In addition to a comprehensive sterility assurance program
(routine use of mechanical/electronic, chemical and biological
indicators), items to be sterilized must be loaded into a
sterilizer in a manner that promotes complete circulation
and penetration of the sterilant.
General Recommendations:
Do not overload the sterilizer chamber. This
will cause the sterilizer to take much longer to heat to a
temperature sufficient for sterilization resulting in inadequately
sterilized goods.
Do not stack instruments. Place packs or
packages on edge to facilitate sterilant penetration of packaging
materials and place unwrapped instruments in a single layer
to allow the sterilant (steam, chemical vapor, dry heat, etc.)
to contact all surfaces.
Allow items to dry completely before removal from
the sterilizer. Wet or damp packs must be considered
contaminated as microorganisms readily migrate through damp
packaging.
Items should not be removed from the sterilizer until
they have cooled. Hot instruments will form condensation
inside the package when they hit the colder room air. Again,
packages will be wet and must be considered contaminated.
Additionally, when hot packages cool, the air in them contracts,
forming a vacuum, which will draw microorganisms through the
packaging to the contents and contaminate them.
Refer to the sterilizer manufacturer's written instructions
for recommended load size and loading procedure.
Specific Recommendations:
(adapted from the Association for the Advancement of
Medical Instrumentation recommended sterilization practices,
ANSI/AAMI ST42—1992 and ANSI/AAMI ST46—1993)
Instrument sets - Mesh-bottom or perforated
trays containing instruments should be placed flat on the
sterilizer shelf. Metal items should be placed on a separate
shelf below packages containing textiles. If a sterilization
container or cassette system is used, the manufacturer's recommendations
for loading should be followed.
Packs containing textiles - Textile packs
(e.g., gauze, towels, etc.) should be loosely wrapped and
placed on edge so that all the fabric layers are perpendicular
to the shelf.
Utensils and glassware - Items capable of
holding water, such as basins and trays, should be positioned
tilted over on edge and oriented in the same direction to
prevent pooling of condensate.
Paper/poly, paper or nylon pouches - Do
not over-fill pouches. Instruments should be able to lie flat
in a single layer. Pouches should be positioned standing on
edge, paper to plastic, to facilitate circulation of the sterilant
around items. Pouch holders, or loading racks/baskets may
be used and are designed for this purpose. Lining the tray
or basket with a surgical or paper towel will aid in removal
of condensate.
In a steam sterilizer, if paper/poly packages must be placed
flat in a single layer, place them paper side down and use
an absorbent, such as surgical or paper towel, to line the
tray to facilitate wicking moisture away from the packaging.
Placing paper/poly packaging plastic side down may cause condensate
to pool inside the pouch resulting in a wet pack, which must
then be considered contaminated.
Solutions - Facilities or offices using
tabletop steam sterilizers should avoid sterilizing solutions,
such as saline and water, unless appropriate equipment and
procedures are in place.
Facilities having appropriate steam sterilization equipment/cycles
and procedures in place should sterilize solutions separately
from all other items and must process them in flasks with
closures specifically designed for this purpose. Never use
screw caps or rubber stoppers with crimped seals. Never use
vacuum cycles or processes other than steam.
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