SVG COMMUNITY COLLEGE; DIVISION OF NURSING EDUCATION

OPERATING THEATRE
METHODS OF STERILIZATION

Presented to: Sr. Gudruda Browne

Presented on: February 16th, 2017

Presented by: Group 7 & 8 Members: Kemesha Charles Leshoan Castello

Renecia Daniel Iesha Cupid
Gabriel Glasgow Leorol Gibson
Karriel Joseph Aneak Joseph
Andrea Noel Cande Neverson
Anastasia Squires Unita Straker
Weneika James Joel Thompson

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OBJECTIVE 1: Define the term sterilization

Sterilization is procedure of destroying all microorganisms in or on a given environment, such as

a surgical instrument in order to prevent the spread of infection. This is usually done by using

heat, radiation or chemical agents.

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OBJECTIVE 2: Distinguish the term sterilization from disinfection and antiseptic

Sterilization is the destruction of all microorganisms on inanimate surface or object. Whereas

disinfection is the process of destroying and eliminating almost all of the microorganism on

inanimate objects and surface, whilst an antiseptic is used on living tissues and cells to destroy

any types of infections which may be living on the tissue. Disinfectants are meant to destroy

microorganisms which can infect nonliving objects. Antiseptics and disinfectants both work to

kill microbes, but antiseptics must also cause little or no harm to the tissues of the body whereas,

disinfectants need not be safe for use on living tissue.

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OBJECTIVE 3: What is the purpose of sterilization?

● The purposes of sterilization are :

- To prevent introduction of microbes and other infective material (e.g., virus, bacteria,

fungus, parasite, prions) into the patient’s surgical wound.

- To prevent wound infection and/or transmission of infectious disease that can lead to life-

threatening illness and in some cases, death.

- To destroy all pathogenic organisms together with spoilage /non pathogenic

microorganisms.

- To achieve safe preservation at room temperature of treated products.

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OBJECTIVE 4: Briefly explain the different methods used for the sterilization of

instruments

There are two main methods of sterilization which includes: Physical sterilization and Chemical

Sterilization.

Physical Sterilization comprises of:

1. Thermal or heat:

2. Radiation

3. Filtration

Thermal sterilization is the most widely used and reliable method which involves destruction of

enzymes and other essential cell constituents. This method is applied to thermo-stable products

and also can be used for moisture sensitive materials.

Thermo-stable: uses dry heat which involves:

 Incineration

 Red heat

 Flaming

 Hot air Oxygen

Moist heat:

 Dry salivated steam: autoclaving

 Boiling water with steam at atmospheric pressure

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  Hot water below the boiling point

The autoclave uses pressurized steam to destroy microorganisms under conditions of:

 Temperature: 1210C (2500F) -1340C (270 0C) for fifteen to twenty minutes under 15

pounds of pressure or 100kPa

 Temperature: 121-1320C for sixty minutes or 1340C for eighteen minutes for Prion

organisms

Radiation Sterilization:

1. Ionizing radiation

2. Non-ionizing radiation

Sterile Filtration:

Chemical Sterilization:

1. Gaseous such as-

1. Ethylene Oxide (EO, EtO): ideal for plastics or heat sensitive

2. Nitrogen dioxide (NO2 gas)

3. Ozone

4. Glutaraldehyde and Formalaldehyde solutions: liquid sterilization agents

5. Hydrogen peroxide

6. Peracetic acid: useful for the sterilization of endoscopes

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OBJECTIVE 5: State the methods of sterilization used at Milton Cato Memorial

Hospital

At the Milton Cato Memorial Hospital the methods that are used for sterilization are

Cidex Soak, Soap and water, Flash Sterilization and Autoclave Machine Sterilization.

Flash steam sterilization: a method of sterilization in which unwrapped instruments are

autoclaved at 1320 C for three minutes at twenty-seven to twenty-eight pounds of pressure.

Flashing is also a method of pasteurization. Flashing is done in emergency situation example

when an instrument falls in the operating theater. The instrument will be sterilized by a quick

blast of high temperature steam for a short period of time.

Autoclave: Autoclaving is one type of sterilization

where moist heat/ steam are used to kill bacteria or germs or any pathogens, eliminating them

from equipment that is used by the staff.

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Soaking: High level disinfection is achieved by soaking instruments in solutions such as

glutaraldehyde such as the Cidex solution, which requires a minimum exposure time of 30

minutes, depending on the manufacturer’s recommendations. Thorough rinsing of equipment

with sterile water or saline solution is necessary before placing them on the sterile field.

Cidex Soak: CIDEX Activated Glutaraldehyde Solution is

used in the operating theater to soak instruments after surgical use. Methanyl spirit is used to soak

instruments as well. It is:

 Effective – achieves high-level disinfection in 20 minutes at 20°C

 Long Lasting – Reusable for up to 14 days when monitored with CIDEX ® Solution Test

Strips

 Compatible – Can be used safely to disinfect a wide range of instruments, reducing the

risk of damage and associated cost of repairs

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OBJECTIVE 6: Briefly state the advantages and disadvantage of the methods used

at MCMH

Autoclaving:

Advantages of steam sterilization

 Steam sterilization is the easiest, nontoxic to patient, staff, environment, safest, and surest

method of onsite sterilization.

 Steam is the fastest method, its total time cycle is the shortest and it’s easy to control and

monitor.

 Steam is the least expensive and most easily supplied agent.

 Penetrates medical packing, device lumens etc.

 Steam leaves no harmful residue. Many items such as stainless steel instruments

withstand repeated processing without damage.

Disadvantages of steam Sterilization:

 Precautions must be used in preparing and packaging items, loading and operating the

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. It must be able to penetrate

packaging material but the material must be able to maintain sterility.

 The timing of the cycle is adjusted for differences in materials and sizes of loads, these

variables are subject to human error.

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  Steam must not be pure. Steam purity refers to the amount of solid, liquid or vapor

contamination in steam.

 If items are not properly sterilized, this can become a breeding ground for microbes.

 Microsurgical instruments maybe damaged by repeated exposure.

 May leave instruments wet, causing them to rust.

 Potential for burns.

 Harmful for heat-sensitive instruments.

 Its high temperature and moisture cannot sterilize camera cords and other sensitive

plastics and glues.

 Incompatible with plastics and rubber substances.

 Cannot penetrate hollow needles or instruments packed in moisture resistant materials

(test tube, glass).

Advantages of dry heat sterilization

 A dry heat cabinet is easy to install and has relatively low operating costs.

 It penetrates materials.

 It is nontoxic and does not harm the environment.

 It is noncorrosive for metal and sharp instruments.

Disadvantages for dry heat sterilization

 Time consuming method because of slow rate of heat penetration and microbial killing.

 High temperatures are not suitable for most materials.

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Advantages of flash sterilization

 Quick method of obtaining needed surgical equipment

 Flash sterilization is considered acceptable for processing cleaned patient-care items that

cannot be packaged, sterilized, and stored before use.

 Used when there is not enough time for the usual method of sterilization,

Disadvantages of flash sterilization

 Possibility of contamination of instruments during transport post sterilization.

 This method is not recommended for implantable devices (devices surgically implanted

into the body).

Advantages of soap and water

 Reduces the surface tension of disease causing microorganisms.

 Inexpensive compared to other methods.

 Convenient as soap and water are readily available.

Disadvantages of soap and water

 Ineffective in killing all disease causing organisms, some bacterial endospores remain on

instruments.

 Can be time consuming having to wash each instrument individually using soap and

water.

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Advantages of soaking in Cidex Solution

 Relatively inexpensive.

 Excellent materials compatibility.

 Commonly used for a quick-turnaround of instruments.

 Achieves high level disinfection in 45 minutes for heat sensitive equipment.

 Not a human carcinogen.

Disadvantages of soaking in Cidex Solution

 Respiratory irritation from glutaraldehyde vapor (active ingredient). Also causes irritation

of nose and throat.

 Pungent and irritating odor.

 Relatively slow mycobactericidal activity.

 Possible skin irritation.

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OBJECTIVE 7:
List the chemicals used in the disinfection/ sterilization at the operating theatre M.C.M.H.

A. Identify the types of organisms destroyed by these chemicals, how it is

destroyed(effects on the organism) and time frame for destroying the organism (5
lines)
B. List at least 5 advantages and 5 disadvantages of each chemical disinfectant
identified
C. What conditions should exist for the disinfectants to achieve its effectiveness.

The chemicals which are used for disinfection and sterilization are:

1. Cidex:

2. Prolystica enzymatic solution

3. Ethyl Alcohol 80%

4. Phenol solution

5. Soap and water

Cidex (Metricide): Active Ingredient: Glutaraldehyde

Indication for use: medical instruments that are heat sensitive such as diathermy leads, scopes.

Cidex Activated solution provides a broad spectrum efficacy against bacteria, mycobacteria,

viruses and fungi. The solution can also achieve some sporicidal activity with longer exposure

time, against bacterial spores and mycobacteria, fungi, protozoa: inhibition of germinations was

noted as the chemical destroys the outer cell layers. Viruses: destruction of the protein DNA

links and capsids (the protein shell of a virus). It consists of several oligomeric structural

subunits made of protein called promoters. Items are to be soaked for 15-30 minutes at 20 oC for

them to be considered sterilized.

pg. 13
Advantages of Cidex:

1. It kills a wide range of pathogens.

2. Relatively inexpensive

3. Compatible – Can be used safely to disinfect a wide range of instruments, reducing the

risk of damage and associated cost of repairs or replacement.

4. Has a long shelf life.

5. Long Lasting – Reusable for up to 14 days.

Disadvantages:

1. Vapors cause respiratory irritation.

2. Irritates eyes and skin.

3. Activity is reduced in the presence of protein.

4. Relatively slow microbial activity.

5. Devices must be totally immersible and Cidex must have contact with all surface areas.

6. Leaves non-volatile residue.

Conditions that must exist for the disinfectants to achieve its effectiveness.

1. All instruments to be disinfected by this chemical must be thoroughly cleansed with

mild protein dissolving detergent such as Prolystica Enzymatic solution.

2. Rinse instrument surfaces and lumens with large amounts of fresh water to remove

residual detergent.

3. All excess moisture must be dried.

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 4. The solution has a reuse life of 14 days.

5. Objects to be sterilized must be completely submersed in the solution.

6. Soak instruments for 15-30 minutes at 20ºC to achieve high level disinfection.

7. Following disinfection materials are rinsed first with water then with Ethanol Alcohol

80%.

Prolystica Enzymatic Solution: It can be used for removal of protein and lipid-based soils. It is

for use on surgical instruments, flexible fiber optic endoscopes, rigid scopes and apparatus where

blood, protein, mucous and lipids form hard to remove soils. By breaking the protein and lipid

chains.

Advantages:

1. Breaks down large, hard to remove materials into smaller, easy to remove fragments.

2. Reduces the need for costly routine maintenance and results in large savings.

3. It is non-corrosive and doesn’t attack any metal surfaces on medical instruments.

4. Shorter cleaning time.

5. Economical – the solution is twice as concentrated as some other products and requires

using less.

Disadvantages:

1. May cause irritation to skin and eyes if in contact.

2. Items need to be further processed after use in order to be deemed as sterilized.

pg. 15
 3. Relatively expensive (it is not ordered by MCMH but is donated from several

organizations including World Pediatric Project (WPP) and other organizations.

Conditions that must exist for the disinfectants to achieve its effectiveness.

1. Water temperature: If lower temperatures are used, a longer cleaning time may be

necessary. Do not exceed 130oF (55oC). If lower temperatures are used, a longer cleaning

time may be necessary. Do not exceed 130oF (55oC).

2. Quality: Water should be discarded daily or when visibly soiled.

3. Contact time: Clean for a minimum of 1-5 minutes. Cleaning times may be longer with

dried on proteinacaeous materials.

4. Concentration: Dilute chemistry 1/8 to ½ fl. oz. per gallon (1 to 4ml per L) of warm

water or 1-2 ounces per gallon.

Ethyl Alcohol 80%: Work through the disruption of cellular membranes, solubilization of

lipids, and denaturation of proteins by acting directly on S-H functional groups resulting cell

death is imminent. Effective also against fungi and some lipid containing viruses (influenza).

Start working within 15-30 seconds, after coming in contact with pathogens that are susceptible.

Advantages:

1. Works fast

2. Economical

3. Doesn’t leave a residue

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 4. Dries fast

5. Does not require preparation time

Disadvantages:

1. Highly flammable

2. Not a broad spectrum disinfectant (not effective against bacterial spores)

3. Hardens plastics and swells rubber

4. Skin irritant

5. Fixes proteins to surface its cleaning

Conditions that must exist for this disinfectant to achieve it effectiveness.

60% - 95% of alcohol must be present in solution.

Phenol: Disrupts the cell wall of a microbe, it also acts as aprotoplasmic poison causing the lysis

or bursting open of the cell. Spectrum covers bacteria, lipid containing viruses and organic

matter. It is noted to be inactive against spores and non- lipid viruses. It works well within 5-10

minutes.

Advantages:

1. Economical

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 2. Phenol can be mixed with quaternary ammonium compounds such as cetrimide to get

stronger and broader antimicrobial effects (e.g. Savlon).

3. Phenol acts on a wide range of microorganisms including bacteria, viruses and fungi.

4. Has a wide range of uses including instruments and surface areas.

5. Does not require preparation time

Disadvantages:

1. Irritates eyes

2. Not Sporicidal

3. Pungent odor.

4. It is toxic, corrosive and skin irritant.

5. Phenol is inactivated by anionic soaps and hard water.

6. Inhalation of phenol vapor may cause lung edema and may cause harmful effects on the

central nervous system and heart, resulting in dysrhythmia, seizures and coma.

Conditions that must be present for this disinfectant to achieve its effectiveness:

 Must not be overly diluted with water

 Must have contact with all surface areas for activity

pg. 18
Soap and water:

Soap and water are used to preliminarily clean equipments in the operating theatre before further

sterilization. Soap and water washes away body fluids and some microorganisms which are

caught up in the soap and washed away with water. Friction should be applied to aid with the

effective removal of microbes.

pg. 19
OBJECTIVE 8: State what are sterilizing indicators?

Sterilization Indicators are methods used to monitor the effectiveness of the sterilization process

and to identify instrument packages that have been processed through the sterilizer. These

sterilization indicators help to distinguish between processed and unprocessed medical devices at

a glance. They assure the sterilizer worker that each pack or item has been exposed to the

sterilization process, without the need to open the pack.

pg. 20
OBJECTIVE 9: Identify three (3) types of sterilization indicators

Three types of sterilization indicators are:

1. Mechanical indicators for monitoring sterilization include assessing the cycle time,
temperature and pressure of sterilization equipment by observing the gauges or displays
on the sterilizer. Correct readings do not ensure sterilization but incorrect readings could
be the first indication that a problem occurred with the sterilization cycle.

2. Chemical indicators internal and external use sensitive chemicals to assess physical
conditions such as temperature during the sterilization process. Chemical indicators such
as heat sensitive tape change color rapidly when a given parameter is reached. An
internal chemical indicator should be placed in every sterilization package to ensure the
sterilization agent has penetrated the packaging material and actually reached the
instruments inside. An external indicator should be used when the internal indicator
cannot be seen from outside the package.

3. Biological indicators are the most accepted means of monitoring the sterilization process
because they directly determine whether the most resistant microorganisms are present
rather than merely determining whether the physical and chemical conditions necessary
for sterilization are met. A biological indicator is the only type of monitor that provides
direct evidence that sterilization process conditions are sufficient to kill spores. It uses
microbes that are highly resistant to the type of sterilization process you are monitoring.

The main sterilizer utilized at C.S.S.D is the Autoclave machine. The electrical autoclave allows

the sterilizer operator to set the time and usually produces a beeping sound to indicate

sterilization has occurred. Meanwhile, the digital autoclave has its own timer which tells the

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specific time period for sterilization of certain products and also beeps when sterilization is

accomplished.

Moreover, one type of sterilization indicator involves the use of indicators that change color or

physical form when exposed to certain temperatures which are classified as chemical indicators.

Examples include:

1. The autoclave tape: This type of indicator is commonly used as an external indicator on

the outside of every pack or pouch to indicate that the item has at least been processed

through a heat sterilizer. Usually, the white lines on the autoclave tape turn black when

processed through the autoclave. This indicates when sterile conditions have been

attained. This distinguishes the items that have been heat-processed from those that have

not; otherwise, the two types may appear identical.

2. Sterilization Strips: are usually placed inside of the instrument sets and will turn black,

green or blue to indicate that sterilization has been accomplished.

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3. Sterilization pouches and bags: called Protex; combines a special blue film and a

medical grade paper to provide breathability, sterile barrier and indication of processing.

The pouch has special markings / external process indicator (usually an arrow) on them

that changes color. When steam sterilized, the arrow turns brown and when ethylene

oxide processed, the arrow turns yellow. However, these color changes are dependent on

the manufacturer of the pouch.

pg. 23
References

 CDC - Disinfection & Sterilization Guideline:Sterile Methods - HICPAC. (n.d.).

Retrieved from

https://www.cdc.gov/hicpac/Disinfection_Sterilization/13_10otherSterilizationMethods.

html

 CDC (2009). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.

Retrieved February 14, 2017, from

https://www.cdc.gov/hicpac/Disinfection_Sterilization/table_5.html

 Milton Cato Memorial Hospital CSSD (2017)

 EBSCOhost Login. (n.d.). Retrieved from http://web.a.ebscohost.com/nrc/detail?

vid=5&sid=96e125b6-9a72-4391-9d9d-

5b2a99ddfdc0%40sessionmgr4007&hid=4106&bdata=JnNpdGU9bnJjLWxpdmU

%3d#anchor=toc&AN=T706246&db=nrc

 Indian dental academy Follow. (2014). Sterilization. Retrieved February 14, 2017, from

http://www.slideshare.net/indiandentalacademy/sterilization-33992268

 Sterilization | Define Sterilization at Dictionary.com. (n.d.). Retrieved from

http://www.dictionary.com/browse/sterilization

pg. 24
 Group Participation Sheet

NAME SPECIFY NO SOME FULL

WORK
PARTICIPATION PARTICIPATION PARTICIPATION
ASSIGNED
GRADE ZER0 GRADE 0.5 GRADE 1

Leshoan Castello # 4 and power Grade 1

point

Kemesha Charles #7& Grade 1

presentation

Ieshia Cupid #3 Grade 1

Renecia Daniel #5 Grade 1

Leorol Gibson #1 Grade 1

Gabriel Glasgow Organization Grade 1

& editing

Karriel Joseph #8 Grade 1

Aneak Joseph #6 Grade 1

Andrea Noel #9 Grade 1

Presentation

Cande Neverson #9 Grade 1

Anastasia Squires #8 Grade 1

Weneika James #5 Grade 1

Unita Straker #2 Grade 1

Joel Thompson #7 Grade 1

pg. 25