Florida Hospitals: Sterilizing Surgical Tools, Ensuring Patient Safety

Sterilization is a critical aspect of surgical procedures, as it ensures that surgical tools are free from microorganisms to prevent infections and disease transmission. In Florida, hospitals employ various methods to sterilize surgical instruments, adhering to stringent standards and guidelines. The sterilization process typically involves multiple steps, including pre-cleaning, decontamination, sterilization using heat, chemicals, or radiation, and proper storage. Safe sterilization practices are essential to protect patients and staff from infections and maintain the integrity of surgical instruments. This process is a complex and intricate part of the healthcare system, and the methods and technologies used are constantly evolving to improve patient safety and care.

Sterilization methods: steam, ethylene oxide, hydrogen peroxide, etc

Sterilization is essential to ensure surgical instruments and medical supplies do not transmit infectious pathogens to patients. Steam sterilization, for example, is highly effective and environmentally friendly, destroying bacteria, fungi, and spores. However, the introduction of heat and moisture-sensitive medical devices has prompted the development of low-temperature sterilization methods.

Steam Sterilization

Steam sterilization is a common method for sterilizing surgical tools. It involves using pressurized systems to achieve greater heat penetration and neutralize pathogens through irreversible coagulation and denaturation of critical proteins. Steam sterilization is ideal for destroying bacteria, fungi, and spores. However, it is not suitable for all medical devices, particularly those made from certain polymers (plastics or resins), metals, glass, or those with multiple layers of packaging or hard-to-reach places, such as catheters.

Ethylene Oxide Sterilization

Ethylene oxide (EtO) is a widely used low-temperature sterilization method for heat and moisture-sensitive equipment. It is often used for large quantities of products that cannot be sterilized by steam, such as gauze or non-woven materials like disposable gowns. EtO is also suitable for sterilizing medical devices with complex geometries or made from specific materials like polymers, metals, or glass. About fifty percent of all sterile medical devices in the US are sterilized using ethylene oxide, including devices used in general healthcare practices (e.g., wound dressings) and specialized devices (e.g., stents). However, ethylene oxide emissions are a concern, and strategies are being developed to reduce them.

Hydrogen Peroxide Sterilization

Hydrogen peroxide is another low-temperature sterilization method. It includes the use of hydrogen peroxide gas plasma (HPGP), vaporized hydrogen peroxide, and immersion and vapor phase peracetic acid. HPGP is considered environmentally safer and more time-efficient than EtO, with a typical cycle time of 75 minutes. Liquid hydrogen peroxide is contained in a sealed cassette, punctured only after the sterilizer door is closed, minimizing operator contact. The by-products of hydrogen peroxide sterilization are water and oxygen, which are non-toxic. However, eye contact with liquid hydrogen peroxide can cause irritation and redness, and corneal ulcerations can develop following contact with concentrated solutions.

Other sterilization methods used in healthcare settings include dry heat, radiation, chlorine dioxide gas, vaporized peracetic acid, and nitrogen dioxide.

Cleaning surgical tools: pre-soaking, pre-rinsing, detergents, brushes

Cleaning surgical tools is a critical aspect of the sterilisation process in hospitals. In Florida, hospitals use a variety of methods to sterilise surgical tools, including ethylene oxide sterilization, moist heat, dry heat, radiation, and vapour sterilisation. While the sterilization methods may vary, the cleaning process for surgical tools typically involves pre-soaking, pre-rinsing, detergents, and brushes.

Pre-soaking

Pre-soaking surgical tools is an important step in the cleaning process as it helps to loosen and remove soil and other contaminants. One product used for pre-soaking is the PRE-KLENZ Soak Shield by STERIS, which comes in small, medium, and large sizes. This product is designed to initiate the pre-cleaning process of surgical instruments immediately after use, with the device tip submerged in an enzymatic detergent to loosen soils.

Pre-rinsing

Pre-rinsing surgical tools is not always mentioned as a standalone step in the cleaning process. However, it is often implied within the broader context of cleaning and sterilisation. For example, after pre-soaking and cleaning, surgical tools are typically rinsed with clean water to remove any remaining detergent or soil particles.

Detergents

Detergents play a crucial role in the cleaning process of surgical tools. Enzyme detergents are preferred as they help break up organic soil more effectively than conventional detergents. Biodegradable and non-toxic detergents, such as EcoZyme, are also commonly used to simplify the cleaning process and reduce negative side effects on technicians. These detergents are designed to break down organic and inorganic biological residue efficiently while being environmentally friendly.

Brushes

Surgical instrument cleaning brushes are essential for removing soil and contaminants from the surfaces of surgical tools. Companies like STERIS offer a wide range of brushes with different styles, diameters, lengths, and bristle materials to ensure effective manual cleaning. It is important to use brushes recommended by the instrument manufacturer to avoid damaging the tools. The brushing process involves soaking the instruments in a bath and using medium-soft brushes to clean all surfaces, including the insides of tubed devices such as endoscopes and handpieces.

Sterilization equipment: autoclaves, mechanical cleaning machines

Sterilization is a critical process in healthcare settings, ensuring that surgical tools and medical equipment are free from harmful pathogens and safe for patient use. Sterilization equipment plays a pivotal role in achieving this goal, with autoclaves and mechanical cleaning machines being essential components of the sterilization process.

Autoclaves

Autoclaves are sterilization workhorses in hospitals, laboratories, and dental clinics. They utilize pressurized steam to effectively sterilize a wide range of items, from surgical instruments and diagnostic tools to lab equipment and biological waste. The high-pressure steam in autoclaves penetrates deeply, neutralizing pathogens through the coagulation and denaturation of critical proteins. This process ensures that medical procedures are conducted in a germ-free environment, safeguarding patients from potential infections. Autoclaves offer shorter run times, greater heat penetration, and lower temperature requirements compared to dry heat sterilization.

Mechanical Cleaning Machines

Before sterilization, thorough cleaning of surgical tools and medical devices is imperative to reduce bioburden and remove foreign materials that can interfere with sterilization. Various mechanical cleaning machines are employed for this purpose, including utensil washer-sanitizers, ultrasonic cleaners, washer-sterilizers, dishwashers, and washer-disinfectors. These machines utilize detergents, enzymatic cleaners, and high-frequency sound waves to eliminate blood, tissue, saliva, and other contaminants, ensuring that items are thoroughly cleaned prior to sterilization.

Wrapping and Storage

After successful sterilization, items are wrapped and stored until they are needed for surgical procedures. Double wrapping, either sequentially or non-sequentially, provides multiple layers of protection against contamination during handling and storage. Sterilized items can be wrapped in materials like polyethylene or muslin, with safe storage times varying based on the type of wrapping and storage conditions. The World Health Organization (WHO) recommends that the storage area be approximately double the size of the assembly and decontamination areas combined.

In conclusion, Florida hospitals, like medical facilities worldwide, rely on autoclaves and mechanical cleaning machines as fundamental components of their sterilization protocols. These specialized pieces of equipment ensure the safety and effectiveness of surgical tools and medical devices, ultimately protecting patients from infections and other complications.

Sterility assurance: SAL, storage, shelf life

Sterility assurance is a critical aspect of surgical tool sterilization, as it minimizes the risk of infection for patients. The concept of sterility assurance level (SAL) refers to the probability of finding a single microorganism on a product after sterilization. A typical SAL for surgical sterilization is 10−6, indicating a very low probability of any microbial contamination.

To achieve the desired SAL, surgical tools undergo rigorous sterilization processes. In Florida, hospitals commonly use steam sterilization, also known as autoclaving, which utilizes pressurized systems and high temperatures to neutralize pathogens. This method is suitable for most surgical instruments made of heat-stable materials. However, for heat- and moisture-sensitive medical devices, alternative sterilization methods are employed, such as ethylene oxide gas, hydrogen peroxide gas plasma, or peracetic acid immersion. These methods ensure that even complex medical devices with multiple layers of packaging or hard-to-reach places are effectively sterilized.

Proper storage conditions are crucial for maintaining the sterility of surgical tools. Hospitals use various wrapping techniques, such as double wrapping with sterilization wrap or polypropylene wrap, to protect instruments from contamination during storage and transport. The choice of wrapping material and technique depends on the instrument's size and shape, ensuring secure storage and minimizing damage due to excessive movement.

The shelf life of sterilized surgical tools varies depending on the wrapping material and storage conditions. Heat-sealed, plastic peel-down pouches and wrapped packs sealed in 3-mil polyethylene overwrap can remain sterile for up to 9 months. On the other hand, supplies wrapped in double-thickness muslin or its equivalent have a shorter shelf life of at least 30 days. Hospitals should adhere to expiration dates and inspect packaging for any tears or punctures before using sterilized items.

While sterilization is essential, it is worth noting that proper cleaning and disinfection procedures are also critical to the overall sterility assurance process. Surgical instruments must be thoroughly cleaned and pre-soaked to remove foreign materials and prevent the drying of blood and tissue. Inadequate cleaning can hinder the sterilization process and increase the risk of infection during surgical procedures. Therefore, healthcare facilities should implement comprehensive programs that ensure consistent and proper cleaning, wrapping, sterilization, and monitoring processes to maintain the highest standards of sterility assurance.

Sterilization practices: central processing, double wrapping, decontamination

Sterilization practices are crucial in healthcare facilities, and Central Sterilization Solutions (CSS) plays a vital role in ensuring the quality of sterilization processes. CSS provides industry-leading education to individuals aspiring to become certified Sterile Processing Technicians. With experienced instructors, CSS equips students with the knowledge and skills necessary to excel in this field.

One key aspect of sterilization practices is central processing, which involves the sterilization and preparation of surgical instruments and equipment. Double wrapping is a common technique used in central processing to ensure the sterility of surgical instruments. This practice can be sequential or non-sequential. Sequential wrapping involves using two sheets of standard sterilization wrap, creating a package within a package. On the other hand, the non-sequential method employs simultaneous wrapping with two sheets, providing multiple layers of protection and saving time.

Decontamination is another critical component of sterilization practices. It involves reducing microbial contamination on surfaces, equipment, and materials. Appropriate disinfectants, such as EPA-registered tuberculocidal disinfectants, diluted bleach solutions, or FDA-cleared sterilants, are essential to effective decontamination. Decontamination prevents researcher exposure to contaminants and maintains the integrity of experiments.

While sterilization refers to the complete destruction of microbial life, typically achieved through heat and steam (autoclaving), disinfection eliminates most pathogenic organisms, reducing contamination to safe levels. Proper disinfection and decontamination procedures are crucial in labs working with human materials or dealing with spills.

Overall, sterilization practices, including central processing, double wrapping, and decontamination, are essential to maintaining a safe and sterile environment in healthcare facilities. These practices help prevent infections and ensure the safety of patients and staff. Adhering to these protocols is vital for any hospital or medical institution.

Frequently asked questions