Which of the following solutions is used to fill the reservoir of an autoclave when sterilizing instruments?

Chemical Indicators

Tape Indicators

Tape indicators are adhesive-backed paper tape with heat sensitive, chemical indicator markings.  Tape indicators change color or display diagonal stripes, the words “sterile” or “autoclaved” when exposed to temperatures of 121°C.  Tape indicators are typically placed on the exterior of the waste load.  If the temperature sensitive tape does not indicate that a temperature of at least 121°C was reached during the sterilization process, the load is not considered decontaminated.   If tape indicators fail on two consecutive loads, notify your Department Safety Manager.

Tape indicators are not designed nor intended to prove that organisms have actually been killed. They indicate that a temperature of 121°C has been achieved within the autoclave.  EHS recommends that you DO NOT use autoclave tape as the only indicator of decontamination or sterilization.

Integrated Chemical Indicator Strips

Integrated chemical indicator strips provide a limited validation of temperature and time by displaying a color change after exposure to  normal autoclave operating temperatures of 121ºC for several minutes.  Chemical color change indicators can be placed within the waste load.  If the chemical indicators fail on two consecutive loads, notify your Department Safety Manager.                             

Biological Indicators

Biological indicator vials contain spores from B. stearothermophilus, a microorganism that is inactivated when exposed to 121.1oC saturated steam for a minimum of 20 minutes. Autoclaves used to treat biological waste will be evaluated with a biological indicator by EHS on a quarterly basis.

Procedure

• EHS will coordinate biological validation testing with laboratory staff.

• The indicators will be incubated by EHS for 24 hours at 60°C with a control that has been maintained at room temperature.

Results

• If the autoclaved indicator exhibits growth, the validation has failed and will be repeated.
• If the second validation indicator fails, EHS will notify the Department Safety Manager and request service on the autoclave.  Autoclave should not be used until service has been conducted and the validation test passes.
• Validation tests results are emailed by EHS staff to the appropriate labs and the Department Safety Manager.
• EHS maintains documentation of all validation tests.

Recordkeeping:

Autoclave Log:

An autoclave log containing the following details should be maintained by lab staff:

• Date, time, and operator’s name

• Contact information: Laboratory, room number, phone number
• Type of material sterilized/cycle
• Temperature, pressure, and length of time the load is sterilized.

Biological Indicator Test Results

• EHS maintains all biological indicator test results.

In this interview, Paul Walker, certified autoclave technician for over 30 years, previous-owner and now senior technician at Duraline Systems, Inc., shares valuable tips buying new and used autoclaves, autoclave cleaning, care and best practices, and the role of autoclaves in sterile processing.

To begin, can you give us an introduction into autoclaves?

Autoclaves are sterilizers that use steam as the sterilant and were first invented in 1879. They are now used globally by millions every day – accounting for 95% of the table-top sterilizer market. Sterilizers perform the most critical part of reprocessing instruments and for sterilizing products used in the healthcare industry. Without sterilization equipment, you wouldn’t have sterile instruments.

There are a number of methods that are used commercially, or in the medical industry to sterilize, the most common being Steam. Other methods are Hydrogen Peroxide Gas, Plasma, Ethylene Oxide Gas, Peracetic Acid, Dry Heat, Chemical Vapor used for various applications, depending on the product density or material being sterilized. They come in all sizes; from small tabletop models to walk-in units.

What are some of the different ways an autoclave can be cleaned, and what are some of the advantages/disadvantages of the various methods?

Proper maintenance of your autoclave will:

• Extend the lifetime of your autoclave (saving you lots of money!)
• Prevent parts from needing to be replaced
• and most importantly, ensure you are sterilizing your instruments! 

Autoclave cleaner comes in two forms: a liquid or powder solution. A favorite liquid autoclave cleaner among medical professionals is DuraClean. All you have to do is pour it into the reservoir to the appropriate amount (there are measurement lines for each serving on the bottle) and then run an empty cycle. The liquid solution efficiently cleans the valves, tubes, and chamber. You will need to empty the water, refill it with new distilled water and run a rinse cycle. Again, empty this water and fill it with new distilled water, and you are ready to go for another 25 cycles.

A popular powder for cleaning autoclaves is ChamberBrite. Simply empty a packet of the powder in the chamber, add pure water into the reservoir, and run an empty cycle.  ChamberBrite is known for leaving a shiny chamber, but also known for leaving behind residue and does not clean the valves as well as DuraClean.

If you want the best of both worlds, I recommend alternating between ChamberBrite and DuraClean.

Following on from this, what is the importance of autoclave cleaning and some of the repercussions of this not being done correctly?

If an autoclave is not cleaned correctly, sterilizer parts will be damaged, and the autoclave will stop sterilizing. It can lead to troubling error alerts (e.g., C983 on Midmark Ritter Gen 2 and Gen 3 models). Clogged valves will cause malfunctions and leaking. Specific autoclave parts affected by lack of cleaning include exhaust valves, vent valves, and gaskets. While sterilizer parts can be replaced, long-term negligence will reduce the performance of your autoclave, requiring repairs from outside technicians, which can bring your office to a stand-still if there are no sterilized instruments to work with. 

How regularly should an autoclave be cleaned?

Steam autoclaves should be cleaned every 25-30 cycles with the autoclave cleaner. For autoclaves not frequently used, we recommend cleaning them once every 30 days to maintain maximum performance. 

Cassette autoclave should be cleaned more frequently, up to once a week. As always, refer to the manufacturer’s operator’s manual. 

Can you tell us a bit about the value of preventative maintenance and how this can be applied in practice?

Preventative Maintenance extends the life of an autoclave and ensures the equipment is sterilizing properly. Some industries require proof of maintenance inspections, as recommended by the CDC. Autoclave Maintenance protects your business practice and ensures you are compliant. 

Most manufacturers recommend preventative maintenance, and it is always best to check your Operator Manual for frequency and details of what should be cleaned. Annual preventative maintenance by a service technician may be enough but sterilizers running multiple cycles per day may need a bi-annual service. I’ve learned the value of maintenance throughout my career, and always recommend that certified technicians do this critical function. 

At Duraline, our certified technicians perform a complete cleaning, and validation service, clean and check all filters, sensors, seals, and valves, replace worn parts, test & verify calibration and perform a 10 Point Mechanical Inspection. We always issue a certification sticker on the autoclave with the date of inspection and compliance records.

What are some of the advantages of using a sterilization center, and how can this be utilized?

Sterilization Centers help to improve your staff’s workflow, efficiency, and productivity – with the end goal to make it as easy as possible to reprocess instruments completely sterile with verifiable proof.  A sterilization center keeps the whole process of “clean to sterile” in focus, with all the necessary products right at hand including equipment and tools needed throughout the various stages. Sterilization centers flow from left to right:  dirty tools and biohazardous waste are on the left, instrument cleaning is in the center, and instrument sterilization and storage area on the right. 

Our SteriLine Sterilization Center uses colors for staff to identify where instruments are in the sterilization process: red is at the beginning (red=hazardous); yellow is in the middle (yellow=caution) and green is on the right side (green=GO!) Items in the green section are sterile instruments ready to be used for your patients. An advantage to this is your staff can easily see which instruments are within the Clean-to-Sterile process. 

Another advantage of sterilization centers is all the necessary equipment is in one place per each section: Cleaning and soaking trays, enzymatic cleaning solutions, brushes, instrument washer-disinfectors and rinse agents, ultrasonic cleaners, water distillers, sterilization wraps, pouches, indicator tape, tubing, biological monitoring, autoclaves, and storage of sterilized instruments. Creating a central workspace flow from"Clean-to-Sterile" encourages best practices, compliance, sterilization ID labeling, and recording. 

Also, sterilization centers like SteriLine look professional, and show that you as a physician care about your staff and most importantly your customers! Since COVID, the public’s awareness of infection control has increased dramatically. Patients are asking to see their physician’s sterilization space. A clean, professional, modern sterilization center can go a long way!

What advice would you give a buyer, in debating whether to buy a refurbished sterilizer versus a new sterilizer?

In choosing new versus refurbished, there are a few things to consider: 

1) Price - can you afford the new sterilizer? Generally, new units are about 30% higher in cost than refurbished unit. 

2) How long do you plan to own the sterilizer? Typically, you can expect 10+ years from a sterilizer. A refurbished unit may be cheaper, but if it's an older model, will the manufacturer support it past 10 years? Will parts be available then? But if you only need one to get you to retirement, a refurbished unit may make the most sense. 

3) Is the new sterilizer being considered a brand-new model that hasn’t been in the market for long? Some new sterilizers have launched and failed a few months in, as they were not tried and tested, only to find that the manufacturer had to upgrade the sterilizers software. 

4) In considering a refurbished sterilizer, what is the warranty policy, and how does the company support the warranty? Find out the support structure of the brand – what technician support do they have nearby you?   

At Duraline BioSystems, we sell “Refurbished Autoclaves” which are “Certified.” Our in-house team of manufacture-certified technicians take used autoclaves and make autoclaves look and function like new. These certified autoclaves must pass a 30-point quality control inspection, and are tested and validated. Refurbished sterilizers are then packaged with special expanding foam-type Sealed-Air packaging molded to the machines to minimize shipping damage. 

Where can our readers find more information?

www.duralinesystems.com

To see real pictures of used autoclaves we sell “refurbished” please go to our website.  These are real pictures of used autoclaves for sale in refurbished condition. They look and function like new with a warranty. For tips on caring for your autoclave and extending its lifespan, go to the Learning Lab. To see what your autoclave is worth, go to our Trade-In center.

About Duraline Sytems

Duraline Systems opened its doors in 1992.  What makes Duraline unique is that we only repair & sell autoclaves and related consumables. We are known to be the specialists in the USA for all brands of tabletop sterilizers. In recent years the company began selling larger stand-alone type sterilizers used in large clinics or hospitals. We sell autoclaves globally and our name has become trusted within the industry.

About Paul Walker

Paul Walker is a Senior Executive at Duraline BioSystems, working with commercial clients to stay up to date with compliance requirements and CDC standards. He launched Duraline BioSystems in 1992 and built relationships with regional franchises for service work (including ENT & Allergy Associates, NYU Langone Health, Banfield Pet Hospital®).  As Duraline’s shop expands, he continues to share knowledge with younger generations of technicians. It’s very fulfilling to see my trainees leading the team!

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