LECTURE 2: Care and Handling of Surgical Equipment and Supplies

What must be removed from instruments and linens regardless of the sterilization technique used?

Gross contamination

What are the three methods of cleaning instruments?

1. Manually

2. Ultrasonic Cleaning Equipment

3. Appropriate Disinfectants

What should be done with linens after use?

Laundered

When should instruments be cleaned after use?

ASAP BRUH 😎

Why should instruments be cleaned as soon as possible after use?

To prevent drying and caking of blood and other debris

Why is cleaning a vital step before sterilization?

It removes organic and inorganic salts that interfere with sterilization

What materials are used for cleaning instruments?

Water and Detergents/Enzymatic Cleaner

What are the two methods of cleaning instruments?

Mechanically and Manually

What are the three mechanical cleaning methods?

1. Ultrasonic Cleaner

2. Dishwasher

3. Utensil Washer/Sanitizer

What do high-level disinfectants destroy?

All microorganisms except some bacterial spores

What are the two methods of high-level disinfection?

1. Liquid Immersion

2. Pasteurization

What do low-level disinfectants destroy?

Vegetative bacteria, some viruses, and fungi

What do low-level disinfectants typically not kill?

Spores and Mycobacteria

What are the eight disinfectants listed in the reviewer?

1. Peracetic Acid–Hydrogen Peroxide

2. Glutaraldehyde

3. Hydrogen Peroxide

4. Improved Hydrogen Peroxide (2%)

5. Ortho-Phthalaldehyde (OPA)

6. Peracetic Acid

7. Ethylene Oxide (EtO)

8. Heavy Metal Ions/Dyes

What alcohol concentrations are used as disinfectants?

Isopropyl Alcohol: 50%–70%, Ethyl Alcohol: 70%

What are the two practical uses of alcohol?

Spot Cleaning and Injection Site Preparation

What are the disinfectant and antiseptic properties of alcohol?

Disinfectant: Good, Antiseptic: Very Good

What is the MOA of alcohol?

Protein denaturation, metabolic interruption, and cell lysis

What are the four precautions for alcohol?

1. Corrosive to stainless steel + volatile.

2. Damage to shellac mountings of lensed instruments.

3. Hardens rubber and some plastic tubing after prolonged use.

4. Irritating to tissues.

What is the agent used in chlorine compounds?

Hypochlorite

What is the practical use of chlorine compounds?

Cleaning floors and countertops

What are the disinfectant and antiseptic properties of chlorine compounds?

Disinfectant: Good, Antiseptic: Fair

In what forms are chlorine compounds available?

• Liquid (sodium hypochlorite)

• Solid (calcium hypochlorite)

What is the MOA of chlorine compounds?

Release of free chlorine and oxygen

What are the four precautions for chlorine compounds?

1. Inactivated by organic material.

2. Corrosive to metal.

3. May cause skin irritation and esophageal burns if ingested.

4. Discolors fabric.

What agent and concentration are used for iodine compounds?

Iodophors (7.5%) scrub solution

What is the practical use of iodine compounds?

Cleaning dark-colored floors and countertops

What are the disinfectant and antiseptic properties of iodine compounds?

Disinfectant: Good, Antiseptic: Good

What is the MOA of iodine compounds?

Iodination and oxidation of essential molecules

What are the two precautions for iodine compounds?

1. Stains fabric and tissue.

2. Do not use on silicone tubing.

What agent and concentration are used for glutaraldehyde?

2% Alkaline Solution

What is the practical use of glutaraldehyde?

Disinfection of lenses and delicate instruments.

What are the disinfectant and antiseptic properties of glutaraldehyde?

Disinfectant: Good (sterilizes), Antiseptic: None

What is the MOA of glutaraldehyde?

Protein and nucleic acid alkylation.

What are the three precautions for glutaraldehyde?

1. Tissue reaction and has 🤢 odor.

2. Rinse instruments well before using.

3. Can be 💀 highly toxic.

What are the two practical uses of hydrogen peroxide?

1. Often used as an antiseptic.

2. Stabilized form used on environmental surfaces.

What are the disinfectant and antiseptic properties of hydrogen peroxide?

Disinfectant: Good, Antiseptic: Very Good (particularly against anaerobic bacteria)

What is the MOA of hydrogen peroxide?

Formation of free hydroxyl radicals (OH), which oxidize thiol groups in enzymes and proteins.

What are the two precautions for hydrogen peroxide?

1. May be irritating to skin at high concentrations.

2. Irritating to eyes.

What is OPA?

Ortho-Phthalaldehyde

What is the practical use of OPA?

Chemical sterilant similar to glutaraldehyde but not irritating to eyes and nasal passages

What are the disinfectant and antiseptic properties of OPA?

Disinfectant: Good (sterilizes and ⚡️ fast acting), Antiseptic: None

What is the MOA of OPA?

Aldehyde binds to the outer cell wall of the organism

What are the three precautions for OPA?

1. Doesn’t smell but wear personal protective equipment when handling.

2. Provide good ventilation.

3. Rinse equipment thoroughly.

What is the practical use of peracetic acid?

Used in automated machines to chemically sterilize instruments

What are the disinfectant and antiseptic properties of peracetic acid?

Disinfectant: Good (effective in presence of organic material, very rapid kill, no harmful residue), Antiseptic: None

What is the MOA of peracetic acid?

Denatures proteins, disrupts cell wall permeability, and oxidizes sulfhydryl and sulfur bonds in proteins, enzymes, and other metabolites.

What are the three precautions for peracetic acid?

1. Unstable and quickly loses activity, particularly when diluted.

2. Corrosive and irritating to:

   1. Eyes

   2. Skin

   3. Respiratory System

3. Can corrode copper, brass, bronze, and galvanized iron.

What is sterilization?

Killing or removal of all microorganisms, including highly resistant bacterial spores

What is disinfection?

Killing of many but not all microorganisms, reduces contaminating organisms to a level that cannot cause infection, some organisms/spores may survive

What are disinfectants?

Chemicals used for disinfection, used only on inanimate objects

What are the two factors determining the reliability of sterilization?

1. Number, type, and inherent resistance of microorganisms.

2. Presence of other materials such as soil or oil that shield against or inactivate the sterilizing agent.

What are the three methods used to sterilize equipment or supplies?

1. High Temperature 🔥

2. Low Temperature 🥶

3. Liquid Immersion 💧

What are the (2) two 🔥 high-temperature sterilization methods?

1. Steam Autoclave

2. Dry Heat

What items are suitable for 🔥 high-temperature sterilization?

• Heat-tolerant critical

• Semi-critical items

Why is steam autoclave unsuitable for many modern devices?

High temperature or moisture

Why is dry-heat sterilization seldom used?

It produces temperatures not tolerated by most devices

What are the (4) four examples of 🥶 low-temperature sterilization systems?

1. EtO Gas

2. Hydrogen Peroxide Gas Plasma (HPGP)

3. Hydrogen Peroxide and Ozone (HPO)

4. Hydrogen Peroxide Vapor (HPV)

What items are suitable for low-temperature sterilization systems?

• Heat-sensitive critical

• Semi-critical items

At what temperature do low-temperature sterilization systems sterilize instruments?

Below 50°C (140°F)

Which devices are ideal for low-temperature sterilization?

Heat- and moisture-sensitive devices like endoscopes and delicate tools

What is liquid chemical sterilization?

Method for sterilizing heat-sensitive, immersible devices by complete submersion in a chemical sterilant solution for a prescribed period.

What does liquid chemical sterilization kill?

All microorganisms including spores through chemical action

What are the three chemical sterilants used for liquid immersion sterilization?

1. Glutaraldehyde

2. Glutaraldehyde + Phenol

3. Hydrogen Peroxide + Peracetic Acid (Various Concentrations)

What are the three key aspects of liquid immersion sterilization?

1. Appropriate liquid sterilant.

2. Proper contact time/temperature/concentration.

3. Subsequent removal of sterilant to avoid recontamination.

Why is liquid chemical sterilization limited in usefulness?

Devices cannot be wrapped and typically need rinsing with water that is often not sterile.

What is a practical and dependable agent for sterilizing heat-tolerant medical supplies and packaging?

Saturated steam under pressure

How does steam rapidly destroy microorganisms?

Coagulation + Cellular Protein Denaturation

What is critical for effective steam sterilization?

Correct relationship between temperature, pressure, and exposure time

What is an autoclave?

Unit used to create high-temperature, pressurized steam

What does a steam sterilizer use to kill bacteria, viruses, fungi, and spores on surgical instruments?

High-temperature/pressure steam

Which spores are the most heat-resistant known forms of life?

Thermophilic aerobe or anaerobe spores

Which is more vulnerable to steam sterilization, virus particles or spores?

Virus particles

What is the most commonly used steam sterilizer in veterinary practice?

Gravity Displacement Sterilization

What is another name for gravity displacement sterilization?

Downward Displacement Sterilizer

What principle does gravity displacement sterilization use?

Air is heavier than steam

What are the seven steps or principles of gravity displacement sterilization?

Supplies loaded into inner chamber, Narrow outer jacket-type chamber surrounds inner chamber, Pressurized steam from outer chamber enters inner chamber and surrounds supplies, Air in inner chamber pulled downward by gravity and exits through a temperature-sensitive valve, Steam accumulation and increased temperature close the steam-release valve, Function based on air moving to the bottom of the autoclave, Careful wrapping and loading of supplies is critical

What does prevacuum sterilization rely on?

Air being actively pulled out of the inner chamber, creating a vacuum

What replaces the air removed during prevacuum sterilization?

Steam

What does the vacuum pump allow steam to penetrate quickly and effectively?

1. Wrapped Instruments

2. Porous Items (Textiles, Bedding)

3. Complex Tools

What is the advantage of prevacuum sterilization over gravity displacement sterilization?

Greater steam penetration in a shorter time

What is another name for immediate-use steam sterilization?

Emergency/Flash Sterilization

When is immediate-use steam sterilization performed?

When an unwrapped, nonsterile item must be sterilized quickly for immediate use and no alternative sterile item is available

What are the four steps of immediate-use steam sterilization?

Use a gravity displacement sterilizer, Place item unwrapped in a perforated metal tray, Sterilize according to manufacturer's time/temperature recommendations, Transport detachable-handle items to the OR in the metal tray

What are the two limitations of immediate-use steam sterilization?

1. Difficult to deliver aseptically.

2. Hot wet unwrapped tray collects dust/debris/microorganisms more readily than dry cool trays with biobarrier protection.

When should immediate-use steam sterilization be used?

Only in emergencies when no alternative is available

What items are generally not recommended for immediate-use steam sterilization?

1. Implantable Medical Devices.

2. Power Equipment (unless specifically approved by the manufacturer)

What test is used if an implant must be flash sterilized?

Rapid read biological spore test, readable in 1 hour for a flash cycle

Where should the sterilizer for immediate-use steam sterilization be located?

Restricted area of the surgical suite or treatment site

What are the two recommended methods for transporting or containing immediately sterilized items?

1. Rigid Sterilization Container Systems (validated for immediate-use sterilization)

2. Single-Wrapper Technique

What are the two examples of chemical gas sterilization?

1. Ethylene Oxide (EtO)

2. Hydrogen Peroxide Gas

How does chemical gas sterilization work?

Uses gases in a closed chamber to kill microorganisms on heat- and moisture-sensitive instruments.

What type of gas is ethylene oxide?

Flammable, explosive gas

How does ethylene oxide kill microorganisms?

Alkylation of proteins, DNA, and RNA, altering normal cellular metabolism and replication

What are the five factors affecting the time required for ethylene oxide sterilization?

Concentration of EtO, Humidity Level, Temperature, Volume or Density, Type of Materials

What are the temperature and time requirements for most items using EtO?

54.4°C (130°F) for approximately 2.5 hours

What are the temperature and time requirements for heat-sensitive items using EtO?

37.8°C (100°F) for approximately 5 hours

Whose recommendations must be followed for EtO exposure time?

Manufacturer's recommendations

What are the features of compact tabletop EtO units?

Ventilation + purge systems

What cycle durations do most veterinary EtO units run at room temperature?

12- and 24-hour cycles