Customers Pay You To Know About
Sterilization and Disinfection
you have customers who "sterilize" vaginal specula
in dishwashers or soak surgical instruments in Barbasol?
We've all heard these horror stories. Moreover, we know that
this is a subject that customers really need help with. Yet
most distributor salespeople would opt for a root canal over
taking time to learn the boring details about sterilization
the answer to a customer's question can give you a competitive
edge, take the focus off price and uncover new selling opportunities.
Besides good customer service and timely product deliveries,
your knowledge is the most important value-added element that
you bring to your customers. It can be the factor that determines
who an account chooses to do business with.
here’s another benefit. Looking at a practice's sterilization
and disinfection practices may uncover selling opportunities
for items such as: autoclaves; sterilization pouches; chemical
indicators; biological indicators; high-level disinfectants,
check strips, soaking bins; rubber utility gloves; eyewashes;
OSHA Compliance manual, training video, newsletter; personal
protective equipment (gowns, masks, etc.).
who has been in this business for a while will know the answers
to the questions below. Both old timers and novices can test
their knowledge of the following common customer queries.
Q: When do we autoclave? When can we just use
a disinfecting soaking solution?
(autoclave) instruments or devices that enter a patient’s
vascular system or other normally sterile areas of the body.
Autoclaving removes all bacteria, fungi, viruses, etc. and
renders an item sterile. Steam autoclaves, by far the most
prevalent type of sterilizers used in physician offices, are
designed to operate at 250ºF
for 30 minutes or in flash mode at 270-273ºF
for 10 minutes. Usually items are wrapped in pouches so that
they continue to maintain sterility during storage before
use on a patient.
high-level disinfectants when the heat or pressure of an autoclave
would damage the device to be disinfected. Good examples of
these items are flexible sigmoidoscopes
Some practices use high-level disinfectants to clean vaginal
specula; others autoclave them. Both are acceptable, but it's
overkill to first soak specula in high-level disinfectant
and then autoclave them. Save your practices money and exposure
to hazardous chemicals by suggesting that they simply soak
in soap and water, then autoclave.
Q: What indicators do we have to run to be sure our autoclave
A: Use chemical
indicators with each load. A common type of chemical indicator
is a tape that changes color after the run has occurred.
biological indicators each week. Government and professional
agencies (see table below) recommend biological indicators
(BIs) for monitoring sterilization
cycles. OSHA relies on CDC guidelines as a widely recognized
and accepted standard to be followed by health care facilities.
The CDC states, “…proper functioning of sterilization cycles should be verified by the periodic use (at least weekly)
of biologic indicators. Heat sensitive chemical indicators
(e.g., those that change color after exposure to heat) alone
do not ensure the adequacy of the sterilization cycle.”
physician offices and clinics use “spore tests” as biological
indicators. Spore strips or ampules
are placed in the center of the load and the sterilization
cycle is run as usual. If the autoclave process achieves sterilization,
the spores on the strips will be killed. To determine this,
incubate the strips overnight and read results by a visual
color change. Some medical offices mail off these tests to
be incubated and read; others do the test on site.
(Assoc. for the Advancement of Medical Instrumentation)
(Association of Operating Room Nurses)
CDC (Centers for Disease Control and Prevention)
At least weekly
Use CDC Guidelines
At least weekly
Use CDC Guidelines
Q: What are OSHA requirements for working with glutaraldehyde?
A: Clean and
rinse instruments to be disinfected prior to soaking. If mucous
and lubricants aren't scrubbed off before disinfection, many
bacteria and viruses (including the HIV virus) can survive
throughout the soaking cycle. Also, OSHA requires the following:
Workers who clean and rinse
instruments must protect themselves from splashes and sprays
by wearing gowns, rubber utility gloves, and face protection.
Have a Material Safety Data
Sheet (MSDS) on file and be sure all employees who use glutaraldehyde
have read it.
The soaking bin must be labeled
with the name of the high-level disinfectant and the hazard
Use in a well-ventilated area
or, if this is not possible, specify that the soaking container
is to be tightly covered at all times except when workers
are inserting or removing objects from the solution.
Q: When using glutaraldehyde-based soaking solutions, do
we need a fume hood? Do employees need to wear monitor badges?
A: No, although
to glutaraldehyde is dangerous. Employers must protect employees
from its vapors which irritate eyes, skin, and the respiratory
system. OSHA’s permissible exposure limit of 0.2 parts per
million of glutaraldehyde was invalidated by court order in
1992. Even so, one or two covered
soaking solutions in a medical practice is
surely below that limit. If you use glutaraldehyde extensively,
employee exposure may exceed healthful limits, even if containers
are kept closed. At that point, consider providing employees
with glutaraldehyde detection monitors and buy a fume hood
or sophisticated ventilation systems.
Q: Does OSHA require that we use check strips to determine
potency of soaking solutions?
No, but if wet instruments are
repeatedly inserted into soaking solutions, it makes good
sense to use them, especially near the end of the disinfectant's
soaking period. Most managed care plans, when auditing medical
practices, require checking the potency of these solutions.
Does OSHA require that we switch to peroxide-based
A: OSHA does not recommend products.
And, the fact is, peroxide-based disinfectants are less toxic
than glutaraldehydes. But before switching, check soaking
times and shelf life. The
new peroxide-based products (which of course are more
expensive) may be harmful to skin and eyes and can corrode
metal. Also, advise accounts to check with the instrument/scope
manufacturer to be sure that the peroxide-based product has
been tested for corrosion, lens-clouding or other problems,
because using a non-approved product may void the warranty.