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System of preselecting and delivering instruments and supplies to the perioperative environment. Prepackaged disposable supplies prepared by the manufacturer according to specific instructions by a particular service at a facility.
Microorganismare at irreducible minimum.

Custom packs

Sterile

Sterilization

Process by which all pathogenic and nonpathogenic microorganisms, including spores, are killed. Thorough cleaning and disinfection of perioperative environment at the end of use
Procedures carried out for the destruction of pathogens at the end of surgical procedure in the OR and in other areas of patient contact.

Terminal cleaning

Terminal sterilization and disinfection

Turnover

Activity geared toward cleaning and preparation of the OR between cases for the next patients arrial. Internal aspect of the sterile package is moist or damp. Indicates nonsterile item.
Passage of fluids through a material by pasiive action.

Wet pack

Wicking

Make sure the instruments are thoroughly dry. Unless contraindicated, place an absorbent towel or foam in the bottom of tray to absord condensate, as for rigid container with vacuum valve. Count and record instruments as they are placed in the tray. Arrange instruments in a definite pattern to prptect them from damage.

Place heavy instruments in the bottom of the tray. Open hinges and box locks on all hinged instruments. Place right-handled instruments on stringers or holders designed for this purpose. Place sharp and delicate instruments at top of other instruments. Place concave or cupped instruments with the cupped surfaces down.

Disassemble all detachable parts. Separate dissimilar metals. Place instruments with a lumen, such as suction tip, in as near a horizontal position as possible. Distribute weight as evenly as possible in the tray. Wrap the tray, or place it in a rigid container. Label the sets appropriately with their intended use, the date sterilized, and the control number.

Packaging considerations
Permit penetration of sterilizing agent. Allow release of sterilizing agent at the end of exposure period. Withstand the physical conditions of the sterilizing process. Maintain integrity of the packaging at varying atmosphereic and humidity level. Provide an impermeable barrier to microorganisms.

Packaging considerations

Cover items completely and easily fasten securely with a tape or a heat seal that cannot be resealed after opening. Resist tears and punctures in handling. Permit identification of the contents and evidence of exposure to sterilizing agent. Be free toxic ingredients and nonfast dyes. Be lint free. Protect contents from physical damage. Permit easy removal of contents with the transfer to the sterile field without contamination. Be economical.

Thermal(Physical)

Steam under pressure/ moist heat Hot air/ dry heat

Chemical
Ethylene oxide Formaldehyde gas and solution Hydrogen peroxide plasma/ vapor Ozone gas Acetic acid solution Glutaraldehyde solution Peratic acid and 0.2% solution Hypochlorous acid

Radiation(Physical)

Microwave Xray (ionizing)

Heat is dependable physical agent for the destruction of all forms of microbial life, including spores.

Advantages

Easiest, safest and surest method of on-site sterilization. Fastest method. Least expensive and most easily supplied agent. Most sterilizer have automatic controls and recording devices that eliminate the human factor from the sterilization process as much as possible when operated and cared for according to the recommendations of the manufacturer. No harmful residue.

Disadvantages

Precautions must be used in preparing and packaging items, loading and operating sterilizer, and drying the load. Items need to be clean, free of grease and oil, and not sensitive to heat. Steam must have direct contact with all areas of an item. The timing of the cycle is adjusted for differences in materials and sizes of loads. Steam may not be pure.

Types of Sterilizers

Gravity Displacement Sterilizer

Types of Sterilizers

Prevacuum Sterilizer

Types of Sterilizers

Flash/High-Speed Pressure Sterilizer

Precautions
Turn on the valve for steam in the jacket before use. Never put heat-sensitive items into a steam sterilizer of any type. Close the door tightly before activating aither the automatic or manual controls. Open the door only when the exhaust valve registers zero. Wash the inside of the chamber according to manufacturers directions. Wipe the gasket daily with lint-free cloth.

Preparing items for sterilizations

Surgical Instruments
Instruments with removable parts should be

disassemble, box lock should be opened, and heavy instruments should be placed at the bottom levels of tray with light items on top. The tray contents should be evenly distributed and not exceed the weight set forth by the manufacturer.

Powered equipment
Placed in cases

Basin set
Separated by inch by porous material, such as towel.

Drape packs
Should be fan folded/ rolled loosely to allow steam

through each layer of material.

Rubber goods and Themoplastics

Should not be folded. Should be covered with a piece of

gauze fabric / towel of the same size, loosely rolled.

Wood products
Individually wrapped and separated from other items.

Advantages

Hot air penetrates certain substances that cannot be sterilized by steam or other methods. Dry heat is protective method of sterilizing some delicate, sharp, or cutting-edge instruments.

Disadvantages

A long exposure period is required. The time and temperature required will vary from different items. Overexposure may ruin some substances.

Types of Dry Heat Sterilizers

Mechanical Convection Oven

Types of Dry Heat Sterilizers

Gravity Convection Oven

Packaging of Materials

Glass
Caps or lids are affixed or screwed tightly into a

container

Stainless steel boats or trays

Covers must fir tightly.

Aluminum foil
Foil conducts heat rapidly

Woven fabric and peel pouches

Can be used for wrapping materials

Used to sterilize items that are sensitive to heat or moisture. Advantages

Effective substitute agent to use with most item sensitive to heat and moist. Provides effective method of sterilizations. Completely permeates all porous materials. Leaves no film on items.

Disadvantages

It is a complicated process that is closely monitored. Takes longer than steam sterilization. Toxic by-products can be formed in the presence of moisture droplets during the exposure of some plastics. Repeated sterilization can increase concentration of total residues in porous items. Vesicant when in contact with skin and mucous membrane. When inhaled gas can irritating to mucous membranes. Long term exposure can cause occupational carcinogen, causing leukemia.

Advantages
Dry and nontoxic. By-products are safely evacuated into the room atmosphere. Aeration is not necessary. A low temperature allows safe sterilizations of some heat-sensitive items. Plasma has significantly less effect on metal. The sterilizer is simple in design and connects to standard outlets.

Disadvantages

Metal trays blocks radiofrequency. Hydrogen peroxide is not compatible with cellulose. Nylon becomes brittle after repeated exposure. This method is not approved in the USA.

A process that destroys organic and inorganic matter. Advantages

It is inexpensive to operate. Does not affect titanium, chromium, silicone, neoprene, and Teflon. Aeration is not necessary. Low temperature is safer fro heat sensitive instrumentation.

Disadvantages

Ozone can corrosive. It destroys natural rubber, such as latex, natural fibers, and some plastics.

Advantages

Has low surface tension. Noncorrosive, no staining, and safe for instruments that can be immersed in a chemical solution. Does not damage lenses or cement on lensed endoscope. It has low volatility and is stable.

Disadvantages

Prolonged exposure may be necessary. Some have hazardous effects. Failure to rinse an endoscope can cause a chemical induced colitis. Sterile transfer is difficult. Solution can be diluted during use of an item is wet when placed in it.

Types

Acetic acid Formaldehyde Glutaraldehyde Peracetic acid Hypochlorous acid

The nonionizing radiation microwaves produces hyperthermic conditions that disrupts life processes. It uses low pressure steam with the nonionizing radiation to produce the localized heat that kills microorganisms.

Ionizing radiation produces ions by knocking the electrons out of atoms. It kills microorganisms by disrupting the deoxyribonucleic acid molecule, thus preventing cellular division and the propagation of biologic life.