There are a variety of packaging options available depending on a practice’s needs. Packaging must be sealed to maintain sterility and compatible with the type of sterilization used. Step 6 – Sterilize and Dry Instruments There are a variety of different sterilization methods including steam sterilization (known as “autoclaving” or “moist heat under pressure”), dry-heat sterilization (electric oven) and chemical vapor sterilization. Critical patient care instruments (instruments that have direct contact with the bloodstream or tissues under the skin) must be sterilized prior to reuse to avoid possible transmission of infections. If the use of critical patient care instruments is a routine occurrence in the practice, it is important to have more than one method of sterilization or multiple sterilizers available to use as a backup in the event equipment breaks down, supplies run low, electricity is unavailable or to avoid disruption in the practice. Steam sterilization is the most commonly used and recommended method of sterilization. To achieve optimal sterilization conditions inside the chamber of steam sterilizers, it is necessary to remove the air trapped inside the chamber once the sterilizer door is closed.
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Traditionally, steam sterilizers have been classified by the method used to remove this air. Gravity displacement sterilizers rely on gravity to force the air out of the bottom of the chamber through a mechanical valve at the beginning of the heating phase. Once specific conditions (temperature, pressure, etc.) inside the chamber are reached, this valve closes and remains closed throughout the remainder of the cycle. Thus there is the potential for small amounts of air to remain trapped in the chamber after the valve closes. This trapped air can result in incomplete sterilization under certain conditions. Another traditional steam sterilizer type is the pre- and post-vacuum sterilizer. These sterilizers use a vacuum pump to remove air from the sterilizer chamber prior to and during the heating phase. Because this method uses a pump to draw the air out of the chamber and its contents instead of relying on gravity to cause the air to be moved to the bottom of the chamber and escape through an open valve, it can remove more air from the sterilizer chamber than gravity displace sterilizers. In this type of steam sterilizer, the vacuum pump is also usually used at the end of the sterilization cycle to remove moisture from the sterilizer contents to shorten the drying time. Pre- and post-vacuum sterilizers tend to be significantly more expensive and also more costly to maintain because of the added components and complexity. The third and newest type of steam sterilizer is the Steam-Flush Pressure-Pulse model. This sterilizer uses an electronically operated valve in place of the mechanical valve used on gravity displacement sterilizers to remove the air from the sterilizer chamber and its contents. Since the valve is electronically controlled it can be opened numerous times as required to vent the air from the chamber, thus maximizing air removal. This type of steam sterilizer offers the low maintenance and cost of the gravity displacement sterilizers with the more effective air removal of the prevacuum sterilizers. This allows some sterilizers of this type to pass air removal tests that are only required by prevacuum sterilizers (an example would be the Midmark M11 UltraClave® Automatic Sterilizer), which removes more air from the chamber vs. gravity displacement sterilizers.Whatever type of sterilizer is being used, follow the sterilizer manufacturer’s instructions for specific instrument packaging, sterilizer operation and maintenance to ensure reliability of the equipment and correct operating procedures. Chemical Indicators should be used in every cycle to validate that the sterilizer reached the appropriate cycle conditions necessary to achieve sterilization. Biological Indicators should be used in the sterilizer at least once a week to validate that the sterilizer is killing all microorganisms.