TEMPLATE POLICY AND PROCEDURE REGARDING STERILIZATION OF INSTRUMENTS I

[PRODUCTS AND SERVICES PROCUREMENT TEMPLATES ASSIGNMENT OF CONTRACT
4H ENTOMOLOGY PROJECT WORD TEMPLATE FOR NAME
7 TEMPLATE FOR THE MEMORANDUM OF ASSOCIATION

APPLICATION TEMPLATE INCUBATOR INITIATIVE FEBRUARY 2021 WINE AUSTRALIA
TEMPLATEEXAMPLE HOSPITAL PEDIATRIC DISASTER PLAN FEBRUARY 10 2012
!DOCTYPE HTML HTML LANGEN CLASSGOVUKTEMPLATE JS FLEXBOX NOFLEXBOXTWEENER HEAD


Template

Policy and Procedure


Regarding Sterilization of Instruments


I. Background1


In the United States, approximately 5 million gastrointestinal endoscopies are performed each year.2 Each procedure involves contact by a medical device or surgical instrument with a patient’s sterile tissue or mucous membranes. A major risk of all such procedures is the introduction of pathogens that can lead to infection. Failure to properly disinfect or sterilize equipment carries not only risk associated with breach of host barriers but also risk for person-to-person transmission (e.g., hepatitis B virus) and transmission of environmental pathogens (e.g., Pseudomonas aeruginosa).


Disinfection and sterilization are essential for ensuring that medical and surgical instruments do not transmit infectious pathogens to patients. Because sterilization of all patient-care items is not necessary, health-care policies must identify, primarily on the basis of the items' intended use, whether cleaning, disinfection, or sterilization is indicated.


II. Policy


It is the policy of the center to sterilize instruments requiring high-level disinfection or sterilization. All packs that include instruments and supplies that are to be used sterile are either received as disposable sterile packs and maintained sterile, or are properly sterilized, labeled, wrapped and maintained sterile. The center will adhere to the OSHA-recommended CDC Guidelines.3


III. Procedure4


Instruments requiring high-level disinfection or sterilization will be processed according to the manufacturer’s guidelines, using the autoclave or an appropriate Environmental Protection Agency approved chemical.


The center will use commercially available strips that change colors to indicate that the internal area of the pack has reached the temperature of sterilization or the gas has penetrated the pack. Sterility indicators must be included inside the pack or pouch containing the items being sterilized.


Disposable sterile packs are stored in a dry area protected from breaks in the sterile wrapping or dampness. Sterilization dates are monitored to determine expiration dates, if indicated. Packs may be re-sterilized and new expiration date noted if so indicated by what methods on the packet.


Packs that are sterilized are wrapped so that they; may be opened without contamination of the contents, include a sterility indicator, are sealed so that they cannot be opened and resealed without re-sterilization, and have contents and sterilization date noted. (Dates on packets must be clearly marked as sterilization date and not expiration date to avoid confusion.)


  1. Sterilization Methods


    1. Steam Autoclave – autoclave must be monitored and serviced to ensure proper function – temperature, pressure and time.

    2. Gas Sterilization – for use on materials damaged by heat and steam such as plastics and cannulas. Proper safety precautions must be used.

    3. Chemical sterilization – only chemicals approved for sterilization can be used – those chemicals defined as disinfectants (alcohol and iodophores) are not adequate. One must ensure that the item is in contact with the chemical for the recommended amount of time for sterilization. Freshly prepared solutions must be used and the expiration date of the prepared chemical be labeled on the container. Because the chemicals can be irritating and toxic, the instruments must be rinsed well with sterile saline before using. These chemicals can also be corrosive to instruments. All chemicals used are included in the material safety data sheet MSDS manual.


  1. Monitoring Sterility


Indicators of sterility must be included inside the pack or pouch containing the items being sterilized. In addition, autoclave tape on the outside of the pack may also be used to indicate the pack was sterilized. The date of sterilization should be written on the outside of the pack or pouch.


The autoclave should also be biologically monitored using a spore test as indicated below:


  1. If the clinic autoclaves a pack(s)/instruments more frequently than five (5) times a week, then a spore test will be done each week.

  2. If the clinic autoclaves a pack(s)/instruments once a week but not more than five (5) times a week, a spore test will be done every other week or bi-weekly.

  3. If the clinic only autoclaves pack(s)/instruments less frequently than the above, spore tests will be done with every load that is run.


  1. Shelf Life of Sterile Materials


Unless a sterile pack or package has been torn, opened or exposed to moisture, the pack/package will be considered sterile. Packs of sterile instruments or materials stored for more than one (1) year should be re-sterilized. The date of sterilization should be clearly marked on the outer wrapper.


  1. Autoclave Maintenance


Autoclave maintenance recommends that the autoclave system be flushed on a monthly basis with recommended cleaner and distilled water. Please refer to autoclave model specific instructions.


Other sterilizing equipment is cleaned between use to prevent contamination and deterioration.


  1. Record Keeping


Records of results of autoclave spore testing should be maintained.


1 http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf

2 For more information see: http://www.cdc.gov/hicpac/Disinfection_Sterilization/1_sumIntroMethTerms.html

3http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf

4 For more information see: http://cid.oxfordjournals.org/content/39/5/702.full

©TACHC, Inc. for adaptation and use only by entities that purchased the 2011 TACHC OC³ CPI Manual. Page 3


( FROM MAH ON HEADED PAPER ) TEMPLATE FOR
(ABSTRACT TEMPLATE) FULL SCALE APPLICATION OF IN SITU AEROBIC
(AUTHOR PLEASE AMEND THIS TEMPLATE AS INDICATED BY RED


Tags: instruments i., sterile instruments, sterilization, policy, instruments, regarding, procedure, template