Leslie Teachout MT(ASCP), CIC
Infection Prevention Riverton and
Lander Hospitals
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Discuss the five steps in Sterilization
Process
Learn what processes in the OR the
Infection Prevention should review
and/or understand.
Learn the five steps to monitor
sterilization
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Behind closed doors
Special clothing-only scrubs
Red lines to cross
Very busy
Sterile!
Patient privacy very important
A very specialized team
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Sterilize instruments
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Remove bio-burden!!!
Proper type of sterilization
Proper instruments in each tray/wrap
Monitor autoclaves/sterilization equipment
Maintain autoclaves/sterilization equipment
Immediate use sterilization
Association for the Advancement of
Medical Instruments Standards
Association of Operating Room Nurses
1.
2.
3.
4.
5.
Clean/Disinfect
Prep/pack
Sterilize
Store
Issue/use
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Open hinged instruments to remove bioburden
Must clean before sterilization!
Rust and/or pitting are the enemy!
Instruments design and material
Don’t reprocess single use instruments
FOLLOW MANUFACTURE
RECOMMENDATIONS!!
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Enzymatic cleaner immediately
Washer sterilizer can be used
Monitor process
with indicator
Load size?
Maintenance
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Hospital specific trays or sets
All surfaces of the instruments must be
contacted by sterilant
Wet packs mean water can contaminate
instruments
Weight limits of trays
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Best way to sterilize
steam (see below for types)
 ETO
 Sterrad (plasma)
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Types of steam cycles
Gravity
 Pre-vacuum
 SFPP (Steam Flash Pressure Pulse)
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Regular Cleaning
Lint trap
Maintenance
1.
2.
3.
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5.
Equipment Control
Load Control
Pack Control
Exposure Control
Record keeping
How to determine if your sterilizer is doing it’s job.
When using dynamic-air removal (i.e. vacuumassisted steam cycles or pre-vac)
Begin each day with a Bowie-Dick
test to detect air leaks.
Air leaks, poor steam quality, inadequate vacuum
and air pockets can lead to poor steam penetration.
Monitor the rest of the day by watching physical
monitors
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Foundation of successful sterilization
process monitoring:
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Biological Indicator or BI
Only way to detect actual killing of microbial spores
Most reliable test
Rapid read outs reduces risk of recalls and is less
expensive
Required with implantable devices
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Use of chemical indicators (CI) for internal
monitoring of packs
Verifies the sterilant has penetrated the pack/peel
pouch
Chemical indicators are designed to react to two or
more of the critical variables required for steam
sterilization:
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Time
Temperature
Presence of steam
CI have classes (not hierarchical!)
Staff aware and understand importance!!
CI Classes
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To know at a glance if the
packs have been exposed
to the sterilization process.
These are CI class 1
process indicators
So packs don’t have to be
opened
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Provides documentation that items have been
processed along with evidence of their
monitoring results.
Extremely important in a recall investigation
Required for accrediation
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How long is the
wrap good for/shelf life?
Inventory control
Look for wet packs
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Are “flashed packs” being usedpreferred
Instruments cleaned prior to IU?
Types of cycles
Monitor for frequency of IU as this may
indicate an instrument need
Is all the OR staff educated and aware of
the whole process?
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Gown up or bunny suit up and go to the OR!
Ask questions!
Ask questions!
Watch processes!
Get educated by staff as well as know the
standards!
Who cleans the OR rooms/how often
Check for cleanliness-white glove test
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Review logs for monitoring and maintenance!
Watch processes in the OR! (i.e. medication
administration)
Open doors!
Check carts be NOSEY!
Look at storage areas especially sterile storage
Look for storage in “hidden sterile storage
areas”(i.e. ED, PT and OB)
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Remember and remind we are all on the
same team!
Find out who does and owns the
processes
Open doors on cupboards!
Check drawer in carts for open skin
preps or medication!
We all have the patients’ safety in mind!
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Monitor Surgical Site Infections for trends:
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OR staff
OR Room
Surgeon
Was the immediate use autoclave used for
instruments
Customize for your hospital
Share findings with OR Staff!
Share findings with Surgeons
Share findings with Anesthesia
Keeping patients’ is everyone's responsibility
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Who process the instruments at your hospital?
Are the individuals employed by your organization!
Check packages – have a process just like checking
outdates
Initials
 Date
 Condition of package
 Indicator on peal pack
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Is SPD cleaning instruments well before
sterilization? Watch process
Are any instruments being used in your facility
coming form outside (vendors, dentists, etc.)
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Is washer used? Then how is it monitored?
Are all autoclave cycles and autoclaves
monitored?
Know what class of monitors are being used
 Frequency and documentation of Biological
Indicators (BI)
 Assure all implants are being monitored with a BI
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What is your recall process when there is a
failure? (make sure your on the list)
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How are autoclaves cleaned (how and
frequency)?
Monitor room cleaning
All patient rooms (ATP or Diazo)
 White glove the tops of high surfaces/high dusting
and vents?
 Frequency of terminal cleaning and difference
between daily cleaning
 Who does the cleaning?
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Cleaned prior?
Walk through process; same a SPD
Cycles used for what and when
Are logs complete?
Who owns this process?
Is OR staff knowledgeable and handles
instruments appropriately?

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Discuss the five steps in Sterilization
Process
Learn what processes in the OR the
Infection Prevention should review
and/or understand.
Learn the five steps to monitor
sterilization



Be aware of the hidden hospital in your
hospital
Stop the spread of the undiagnosed cancer!
Bring the process into the light!