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Hospital Sterilizers: Operations
Table of Contents
Background and Overview
Reasons for Change
P2 Opportunities
Glossary of Terms
Where to Go for P2 Help
Complete List of Links

Essential Links:

Association for Professionals in Infection Control and Epidemiology (APIC)
Website: APIC's mission is to improve health and patient safety by reducing risks of infection and o...

Best Management Practices for Hospital Waste
Report: Comprehensive 392 page document handling all types of hospital waste. Includes section on ai...

Best Practices for Cleaning, Disinfection and Sterilization - In All Health Care Settings
Thorough overview of best practices including a glossary of terms, assistance with selecting SUD res...

Detox Sterilization and Disinfection
PowerPoint about balance between sporicidal, viricidal, and bactericidal effectiveness, human and en...

Infection Control Guidelines
This collection of guidelines pertains to keeping patients and healthcare workers in healthcare sett...

Sterilants and Disinfectants in Healthcare Facilities
Website dedicated to those who want to go beyond mere compliance. Describes properties of sterilants...

Medical instrument disinfection and sterilization

Proper cleaning and disinfection or sterilization of reusable medical instruments is critical in a hospital environment. Over their lifetime, such instruments are used on a progression of patients. Inadequate destruction or inactivation of pathogens (bacteria, fungi, viruses, spores, and other microorganisms) left on an instrument by one patient can result in serious adverse clinical outcomes, including death, in the next patient. The risk is particularly acute for instruments used invasively.

A variety of different microorganisms exists that require different methods to kill. There are also a number of different cleaning, disinfection and sterilization technologies available. The FDA certifies appropriate levels of disinfection or sterilization, and appropriate sterilization techniques on an instrument-by-instrument basis. Device manufacturers also make recommendations about the sterilization method(s) that work best with their products. Disinfection and sterilization practices are also the subject of extensive guidelines issued by the Centers for Disease Control (CDC) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Primary Processes

The major steps involved in an organizational strategy for sterilization include:

Central sterilization/disinfection organization
Sterilization is generally managed by a central operation within a hospital. This group designs and implements processes and oversees all sterilization, disinfection and cleaning needs including training staff and monitoring results. Hospitals today generally do an excellent job of managing sterilization needs internally. Challenges tend to be infection risks coming in from outside the hospital, from health care workers or from patient to patient as well as the resistance of some infections to the sterilizers and disinfectants.

Healthcare facility design and construction
Many organizational infection risks can be controlled early in the design and construction stages of health care facilities. Early involvement in the conceptual phase helps ascertain the risk for susceptible patients and to minimize disruption of essential patient services. Decisions are made about numbers and types of isolation rooms, hand washing facilities and separation of patients with communicable diseases, for example. These decisions are predicated on an "infection control risk assessment." In addition, many microorganisms are introduced into a facility during construction. Strategic, proactive architectural design and construction planning can mitigate environmental sources of microbes and prevent infection, as well as accommodate the specific needs of the population served by the facility.[1]

Categorization of sterilization or disinfection needs
One way to classify the types of infections that patients can contract within a health care facility is to distinguish the source of infection as follows:

It is also necessary to determine how serious an infection risk is. In a health care facility, not all risks of infection are the same. Infection risks can be divided into the following three categories.[2] Based on the category of infection risk, which is determined by the way an instrument is used, different sterilization methods are required.

Choosing the appropriate level of sterilization
Different microorganisms require different response levels in order to achieve the necessary degree of sterility.

Creating an inventory of devices and their agreed upon sterilization or disinfection methods
Since hospitals may use hundreds of different devices and equipment requiring cleaning, disinfection or sterilization, it is necessary to create a manageable recordkeeping system so that sterilization is done properly. Staff needs to be trained and records accessible to those that need them. Cleaning, disinfection and sterilization equipment as well as disposal or storage facilities for items to be reprocessed, need to be conveniently located.

To determine the kind of sterilization a device requires, the following questions can be asked:

With answers to these questions, a system can be put into place that insures that each device is sterilized, re-processed or used once as is appropriate. Once an inventory is prepared, documentation can be created and staff trained.

Sterilization of equipment [3]
Many steps are required to ensure that instruments are appropriately sterilized. These include pre-cleaning, cleaning, milking, inspection, packaging, wrapping, autoclaving and maintaining the autoclave.

Demonstration of quality health care includes documentation of outcomes of care. Surveillance is a comprehensive method of measuring outcomes and related processes of care, analyzing the data, and providing information to members of the health care team to assist in improving those outcomes. Surveillance is an essential component of effective clinical programs designed to reduce the frequency of adverse events such as infection or injury.

To ensure quality of surveillance, the following elements must be incorporated:

Conduct on-going risk assessment, identify, and implement interventions and strategies to reduce infection risks:
Using information gained from the surveillance program and a model for continuous improvement, hospital administrators can continue to refine and improve upon the infection record in the facility. Some of the tasks that can facilitate reduced infection rates are:

[1] "The role of infection control during construction in health care facilities"
[2] Sterilants and disinfectants in healthcare facilities, Hospitals for a Healthy Environment,
[3] Proper Sterilization of Instruments is Essential to Patient Safety,
[4] Recommended Practices for Surveillance, American Journal of Infection Control,


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Hub Last Updated: 5/21/2015