Sterilization and Maintenance of Surgical Equipment PDF

Sterilization and Maintenance of Surgical Equipment P R I SCI LO P. FON TANI LLA , JR. COLLEGE OF VETERINARY MEDICINE DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY NORTH LA UNION CAMPUS...

Sterilization and Maintenance of Surgical Equipment P R I SCI LO P. FON TANI LLA , JR. COLLEGE OF VETERINARY MEDICINE DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY NORTH LA UNION CAMPUS Bacnotan, La Union Definition of Terms ◦ Sterilization ◦ The process intended to kill or remove ALL types of micro-organisms on an item/object. ◦ Object ◦ Things that come in contact with sterile tissue or enter the vascular system ◦ Disinfection ◦ A process that eliminates many or all pathogenic microorganisms, EXCEPT bacterial spores, on inanimate objects Methods of Sterilization 1. Autoclaving (Steam Sterilization) Method: Uses saturated steam under pressure. Process: o Clean and dry instruments o Wrap in sterile packaging. o Place in an autoclave at 121- 134°C (250-273°F) for 15-30 minutes. Advantages: Highly effective, quick, and cost-efficient. Autoclave Disadvantages: Not suitable for heat-sensitive instruments. Methods of Sterilization 2. Ethylene Oxide (EtO) Sterilization Method: Uses ethylene oxide gas. Process: o Clean and dry instruments o Placed in a sterilization chamber with ethylene oxide gas at 45 - 60ºC @ 10 – 12 psi o Aeration period follows to remove gas residues. Advantages: Effective for heat- and moisture-sensitive instruments. Disadvantages: Time-consuming and Ethylene Oxide sterilizer requires proper ventilation due to toxicity. Methods of Sterilization 3. Cold Chemical Sterilization Method: Uses chemical agents such as glutaraldehyde, peracetic acid, or hydrogen peroxide. Process: o Immerse instruments in a chemical sterilant for a specified period. o Contact time: Sterilization ▪ 2% Glutaraldehyde – 6 – 10 hours of immersion ▪ 1% Peracetic acid – 30minutes – 1 hour of immersion ▪ 35% Hydrogen Peroxide solution – 6 – 12 hours of immersion o Rinse with sterile water to remove chemical residues. Advantages: Suitable for heat-sensitive instruments. Disadvantages: Chemical residues can be hazardous if not properly rinsed. Methods of Sterilization 4. Dry Heat Sterilization Method: Uses hot air ovens. Process: o Clean and dry instruments. o Place instruments in a dry heat oven at 160-170°C (320-338°F) for 1-2 hours. Advantages: for instruments that can withstand high temperatures. Dry Heat Sterilizer Disadvantages: Time-consuming and not suitable for heat- sensitive instruments. Methods of Sterilization 5. Radiation Sterilization Method: Uses gamma rays or electron beams. Process: Expose Instruments to radiation (X-rays, UV, Gamma) in a specialized facility. Advantages: Suitable for single- use, pre-packaged instruments. Disadvantages: Expensive and not practical for routine sterilization.  Preparation of the Surgical Pack for Sterilization STEPS: 1. Gathering and Sorting Instruments Collect all instruments and supplies needed for the surgical procedure. Sort instruments by type (e.g., cutting, clamping, retracting) and by size to facilitate the cleaning process. 2. Cleaning and Decontamination Manually clean instruments using brushes and detergents to remove all visible soil and organic material. Rinse instruments thoroughly with distilled water to remove cleaning agents. Inspect instruments for cleanliness, damage, and proper function. Hinged instruments should be opened and checked for residue.  Preparation of the Surgical Pack for Sterilization STEPS: 3. Assembly of the Surgical Pack Allow instruments to dry completely to prevent moisture from interfering with the sterilization process. Group instruments by function or by the sequence in which they will be used during the procedure. ▪ Cutting instruments (e.g., scalpels, scissors) ▪ Clamping instruments (e.g., hemostats, clamps) ▪ Grasping instruments (e.g., forceps, needle holders) ▪ Retracting instruments (e.g., retractors) Protect sharp instruments using tip protectors or silicone mats to prevent damage and injury. Place instruments in perforated sterilization trays. Heavy instruments are placed at the bottom, lighter ones on top. Hinged instruments are kept open. Add sterile gauze, sponges, drapes, and other consumables required for the procedure. Place sterilization indicator strips inside the pack to verify that sterilization conditions have been met.  Preparation of the Surgical Pack for Sterilization STEPS: 4. Wrapping the Surgical Pack Single or Double Wrap: o Wrap the pack using sterile wrapping material. Double wrapping provides an extra layer of protection. Proper Folding Techniques: o Use proper folding techniques to ensure the wrap remains secure and allows for adequate steam penetration. Preparation of the Surgical Pack for Sterilization Wrapping Instrument Packs Preparation of the Surgical Pack for Sterilization Folding and Wrapping Surgical Gowns Preparation of the Surgical Pack for Sterilization Folding and Wrapping Drapes Preparation of the Surgical Pack for Sterilization Unwrapping and Opening Sterile Items Preparation of the Surgical Pack for Sterilization STEPS: 5. Sealing and Labeling Use sterilization indicator tape to seal the wrapped pack. The tape changes color when exposed to sterilization conditions, providing an external indication. Label the pack with information such as the contents, date of sterilization, and expiration date. 6. Sterilization Process Load the wrapped packs into the sterilizer, ensuring adequate space between packs for steam circulation. Select the appropriate sterilization cycle parameters (temperature, pressure, and time) based on the instruments and materials. Start the sterilization cycle and monitor it using the sterilizer’s controls and indicators.  Preparation of the Surgical Pack for Sterilization STEPS: 7. Post-Sterilization Handling Allow the packs to cool in a sterile environment to prevent condensation. Inspect the internal and external indicators to ensure successful sterilization. Conduct a final inspection to ensure the integrity of the wrap and the sterility of the pack. 8. Storage Store the sterilized packs in a designated sterile storage area, which should be clean, dry, and free from contaminants. Organize packs by type and date to ensure a first-in, first-out (FIFO) system is followed, using the oldest packs first.  Maintenance of Surgical Equipment STEPS: 1. Cleaning o Method: Physical removal of organic and inorganic debris. o Process: ▪ Instruments should be rinsed immediately after use to prevent drying of blood and tissue. ▪ Use enzymatic cleaners or mild detergents. ▪ Ultrasonic cleaners can be used for thorough cleaning. o Importance: Essential to remove all residues before sterilization. 2. Inspection o Method: Regular checks for damage or wear. o Process: ▪ Inspect instruments for cracks, dullness, or misalignment. ▪ Ensure all parts move smoothly and locking mechanisms function properly. o Importance: Prevents malfunction during surgery and ensures patient safety.  Maintenance of Surgical Equipment STEPS: 3. Lubrication o Method: Use of instrument lubricants. o Process: ▪ Apply instrument milk or other suitable lubricants to hinged and moving parts. o Importance: Maintains smooth operation and prevents corrosion. 4. Repair and Sharpening o Method: Professional servicing. o Process: ▪ Send instruments to specialized technicians for repair or sharpening as needed. Pre-Autoclave Instrument Dip o Importance: Extends the life of instruments and maintains precision.  Maintenance of Surgical Equipment STEPS: 5. Storage o Method: Proper storage to prevent damage and contamination. o Process: ▪ Store instruments in a clean, dry environment. ▪ Use protective cases or trays to prevent damage. ▪ Ensure sterile instruments remain sealed until use. o Importance: Maintains sterility and functionality.  Sterilization Monitoring Ensures that sterilization processes are effective and that surgical instruments are free from microbial contamination. Monitoring methods 1. Biological Indicators (Spore Test) - gold standard for monitoring sterilization efficacy. o Use of bacterial spores of heat-resistant bacteria – Biological Indicators ▪ Geobacillus stearothermophilus (for steam and hydrogen peroxide sterilization) ▪ Bacillus atrophaeus (for ethylene oxide and dry heat sterilization) are used. o Best indicator of sterilization efficacy o After sterilization, the biological indicator is incubated to see if any spores survive. If no growth is observed, the sterilization process is considered effective. Sterilization Monitoring 2. Chemical Indicators used to provide a visual confirmation that the conditions required for sterilization have been met. Change color when exposed to sterilization conditions o These indicators contain chemicals that change color when exposed to certain temperatures, pressures, or chemical concentrations. o The color change indicates that the sterilization conditions have been achieved. External Indicator Types: o External Indicators: Applied to the outside of sterilization packs or containers. They provide a quick visual confirmation that the pack has been exposed to the sterilization process. o Internal Indicators : Placed inside sterilization packs to confirm that the sterilizing agent has Internal Indicator penetrated the pack and reached the contents. Sterilization Monitoring 3. Mechanical Indicators - involve monitoring and recording the physical parameters of the sterilization process, such as temperature, pressure, and time. Monitor and Record Sterilization Parameters o uses built-in sensors and recording devices in sterilization equipment to track critical parameters (temperature, pressure, and cycle duration) Provide Immediate Feedback on the Process o Any deviation from the set parameters can be identified and corrected promptly.  Importance of Using All Three Monitoring Methods Biological Indicators - confirm that the sterilization process can effectively kill highly resistant microorganisms. Chemical Indicators - provide immediate visual confirmation that sterilization conditions have been met for each item. Mechanical Indicators - continuously monitor and record the sterilization process, providing a detailed log of each cycle’s conditions.  Operating Room Setup and Protocols Operating Room Setup 1. Layout and Design Sterile Field - Establish a sterile field around the patient and surgical team. Zones: unrestricted, semi-restricted, and restricted. The restricted zone includes the operating area and is maintained as sterile. Lighting - Ensure adequate and adjustable lighting. Ventilation: Maintain proper ventilation with High-Efficiency Particulate Air (HEPA) filters to minimize airborne contaminants. HEPA filters traps 99.97% of particles as small as 0.3 microns. 2. Equipment and Instruments Surgical Instruments - Instruments should be organized logically for quick access. Monitoring Equipment: Set up monitors for vital signs (e.g., heart rate, blood pressure, oxygen saturation) within easy view of the anesthesiologist and surgical team. Anesthesia Equipment: Ensure anesthesia machines, ventilators, and emergency drugs are ready and functioning. Suction Apparatus: Prepare suction devices for clearing fluids during surgery. Sterile Supplies: Include sterile gloves, gowns, drapes, and dressing materials. 3. Patient Preparation Positioning: Position the patient appropriately based on the surgical procedure. Secure the patient to prevent movement. Skin Preparation: Cleanse and disinfect the surgical site with an antiseptic solution. Draping: Use sterile drapes to isolate the surgical site from other body areas and maintain a sterile field.  Operating Room Setup and Protocols Operating Room Protocols 1. Aseptic Technique Perform surgical scrubs thoroughly before gowning and gloving. Wear sterile gowns and gloves to prevent contamination. Avoid touching non-sterile surfaces and ensure that sterile instruments do not contact non-sterile items. 2. Surgical Safety Checklist Verify patient identity, surgical procedure, and surgical site. Confirm all necessary equipment and supplies are available. Conduct a time-out before incision to confirm correct patient, procedure, and site. Ensure all team members are in agreement. Postoperative Verification: Confirm the procedure is completed correctly, and all instruments and materials are accounted for. 3. Infection Control Clean and disinfect the OR before and after each procedure. Use properly sterilized instruments. Follow strict protocols for handling and storing sterile items. Wear appropriate PPE, including masks, caps, and shoe covers, to minimize contamination risk. 4. Patient Safety Continuously monitor the patient’s vital signs and anesthesia depth. Be prepared to address any changes or complications promptly. Maintain clear and effective communication among the surgical team. Be prepared for emergencies with readily available resuscitation equipment and protocols. 5. Documentation Document all relevant information, including patient details, procedure specifics, anesthesia records, and any complications or unusual events. Perform instrument counts before, during, and after the procedure to ensure nothing is left inside the patient.