The Decontamination and Sterilisation of Surgical Instruments; An Introduction to Sterile Operations

Introduction

Each hospital will have a section dedicated to decontamination and sterilisation of surgical instruments. This section provides all medical and surgical equipment necessary for treatment at the hospital. Therefore, it can be said that the NHS Sterile and decontamination technicians sterilise the equipment and deliver it to be used by surgeons and other specialists.

Until the late 1930s, we only kept hospital equipment in designated departments and locations. There was a great deal of compromise in utilising equipment and storing such items properly in such a setting. People were unaware of the modern methods of decontamination and sterilisation of surgical instruments. Hospitals started having sterilising departments in the 1940s.

Apart from the reasons stated above, the primary reason for establishing a distinct department is that the variety and quantity of medical equipment have increased significantly. As a result, it became necessary to establish a distinct scientific and methodical department for the decontamination and sterilisation of surgical instruments. W. B. Underwood was a proponent of establishing a distinct department for sterilisation. He emphasised having a separate department for sterilising medical equipment.

Significant sterile processing divisions

The three stages of sterilisation

• Assembling 
• Basic decontamination procedure
• Preparing for distribution

The decontamination and sterilisation of the section of the surgical instrument clean the equipment using a series of processes. They can be manual or mechanised methods of cleaning.

After the decontamination and sterilisation of surgical instruments, the surgical instruments technician will take the equipment to the hospital's assembly and packing area. They are initially stored here. Later it will be issued for different purposes.

Let us examine each of these processes in detail.

Decontamination

Decontamination entails keeping equipment free of bacteria and pathogens. This can be a chemical or non-chemical reaction process. After contact with a patient, the equipment becomes a breeding ground for germs and pathogenic bacteria. Therefore, decontamination aids in the elimination of these germs and infectious organisms. 

The steps involved in the decontamination procedure

Conveyance

Transporting old equipment to a decontamination facility is a significant task. 

NHS Sterile and decontamination technicians will pack these requirements to prevent them from contamination in the hospital. They give very high care while transporting sterile surgical instruments as there is a huge chance of contamination during transportation.

Protection of the individuals Working in the section

Because the surgical instruments technicians are working in a high-risk area, they should constantly wear protective clothes while on the job. A sterile service technician in this field will most likely wear scrub uniforms. Additionally, they must wear protective shoes, gloves, and a hair covering. Additionally, the entire outfit for workers in this section will include a face mask and goggles. And the individuals transporting sterile surgical instruments will also have to wear the same level of protection.

Sorting used objects 

Once the person transporting sterile surgical instruments reaches the facility. They will start sorting one-time usable things. NHS Sterile and decontamination technicians will take them out to be disposed of later. Surgical instruments technicians cannot clean these pieces of equipment with other equipment as blood is difficult to remove. Professionals employ blood removal devices in these instances.

Cleansing

NHS Sterile and decontamination technicians clean with certain chemicals, such as detergents. However, they should ensure that the cleaning method is appropriate for the type of equipment. When using cleansers, professionals should follow instructions from the manufacturer. Numerous gadgets are employed to clean the equipment throughout the cleaning procedure. Here are some of the most utilised cleaning tools: 

The washer or decontaminator  

It is used to clean materials resistant to heat. The washer has a decontamination cycle. It entails rinsing and cleaning things multiple times. Following that, the equipment is steam sterilised. Professionals determine this by considering the number of items in the total load. However, this method does not sterilise the equipment. 

Ultrasonic Sound Washers

Ultrasound washers help us remove minute particles from medical equipment. Professionals carry pieces of equipment after washing. However, this should occur before the sterilising procedure.

The process is also known as cavitation. Here, the device converts ultrasonic sound waves to vibrations, cleaning the equipment at the surface. Ultrasonic sound waves create bubbles. This results in the attraction of the smallest particles to the vacuum generated by the implosion of minute bubbles caused by the high-frequency vibrations. Here, the bubbles remove contaminants from the instruments' curves and nooks.

Washer Tunnels

This method of cleaning equipment is comparable to automobile washing facilities. Once the technician places the pieces of equipment in the tunnel, the whole process is automatic. Within the tunnel, the equipment is rinsed and cleaned. The most advantageous aspect of this procedure is that it is fully automatic. 

Washer carts

The transportation equipment must be clean to ensure that the equipment transported remains sterile. Typically, NHS sterile services technicians store transportation carts in a slanted posture. This posture guarantees that water does not stay in the cart.

Additionally, they should be allowed to dry entirely after washing them. There should be no traces of water in the carts. Professionals must verify it before loading the cart with equipment. 

After cleaning, Professionals should examine the equipment. They should only pack it after a thorough inspection. In addition, they should thoroughly check all device components before verifying. Sharp tools, such as scissors, should be inspected for sharpness, dents or cracks.

To ensure proper operation, they should inspect the hinges and joints of equipment to verify their condition. If the professionals discover any faults during these inspections, they should be discarded and replaced.

Assembling of the equipment

Assembling is a critical step following the sterilising procedure. NHS sterile services technicians have to organise the pieces of equipment neatly and orderly. There are precise methods and instructions for assembling and arranging the equipment in the tray.

The professionals should retain the equipment package in its original state since it is critical to keep the equipment sterile. If someone takes the equipment from packages, there is a significant risk of contamination. One should do the packaging to be in contact with the package, and the equipment should stay sterile during this contact. The equipment may be reused immediately or after weeks or months. The professionals should do the packing to keep the equipment in great condition for usage even after months. The wrapping material should not be difficult to remove from the packet as it will cause difficulty in usage time. 

Sterilisation Techniques

The various sterilisation methods are determined by how the sterilising agent comes into contact with the object. Sterilisation procedures vary according to the type of equipment and the average time required for sterilisation. 

Sterilisation with steam

Steam heat eliminates any pathogenic germs from the equipment. Steam alone is insufficient for full sterilising. Professionals require a very high atmospheric pressure to increase the temperature sufficiently to eradicate the micro-organisms. Denaturation is the term used to describe the process of killing bacteria by subjecting them to extreme heat and pressure. 

Steam makes contact with the equipment's surface. Steam at a very high temperature for an extended period permeates all parts to achieve sterilisation. When the machine pumps the steam into the chamber, it comes into contact with other non-hot materials, the heat is released, and the steam becomes moist. The equipment as a whole becomes damp. This demonstrates the need for both heat and water.

Extreme high temperatures for an extended period can destroy any bacterium or germ.

If the temperature is high, it will take very little time. Following the procedure, the water is re-evaporated, dries the contents and maintains sterility.

Using Ethylene Oxide

There will be some pieces of equipment that are extremely sensitive to changes in humidity and temperature. Ethylene Oxide is the perfect solution here. Ethylene Oxide is a gas that should come into close contact with micro-organisms to destroy them.

NHS sterile services technicians should exercise caution as it is a dangerous gas and should only use it in enclosed facilities. Because the gas is extremely harmful, exposure to it will be fatal. However, it is an extremely effective sterilising agent. However, sterilising with ethylene oxide takes a very lengthy time. This process takes around 16-18 hours to complete.

This sterilising procedure is contingent upon the following four variables:

1. The gas's concentration

2. The relative humidity

3. The ambient temperature.

4. Exposure length

Alternate methods

Apart from the ways listed above, there are more methods for sterilisation:

Dry Heat

NHS sterile services technicians utilise this sterilisation method to clean oils, some petroleum compounds, and some powder materials when the equipment is not resilient to other methods. Heat destroys the microbes here. This is an extremely slow method of germ elimination.

Microwaves

Microwaves interrupt bacteria's natural existence by producing hyperthermic circumstances. In addition to that, Microwave radiation generates localised heat that kills bacteria. Professionals place the equipment in a glass container for this purpose. 

Formaldehyde gas sterilisation

This is an old type of sterilising that dates back to the early 1800s. Formaldehyde gas destroys microbes by coagulating the protein within their cells. Compared to other sterilisation methods, this is a complicated and ineffective procedure. Technicians use this method when the equipment is not resistant to heat or other methods. Numerous nations have prohibited this method of sterilisation due to its inherent dangers. It is, nevertheless, still used in several Asian and European countries.

Plasma method

Plasma is the fourth state of matter, following solid, liquid, and gas. A particle reaches this state when sufficiently heated or subjected to a strong electromagnetic field. Plasma is the state of ionised gas. NHS sterile services technicians make plasma in steriliser by heating water and Hydrogen peroxide at very high temperatures. The system then distributes plasma throughout the sterile chamber, effectively oxidising all micro-organisms on the go.

Ozone Gas

Ozone gas is an excellent sterilising agent. This procedure thoroughly cleans the equipment of both organic and inorganic pollutants. Ozone is an explosive, poisonous, and corrosive gas. However, the likelihood of exposure is quite low in the event of sterilisation. Professionals create ozone within the steriliser using medical-grade oxygen. Experts widely acknowledge the efficiency of this technique in the field of sterilising sensitive medical equipment. But, this method of sterilising takes a minimum of one hour on average. However, this time frame may vary depending on the equipment size.

Chemical Solutions

Medical agencies have agreed to use certain chemicals for sterilisation. NHS sterile services technicians use this method to sterilise when the equipment is sensitive to heat and other technologies such as plasma and gas. However, they do it under the manufacturer's recommendations.

Ionizing Radiation

 Ionising radiation kills germs by utilising short wavelength, high-intensity radiation. Gamma rays or X-Rays can generate this radiation. In contrast, ionising radiation makes use of low energy and wavelengths. This method of sterilisation is intended solely for business use. This process removes electrons from atoms. Electrons come into contact through a nearby atom or by dislodging an electron. This results in the generation of thermal or chemical energy. This energy disrupts cell division and the overall life of the bacteria.

The majority of ionising radiation is composed of beta particles and gamma rays. The electrons will permeate the equipment's surface. The success of this technique is contingent upon the equipment and its characteristics. 

 Electromagnetic waves

 Electromagnetic can penetrate far further than beta rays. Gamma rays travel at the same speed as light. These rays will destroy the cellular integrity of the Microorganisms. This method of sterilisation takes around 15 hours. NHS sterile services technicians use Cobalt 60 as the most often used sterilant.

Assuring the sterilising process's quality

Rather than establishing just a sterilising department, it is critical to establish a monitoring team to guarantee proper sterilisation.

Observation of activities

NHS sterile services technicians should observe and monitor these activities carefully. Each activity should have written instructions, and technicians should follow this in the sterilisation process. 

Important points to give attention

• Disposal of single-use equipment
• Safety of the equipment.
• Packing of the equipment with identifiers.
• Operation of the Steriliser.
• Keep track of each activity.
• Complete compliance with the protocols and restrictions 
• Storage of sterilised equipment.

Most sterilisers have built-in timers, thermometers, and many other devices that monitor the operation. In addition, most of them operate automatically and have locking features. The sterilisers meticulously document the operation. As a result, technicians have to use these aids and make no mistakes.

Chemical markers for verification

Experts recommend packaging to distinguish between sterilised and non-sterilised pieces of equipment. NHS sterile services technicians accomplish this through the use of chemical markers. They use the changes in these chemical markers to verify the sterilisation process. As a result, they confirm the sterilisation process when they get the required results. And, if they don't get the desired results, they will mark it as not sterilised. It would be prudent to keep the indicator at a location where the steriliser would have a tough time penetrating. Chemical indications such as stickers or tapes are quite frequent. Professionals verify a piece of equipment as sterile when they pass certain standards. 

Certain sterilisers indicate temperature and pressure variations. In addition to that, they will provide a range of acceptable values and a range of unacceptable values. One must rely on these factors to establish a conclusion.

Biological indicators

The most obvious indicators for decontamination and sterilisation of surgical instruments are biological ones. NHS sterile services technicians add controlled micro-organisms with the equipment. Following sterilisation, the sterilised object should be free from these micro-organisms. Once the method sterilises the equipment correctly, there will be no micro-organisms. This will be a lengthy check, lasting around 1-2 days.

A biologic indicator must adhere to NHS testing criteria. Numerous hospitals do daily checks; others conduct tests on a cyclical basis. Sterile service technicians closely monitor implantable devices and don't give them clearance before getting negative results. Biological indicators are also useful for new goods or packaging materials following steriliser repairs or a sterilisation failure. The sterile service technicians keep all test results on file for each steriliser.

Conclusion

Decontamination and sterilisation of surgical instruments department is an integral part of present-day hospitals. The importance of this department is immense in that a small mistake here may cost a patient's life. And the importance of this department increases the career opportunities in the field. Sterile and decontamination technician salary is much higher than many other professions. In addition to that, if you are passionate about such a job, there are plenty of Sterile and decontamination technician courses available online and offline. Therefore, these Sterile and decontamination technician courses can help an aspirant land in a very demanding and rewarding profession in the health sector.