Instrument Processing
Outlines
Overview
Level of disinfection or serialization required
Introduction to chemical disinfectants
Description of steps in processing item
Monitoring sterilization procedure
Safe storage and transport of sterile/ HLD Instrument
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Session Objective
Understand General overview of sterile services
Describe the steps of instruments and other items processing
List commonly used disinfectants
Elucidate the steps of cleaning process, sterilization and HLD
Explain how to store safely sterilized and high level disinfected
instrument and other items
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Overview
Instruments which are reused without being properly processed and made
safe are one of the causes of infections in developing countries.
Healthcare workers are increasingly at risk of becoming infected with
serious blood borne viruses such as HBV, HCV and HIV.
The basic infection prevention processes recommended to reduce disease
transmission from soiled instruments; surgical gloves and other reusable
items are by way of cleaning and either sterilization or high-level
disinfection (HLD).
In all steps, special attention should be given to proper handling of the
instruments and other items to
Minimize the risk of accidental injury or exposure to blood and other body
fluids of the sterile processing staff and
To attain high quality end result.
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Level of Disinfection or Sterilization Required
A rational approach for processing medical devices
and surgical instruments for patient care was first
described by Earle H. Spaulding in 1968.
It is still relevant in making decisions about the final
approach to instrument processing.
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Spaulding’s category of potential infection risk
Spaulding classified instruments and patient care devices
into three categories, based upon how the device is used.
Items are classified as:
Non-critical—come in contact with intact skin but not
mucous membranes
Semi-critical—come in contact with mucous
membranes or non-intact skin
Critical—come in contact with sterile areas of the body
including the vascular system
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Spaulding’s Risk Classification and Level of Processing
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Work flow for instrument processing
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Current Common practices in Ethiopian HCI
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What is Decontamination?
Decontamination is the process of making inanimate
objects safer to handled by staff before cleaning.
It is done by soaking the equipment in 0.5% chlorine
solution
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Decontamination
Principles:
Inactivates HBV and HIV
Makes items safer to handle
Must be done before cleaning
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Instructions for Preparing Dilute Chlorine Solutions
% Concentrat e -1
Total parts (TP) (H2O) = % Dilute
5% Concentrat e = 9 Total parts (TP) (H2O)
Total parts (TP) (H2O) = -1
.5% Dilute
To make a 0.5% chlorine solution from 5% bleach, mix 1 part
bleach to 9 parts water.
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Instructions for Preparing a Chlorine Solution from a
Powder
% Dilute
Gram/Liter = X 1000
% Concentrat e
Gram/Liter =
.5% Dilute X 1000 = 14.2 Gram/Liter
35% Concentrat e
To make a 0.5% chlorine solution from
a 35% chlorine powder,
mix 14.2 grams of powder to 1 liter of water.
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Examples Using 5% Bleach for 0.5% Concentration
One part bleach to 9 parts water (use the same container to measure the bleach
and water)
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Household Bleach Safety
Use mask, goggles, rubber gloves, waterproof apron
Mix in well-ventilated area
Do not use or mix with other detergents
Use cold or room temperature water to mix
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Decontamination Practices # 1
Place instruments and reusable gloves in
0.5% chlorine solution after use
Soak for 10 minutes and rinse
immediately.
Wipe surfaces (exam tables) with chlorine
solution
Flush syringe and needles with 0.5% chlorine
solution
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Decontamination Practices # 2
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Cleaning
Principles:
Removes organic material that:
Protects microorganisms against sterilization and
HLD
Can inactivate disinfectants
Must be done for sterilization and HLD to be
effective
Method of mechanically reducing the number of
microorganisms, especially endospores
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Cleaning
Practices after items are decontaminated:
Use PPE during cleaning
Disassemble instruments
Wash with detergent, water, and a soft brush.
Scrub instruments under the water surface until
visibly clean.
Thoroughly rinse with clean water.
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Effectiveness of Methods for Processing
Instruments
Method Effectiveness End Point
(kill or remove
microorganisms)
Decontamination Kills HBV and HIV and 10-minute soak
most microorganisms
Cleaning (water only) Up to 50% Until visibly clean
Cleaning (water and Up to 80% Until visibly clean
soap)
Sterilization 100% High-pressure steam,
dry heat, or chemical
High-Level 95% (does not inactivate Boiling, steaming, or
Disinfection some endospores) chemical for 20
minutes 21
Storage of Sterilized & HLD Instrument#1
Storage Area
All sterile items should be stored appropriately to protect them from
dust, dirt, moisture, animals and insects.
The storage area should be located next to the place of sterilization
or connected to it in a separately enclosed area with limited access that
is used just to store sterile and clean patient care supplies.
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Storage of Sterilized & HLD Instrument#2
Keep the storage area clean, dry, dust-free and lint-free.
Control temperature and humidity (approximate temperature 24 0C
and relative humidity <70%) when possible.
Packs and containers with sterile (or high-level disinfected) items
should be stored 20 to 25cm off the floor, 45 to 50cm from the
ceiling and 15 to 20cm from an outside wall.
Do not use cardboard boxes for storage because cardboard boxes
shed dust and debris and may harbor insects.
Date and rotate the supplies (first in/first out). This process serves
as a reminder, but does not guarantee sterility of the packs.
Distribute sterile and high-level disinfected items from this area.
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Shelf Life of Instruments
The shelf life of an item (how long items can be considered sterile)
after sterilization is event-related.
An item remains sterile until something causes the package or
container to become contaminated as time goes on since
sterilization is not the determining factor.
An event can be a
Tear or worn-out area in the wrapping,
The package becoming wet or
Anything else that will enable microorganism to enter the
package the package or container.
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Shelf Life of Instruments…
Quality of the wrapper or container.
Number of times a package is handled before use.
Number of people who have handled the package.
Whether the package is stored on open or closed shelves.
Condition of storage area (e.g. humidity and cleanliness).
Frequent or improper handling or storage.
Use of plastic dust cover and method of sealing
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Thank You!
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