisture. The gas chamber is maintained at 20-40% humidity with temperature ranging from 49-600. Timing of the goods depends on the following factors: concentration of ethylene oxide, temperature, humidity and the density and type of materials to be sterilized. The only difference between steam and gas sterilization is that the latter would require aeration to dispel any residual gas that is on the instrument or items. General rule when preparing any equipment for gas sterilizationis that loose is better than restricted. Ionizing Radiation Sterilization. A pre-packaged equipment from the manufacturer has already been sterilized using ionizing radiation or cobalt 60. This process is used commercially because of its cost. Sutures, sponges and disposable drapes are some of the presterilized products available in the market.

Cold Chemical Sterilization. A lot of liquid chemical agents today can sterilize an item immersed in it. But, most of these chemicals are so corrosive and damaging to the equipment being sterilized that they cannot be used for this purpose.

There are only two products that can be safely used: * 2% solution of glutaraldehyde. Non-corrosive and provides a safe means of delicate lensed instruments such as cystoscopes, and broncoscopes. Sterilization of an item in glutaraldehyde requires approximately 10 hours of soaking. Disinfection takes place in approximately 10 minutes. Because it is extremely difficult to thoroughly clean endoscopic accessory instruments such as biopsy brushes, these items are now available as single-use items that are disposable following surgery. Remember that disinfection is not sterilization. * peracetic acid is utilized at low temperature. Caution: For any of these sterilization processes, it is always important to read and understand the instructions or manual provided by the manufacturer. Each item to be sterilized by either pressurized steam or ethylene oxide must be wrapped properly. The procedure for wrapping goods is not based on convenience or personal preference but based on one principle: enhancing the ease of sterilization and of preserving the sterility of the item. The wrapper used should: * Protect the item from vermin, penetration and dust. * Resistant to tearing or delamination (separation of layers) * Easy to handle to facilitate wrapping and delivery

Fabric Wrappersare made from high-quality cotton muslin which is commonly referred to as linen. Muslin has sufficient density to protect goods from contamination and yet it is porous enough to allow the penetration of steam or gas.

Paper and Unwoven Fabrics. For instance those utilized in the manufacturing of disposable drapes are also used. Non-fabric wrappers should be durable and flexible. These wrappers are intended for one time use only. If it is already used in sterilization, they may lose their ability to prevent contamination.

IDENTIFICATION OF PACKAGES

Whatever the type of the packaging your operating room has, each package must be marked by the current date and the date of expiration, including the item name. In our hospital, we also signed in our names so in any case that (for instance) I labelled a certain instrument wrong; they could throw the blame into my court.

STORAGE AND HANDLING OF STERILE SUPPLIES The rule of this is first in, first out. Shelf Life. This is defined as the length of time a wrapped sterile package remains sterile when in storage. This is dependent on a lot of factors. Whether the package remains sterile depends completely on the conditions under which the item was stored and on the handling of the item. Another factor is the type of thickness of the packaging material. This also determines how strong the barrier it provides. The packages that offers the most resistance to contamination is the heat-sealed plastic and the plastic-paper packages. Under the ideal condition, these packs may remain sterile for about a year. Environmental conditions such as temperature, humidity, and air turbulence are important in maintaining ideal shelf life.

Excessive temperature scans cause sweating and condensation around packs. Any moisture can wick bacteria from a nonsterile surface through a wrapper and contaminate the contents of the package. Air turbulence such as that near doorways or halls can sweep bacteria-laden particles over sterile supplies and diminish their shelf life. Other sources of humidity such as aerosol effect from sinks or cleaning areas may also contaminate wrapped goods. The package closure also affects shelf life. Heat-sealed packages have a longer shelf life than those that are sealed with tape. Dust covers likewise prevent particulate material from entering the pack. Items that are seldom used can be over wrapped with a plastic dustcover to prevent the need for frequent sterilization.

SHELF LIFE FOR WRAPPED GOODS (Under Ideal Conditions) * Linen (140-thread-count, four thicknesses) (280)-thread-count, two thicknesses) 7 weeks * Linen-wrapped items, heat sealed in dust covers after sterilization 9 months * Linen-wrapped items, tape sealed in dust covers after sterilization 3 months * Paper 9 weeks * Plastic-paper, combination, heat sealed 1 year * Plastic films, tape sealed 3 months * Plastic films, heat sealed 1 year * Nonwoven fabrics 30 days

From Groah L: Operating Room Nursing: Perioperative Practice, 2nd ed.Norwalk CT, Appleton& Lange, 1991.

The storage system, whether in the form of open or closed cabinets or open or closed bins, often determines shelf life. Remember the basic rule inside the operating room, when in doubt, throw it out. Trust your surgical instinct and conscience because it will never fail you.
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