Autoclaves

Hi

I sterilize all my instruments in an autoclave I bought off e bay

It works really well but don't put the plastic specs in them

Regards

Doc

That's a good jumping off point docmac0705, sterilization, one of the most important aspects as far as instruments go. Now I know of disposable things, plastic usually, throw them out after use, and then, apparently autoclaves work well, but what else can people use to be safe? Any other ideas?

We always make sure everything is washed but still wipe them off with alcohol before using again.

Over the years, since I do not have an autoclave, after washing them thoroughly, I have boiled all medical instruments that can be autoclaved in water for an extended period of time. After doing so,and they are dry,I seal them in new unused ziploc bags until their next use. Then before each use, I swab them with alcohol and let dry before lubrication and insertion.

G.N.

Except for items that do not enter a body opening, or puncture the skin -- such as stethoscope, reflex hammer, BP cuff, etc. I only use disposibles. When I used a glass rectal thrmometer,I always serilized in in alcohol after washing it.

I have to agree, any items entering the body must be sterile. Medical play is fun, but it is no fun picking up a serious infection. Sterilizing instrument that are reused is a must, and using sterile disposable instruments when appropriate. Keeping other instruments that come in contact with the body clean, and keeping surfaces of exam tables, etc., wiped down and clean.

As a sidebar to "sterile" disposable instruments, disposables are not necessarily sterile. Certainly items such as needles and catheters are sterile, typically using radiation or gas techniques. However many items such as vaginal or rectal specula are described as "clean" and they are not sterile. Clean items are manufactured in a controlled environment however they do not undergo a sterilization process. Most of these instruments carry instructions on approved sterilization procedures if the user requires them.

FDA certification requires a statement on the package if the item is Sterile. Unless it states that it is, assume it is Clean. The label must also carry a description for re-use. Single Patient Use means the item may be reused on the same patient (e.g. urinary drainage bags, enema bags). Single Use means precisely that, one patient one time.

Excellent information DrJ58. Thank you for posting.

[quote author=DrJ58 link=topic=13961.msg141920#msg141920 date=1226420841]

Most of these instruments carry instructions on approved sterilization procedures if the user requires them.

[/quote]

What are the approved sterilization procedures for plastic speculums and plastic anoscopes?

Welch-Allyn who are the largest supplier of disposable vaginal and rectal specula certify their products to be safe under formaldehyde gas sterilzation. This requires a gas sterilizer usually only found in hospital CSR departments due to venting requirements.

Sterilization of these instruments would only be required if they being used surgically. In a surgical setting most of the other instruments will be stainless steel which has been steam sterilized in an autoclave so typically the specula will be stainless steel as well.

If you wish to "sanitize" plastic instruments for re-use on the same patient you can use a cold immersion solution. Delicate instruments such as cystoscopes and flexible endoscopes may not be subjected to the temperatures of an autoclave so a number of excellent products are available. Cidex is the most popular immersion solution for endoscopy which is formaldehyde based. It is fairly ugly stuff which does an excellent job but smells horrid and often leaves the equipment with a yellow tint. Germaphine is another product designed for urological disinfection which is much less offensive and in the correct dilution safe for patient prep. Both are supplied in a concentrated form and must be diluted with water.

If you have a local store who sells home health care and urological/incontinence supplies they should be able to provide a suitable sanitizer for same patient re-use of your plastic (and metal) instruments. Betadine is a very common solution however it is iodine based and will stain plastics orange.

Regarding metal instruments - Not everyone can afford a professional steam autoclave since even used ones fetch a high re-sale to people like veterinarians and tattoo parlours. However most people can afford a pressure cooker used for home preserving and canning. Boiling is not really sufficient for proper sterilization, steam under pressure reaches higher temperatures which are effective. Twenty (20) minutes in a pressure cooker will be almost as good as a professional autoclave.

Don't forget about good old Clorox household bleach. Chlorine is an effective sanitizer when used for immersion. Even if you have a steam autoclave, washing the instruments in a bleach solution prior to sterilization is good practice. Washing the instruments carefully before sterilization is essential anyways, use a brush and make sure the instrument is 100% clean before going any further. Add a bit of bleach to the wash but never boiling or in an autoclave as it will produce sufficient chlorine gas to be harmful or even fatal.

Caveat: Bleach and Plastic don't get along very well. Many plastics will become brittle or foggy after prolonged exposure to chlorine. Bleach works well to sanitize plastic however the reasonable lifespan is reduced. Solutions like Cidex and Germaphine are compatible with plastics and prefered over bleach.

You can use a pressure cooker to sterilize metal instruments. If you do a google search on pressure cooker autoclave you'll find results. Basically if you don't have access to an autoclave you can get a pressure cooker for relatively cheap, under $100. Use a metal can and punch holes in it to keep the instruments out of the water, place the cooker rack next, put a paper towel on the rack, then place instruments on the towel. Run pressure cooker for a minimum of 30 minutes to reach 250 degrees Fahrenheit.