CESO Education Day November 30, 2004 Shawn Kenny Manager, Central Processing Department University Health Network

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CESO Education DayNovember 30, 2004Shawn Kenny
Manager, Central Processing DepartmentUniversity
Health Network Toronto General Hospital
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Goals

• Sterilization Technologies
• Sterility Assurance
• HLD Technologies
• Current Challenges

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Sterilization Technologies

• Steam
• PreVacuum
• Gravity Displacement
• Flash
• Ethylene Oxide (EO)
• Hydrogen Peroxide Plasma (Sterrad)
• Ozone (TSO3)
• Gamma Irradiation

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Sterilization TechnologiesSteam

• Most commonly used sterilization method in health
  care facilities
• Cost effective
• High or low volume
• Environmentally safe

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Sterilization TechnologiesSteam

• PreVacuum
• Sterilization conditions created by creating
  chamber vacuum to displace air within chamber and
  instrumentation
• Short exposure time
• High temperature
• Drying phase

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Sterilization TechnologiesSteam

• Gravity Displacement
• Steam is injected directly into the chamber
  sleeve and air is displaced passively through a
  drain
• More gentle method, often utilizing lower
  temperatures with longer exposure times
• Drying phase

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Sterilization TechnologiesSteam

• Flash
• Point of care sterilization
• Utilizes gravity displacement or prevacuum
• Wrapped or unwrapped
• Porous and Non-Porous cycles
• Normally no drying phase
• Urgent requirements, not recommended for normal
  practice

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Sterilization TechnologiesEthylene Oxide

• Low temperature sterilization for delicate
  devices
• Long cycle time (aeration)
• Low volume
• Controlled substance

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Sterilization TechnologiesEthylene Oxide
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Sterilization TechnologiesHydrogen Peroxide
Plasma

• Low temperature
• Short cycle time
• Expensive
• High load failure rate
• Environmentally safe
• Destructive process for many materials
• Ineffective for long narrow lumens
• Proprietary technology

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Sterilization TechnologiesOzone

• Low temperature
• Inexpensive
• Low volume
• Short cycle time
• Environmentally safe
• Destructive process for many materials
• Ineffective for long narrow lumens
• Proprietary technology

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Sterilization TechnologiesGamma Irradiation

• Used in manufacture of single use medical devices
• High throughput for packaged materials
• No current standards for use as sterilization
  method outside the manufacturing process

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Sterility AssuranceMechanical Indicators

• Time, temperature and pressure
• Every load
• Part of Sterilization Record

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Sterility AssuranceChemical Indicators

• Indicates sterilant exposure only
• Every item or package
• Internal and external
• Must be verified at point of use
• Class 1 Indicator (AAMI)

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Sterility AssuranceBowie-Dick Testing

• Daily Air Removal Test (DART)
• Performed daily prior to first active load (or
  after significant maintenance)
• Prevacuum autoclaves only

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Sterility AssuranceBiological Indicators

• Log reduction in viable spores
• Daily / Parameter change / Sterilizer
  maintenance/repair
• Incubation required
• Part of Sterilization Record
• Steam, Hydrogen Peroxide Plasma, Ozone
  (geobacillus stearothermophilus)
• Ethylene Oxide (bacillus subtilis)

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Sterility AssuranceIntegrators

• Currently, most commonly used for Flash
  sterilizers
• Quantifiable measurement of steam exposure (time
  / temperature / quality)
• Class 5 Indicator (AAMI)

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High Level DisinfectionPasteurization

• High temperature (170 F x 20 min)
• High volume
• Requires sterile driers
• Mechanical indicators only

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High Level DisinfectionSoaking

• Gluteraldehyde
• Occupational health hazard
• Being eliminated where possible
• CIDEX OPA
• Safe
• Contraindicated for urological procedures
• Accelerated Hydrogen Peroxide
• Safe
• Expensive
• Destructive to many materials

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High Level DisinfectionParacetic Acid

• Point of care sterility?
• Expensive
• Low volume
• Destructive to materials over time
• Mechanical, chemical and biological indicators
  (available)

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High Level DisinfectionAutomated Scope Processors

• Emerging technologies
• Gluteraldehyde, CIDEX OPA, Paracetic Acid
• Some technologies conflicting with current
  standards

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Current Challenges

• Oddball parameters for sterilization
• Loaner instrumentation
• Manufacturers keeping up with technology
• Technology keeping up with manufacturers
• Standards organizations keeping up with
  technology
• SUMeds

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In Summary

• 2004 was a tough year to be a sterile processing
  manager in Ontario
• 2004 has been a GREAT year to be a sterile
  processing manager in Ontario!
• Increased public awareness
• Increased institutional awareness
• Increased government awareness

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Questions?