Sterilization and Infection Control News Update - July 2016

We're happy to present you with this month's collection of top industry related news and articles. Ejoy!

 

Huntington Hospital Faces Up to Infection Crisis

Whittier Daily News – 16 June, 2016

Almost every hospital encounters complicated and serious needs to improve sterilization, expecially endoscope sterilization. How do hospitals deal with the crises?

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UPMC, AHN Fined for Illegal Dumping of Medical Waste

Trib Live – 21 June, 2016

Medical waste from hospitals needs to be treated before it enters the general waste stream, essentially sterilized.

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It's Not Easy Running A Hospital Without Running Water

NPR – 23 June, 2016

A third of hospitals in low and middle income countries may not have running water all the time.

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Healthcare Plastics and the Circular Economy

3BL Media – 23 June, 2016

If you’ve ever spent time in a hospital, you probably noticed the massive amounts of materials that were being tossed into trash bins. Sterilization wrap, gowns, irrigation bottles, IV bags, basins, pitchers, trays, rigid and flexible packaging materials are all used once and then thrown away.

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Some Ouellette Campus Operating Rooms Closed

BlackburnNews.com – 23 June, 2016

Ouellette campus operating rooms close as a pressure release valve on autoclaves has failed.

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Balancing Clinical, Central Supply Chains a Critical Pursuit

HPN Online – 01 June, 2016

If there is one common and continual complaint about the Supply Chain department from their clinical customers, which, by and large, represent general, surgical and critical care nurses, it’s not just about product choice, evaluation and selection.

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Textiles Used in Hospitals and Medical Offices – Germs Don’t Stand a Chance

Medica Magazine – 01 June, 2016

Many textiles in hospitals can potentially transmit germs. Specific procedures to treat the textiles could help to reduce transmission.

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It Takes a Village to Raise a Department: Why Facilities Fail Without CS/SPD Support Staff

LinkedIn – 05 July, 2016

Weston Hank Balch is here to remind us that Sterile Processing is not just technology, it's all about the people who operate and manage it. This well written article raises some difficult question.

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First Ever Biosafety Report Details 199 Mishaps with Toxic Agents

KFGO – 30 June, 2016

The Federal Select Agent Program, which oversees dangerous substances such as anthrax and bird flu in federal, academic and private labs, reported 199 incidents in which lab workers were potentially exposed to infectious or toxic agents in 2015.

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Analysis of 1976 Ebola Outbreak Holds Lessons Relevant Today

National Institutes of  Health – 29 June, 2016

In 1976 the Ebola outbreak laste 11 weeks and 280 deaths reported. In the current outbreak there were 11,310 outbreaks and it lasted over 2 years. Annnnalysis of the 1976 Ebola outbreak teaches us some lessons relevant for today.

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Do More of What Already Works

LinkedIn – 6 July, 2016

How a 5 step checklist saved 1,500 lives and 75$ million.

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Who is to blame for Superbug DeathsAn Inside Look at a Hospital Located in an Airplane

Travel+Leisure – 04 July, 2016

It's a bird! It's a plane! It's a flying hospital! And in case you were curious, yes of course there's a sterilization area in this airplane hospital. The flying hospital has everything needed to perform six to eight eye surgeries for kids a day. Tuttnauer salutes the initiative of giving eyesight to kids in developing countries.

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The First Transparent 3D-printed Skull Has Been Successfully Implanted

Extreme Tech –  27 March, 2016

As medical technology advances the variety of materials that need to be sterilized grows. This 3D-printed skull is made of a plastic material polyetherketoneketone (PEKK, a thermoplastic) and is heat resistant which makes it suitable for high temp sterilization in an autoclave.

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Sterilization Blunder at Edmonton Clinic Puts Hundreds of Patients at Risk of Hepatitis

Global News – 18 July, 2016

Health officials say improper sterilization of equipment at a north Edmonton clinic may have put nearly 300 people at risk of Hepatitis B and C.

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Sterilization in Dentistry is Extermly Important

 

 

Something did Change: New CDC Documents Streamline Dental Infection Control

RDH Magazine – 17 June, 2016

These documents make doing what is right so much easier, as well as give dentists more information on compliance and a compliance program for their office.

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Duendoscope ToolFort Bliss: Chambers Dental Clinic Patients Possibly Treated with Unsterilized Instruments

ABC Kvia.com – 23 June, 2016

When dental clinic patients are treated with unsterilized instruments often no one gets infected but the price the clinic pays is still high.

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Dentist who Ran Medicaid Billing Scam, Exposed Patients to Viruses Gets 6-month Home Arrest

Raw Story – 14 July, 2016

A former Oklahoma dentist was sentenced on Thursday to six months’ home confinement for a federal money-laundering charge stemming from complaints his unsanitary practice exposed at least one of his patients to hepatitis and could have exposed thousands to HIV.

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Disclaimer: The views and opinions expressed in the referenced articles and blog posts are solely those of the original authors and other contributors. These views and opinions do not necessarily represent those of Tuttnauer, the tuttnauer.com staff, and/or any/all contributors to this site.

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Class N Tabletop Autoclaves

Sixth post in series, "Autoclave Sterilization Basics"

Now that we’ve explored the science behind steam and applied it to the autoclave, it’s time to look at specific types of autoclaves to understand how they function. In this article, we will look at one popular tabletop autoclave, the Class N, known by the moniker EN 13060. The term “tabletop autoclave” refers to the microwave-sized small autoclaves typically found in clinics and dental offices. 

But before we explore this, let’s review. The goal of sterilization is to have sterile equipment that can be reused. That means that all microorganisms are destroyed, essentially hitting the “reset” button on these devices/media to return them to a sparkly sterile state. Sometimes, however, we have a second goal as well. It may not be enough to sterilize the tools if they will not be used immediately; rather, we also have to consider how to store them properly so they do not become recontaminated. Therefore, the second goal of autoclave sterilization (if the load will not be used immediately) is to isolate the sterilization load from outside germs and deprive the load of any water -- thus ensuring an inhospitable environment for the spread of germs and lowering the chance of recontamination. The way in which we achieve this second goal is to wrap the sterilization load in autoclaveable paper or pouches.

View of the inside of a pressure cooker - Tuttnauer - Sterilization BasicsAutoclave pouches inside a Tuttnauer tabletop autoclave

Class N Tabletop Autoclaves

In clinics with high-turnaround, as soon as the freshly sterilized tools are autoclaved, they are ready to be used again in the next procedure. For these clinics, the Class N tabletop series gets the job done. If the tools are needed immediately, then they are placed directly on the autoclave tray, but if they will be stored for later use, they are lightly packed in sterilization paper or small pouches.

(Note: In countries that conform to the European Committee for Standardization (CEN), only unwrapped loads are autoclaved in Class N autoclaves; many non-European countries do process lightly packed loads in Class N autoclaves.)

How Does the Class N Autoclave Work?

Let’s take a look now at what actually happens inside the autoclave chamber. After we place the autoclave load inside -- either unwrapped solids, liquids, or hollows -- or small lightly-wrapped packages, we close the door and turn on the autoclave.

  1. The steam pushes out (displaces) the air (and some of the steam) through the air jet, or by positive pulses by a process called gravity displacement.
  2. Then we reach the sterilization temperature of 121℃/134℃. This stage is called sterilization time or holding time. It is at this stage that the actual sterilization takes place. The amount of time depends on the contents of the load. Two of the most popular loads are delicate and standard. The autoclave cycle lasts for fifteen minutes at 121℃ for delicates, like plastics, and other delicate items that need a lower temperature. For a standard load, which contains glassware or metal solids, hollows, porous items or textiles, the sterilization time is three minutes at 134℃.
  3. The next stage is called the exhaust stage, in which we remove the pressure back to atmospheric pressure through the exhaust valve.
  4. Finally, the last stage is the drying stage. Depending on the autoclave, this may be achieved via aeration pump or by opening the autoclave door.

Classy Conclusion

We explained the two goals of autoclave sterilization: 1. Ridding microbial life (germs) from the load and 2. Ensuring that said load stays sterile by wrapping it in a sterilization pack or pouch. We discussed that Class N can be used for unwrapped loads, for instruments that will be used right away, or small lightly packed pouches that will be stored for later use. We then took a look at what happens inside the autoclave when we turn it on. In a nutshell, steam builds up in the chamber, and air is removed. Next comes sterilization time, then the exhaust phase, and finally drying.

Thanks for coming along for the ride in Tuttnauer autoclave land. Next stop: Class B tabletop autoclaves!

Comments and questions are welcome, as always, in the comment section below.

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Steam in the Autoclave

Fifth post in series, "Autoclave Sterilization Basics"

This is not just another ho-hum article about steam, temperature, and pressure. Instead, we have a unique perspective on what makes steam such a great fit for sterilizers, which are the type of autoclave found most often in medical and scientific settings. The three central reasons are availability, safety, and time.

Steam in the Autoclave

Availability

Steam is widely available since there are only two ingredients needed: water and a source of heat. Since every clinic, even an ambulatory emergency clinic, must have access to water, it follows that finding water for operating the autoclave is reasonably likely and reliable. In addition to being available, steam is also cost-effective. Since the steam sterilizer, or autoclave, does not require the use of any other chemicals, it’s relatively inexpensive to operate. 

Safety

Unlike many other sterilizing agents, steam is non-toxic. Since steam is a form of water vapor produced by boiling, and essentially has the same properties of water, it is not dangerous to inhale or be close to, though one should obviously take precautions to not get hurt by hot steam!

Many other sterilizing agents are poisonous chemicals, such as ethylene oxide, which have been proven to be carcinogenic and must be treated with extreme care. In addition, because chemicals like ethylene oxide are so dangerous, the aeration time post-sterilization can take up to 36 hours until the load is safe to handle, and even then, there is still a chance of residual ppms (parts-per-million) of this chemical.

Cycle Time

One of the most effective ways to transfer heat energy is via humidity, contained within the steam. Think of a wound caused by boiling water or water vapor versus a wound caused by being exposed to dry heat. The wound that resulted from moist heat will hurt more and go much deeper than the one caused by dry heat. Similarly, steam’s moist heat is able to strike microorganisms faster than dry heat, and that’s because steam can transfer heat faster than hot air.

How? Steam sterilization requires a shorter cycle time than other methods, like dry heat, so that when we raise the temperature inside the chamber we achieve sterilization faster. Sterilization by steam can be done for three minutes at 134℃ for a standard load or 15 minutes at 121℃ for a delicate load. The effect will be the same. In contrast, if we use dry heat it will take about 180 minutes at 250℃ to achieve similar sterilization results.

Recap: The Steamy Sterilant

We applied our new understanding of steam to explore why it’s the most effective agent for the sterilization of medical instruments.

  • First, we explained that steam is easily accessible, both in its availability and its low cost.
  • Second, we discovered that of all the sterilization agents on the market, steam is likely the safest option since it is non-toxic, unlike other sterilants like ethylene oxide.
  • And finally we investigated how steam efficiently transfers heat energy via humidity to the load inside the autoclave, and how by raising the temperature, we are able to achieve sterilization faster than with dry heat.

Now that we understand why steam is the most effective agent for sterilizers, it’s time to learn more about the basic processes of autoclaves. Stay tuned for the next post in this series, which will take you deeper into the how’s and why’s of tabletop autoclave operation.

Comments and questions are welcome, as always, in the comment section below.

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