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Sterilization packaging systems play an important role in sterilization by promoting sterilant contact with all surfaces of reusable medical devices; maintaining device sterility; and protecting items from contamination during handling, storage, and transport. Packaging should be performed in ergonomically appropriate workspaces to help personnel avoid musculoskeletal injuries. When using packaging systems, personnel should adhere to the manufacturer's instructions for use. The recently updated AORN “Guideline for sterilization packaging systems” provides perioperative team members with information on evaluating, selecting, and using sterilization packaging systems. This article provides an overview of the guideline and discusses recommendations for preparation for packaging, sterilization wrap, peel pouches, and quality. It also includes a scenario describing specific concerns related to sterilization wrap defects. Perioperative nurses should review the guideline in its entirety and apply the recommendations when using packaging systems.

ABSTRACTProper sterilization of instruments and medical devices is important in ensuring patient safety and preventing surgical site infections. Adhering to the manufacturer's written instructions for use of an item, its packaging, and the sterilizer is essential to ensure instruments and medical devices are properly sterilized. Quality assurance measures should be used to evaluate and monitor sterilization processes and increase patient safety. The recently updated AORN “Guideline for sterilization” provides perioperative nurses with guidance for processing, transporting, and storing reusable medical devices for use in perioperative and procedural settings. This article provides an overview of the guideline and discusses recommendations for selection of a processing method, transport and storage of sterile items, steam sterilization, and quality. It also includes a scenario describing specific concerns related to quality assurance and steam sterilizer maintenance. Perioperative nurses should review the guideline in its entirety and apply the recommendations when processing reusable medical devices.

In this work, a sensor to evaluate sterilization processes with hydrogen peroxide vapor has been characterized. Experimental, analytical and numerical methods were applied to evaluate and study the sensor behavior. The sensor set-up is based on planar interdigitated electrodes. The interdigitated electrode structure consists of 614 electrode fingers spanning over a total sensing area of 20 mm2. Sensor measurements were conducted with and without microbiological spores as well as after an industrial sterilization protocol. The measurements were verified using an analytical expression based on a first-order elliptical integral. A model based on the finite element method with periodic boundary conditions in two dimensions was developed and utilized to validate the experimental findings.

Background With the trend toward pay-for-performance standards plus the increasing incidence and prevalence of periprosthetic joint infection (PJI), orthopaedic surgeons must reconsider all potential infection control measures. Both airborne and nonairborne bacterial contamination must be reduced in the operating room. Questions/purposes Analysis of airborne bacterial reduction technologies includes evaluation of (1) the effectiveness of laminar air flow (LAF) and ultraviolet light (UVL); (2) the financial and potential health costs of each; and (3) an examination of current national and international standards, and guidelines. Methods We systematically reviewed the literature from Ovid, PubMed (Medline), Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, NHSEED, CINAHLPLUS, and Google Scholar published until June 2010 focusing on ultraclean air, ultraviolet light, and laminar air. Results High-level data demonstrating substantial PJI reduction of any infection control method may not be feasible as a result of the relatively low rates of occurrence and the expense and difficulty of conducting a large enough study with adequate power. UVL has potentially unacceptable health costs and the Centers for Disease Control and Prevention (CDC) recommends against its use. European countries have standardized LAF and it is used by the majority of American joint surgeons. Conclusions Both LAF and UVL reduce PJI. The absence of a high level of evidence from randomized trials is not proof of ineffectiveness. The historically high cost of LAF has decreased substantially. Only LAF has been standardized by several European countries. The CDC recommends further study of LAF but recommends UVL not be used secondary to documented potential health risks to personnel.

PUTTING ON GOWNS AND GLOVES * Select a surgical gown that provides adequate barrier protection as determined by the: - team member's role - type of procedure (minimally invasive versus open) - anticipated blood loss - anticipated volume of irrigation - anticipated patient contact - length of the procedure - probability of handling hazardous medications * Select a surgical gown that wraps around the body and completely covers the wearer's back. * Perform surgical hand antisepsis before putting on a surgical gown and sterile gloves. * Prevent contamination when donning a sterile gown by: - following the manufacturer's instructions for use (IFU) - placing and opening the surgical gown away from the sterile field - avoiding putting sterile gloves on top of the open surgical gown - ensuring hands and arms are dry before putting on the surgical gown - only touching the inside of the gown when putting it on - only touching the sterile glove wrapper after the surgical gown has been put on * Wear two pairs of sterile gloves and use a perforation indicator system when scrubbed into the sterile field. * Cover the surgical gown cuffs with the gloves. * Change surgical gloves: - every 60 to 150 minutes - when known or suspected contamination occurs - when a defect or perforation is identified or suspected - after touching » methyl methacrylate » a C-arm » drapes used to protect the sterile field from contamination during lateral movement of the C-arm » a surgical helmet or visor » optic eyepieces on a microscope * Avoid using penetrable materials (eg, sterile towels) to manipulate or hold unsterile items (eg, cell phones). * Surgical gowns are tested by the manufacturer for liquid barrier protection and labeled with barrier level properties (ie, levels 1 [lowest] to 4 [highest]) based on the anticipated risk of exposure. PREPARING THE STERILE FIELD AND DRAPING * Prepare the sterile field as close as possible to the time of the procedure. * Avoid moving the sterile field to another room once it is set up. * Keep sterile fields and instrumentation separate for procedures that involve more than one wound classification (eg, clean, clean-contaminated, contaminated, dirty). * Prepare sterile fields according to the health care organization's process when using isolation technique. * Place sterile drapes as close as possible to the time of the procedure and in accordance with the manufacturer's IFU. * Avoid leaning or reaching across an unsterile area when placing surgical drapes. * Shield gloved hands by cuffing the sterile drape. * Avoid moving the drapes once they are placed. * Use a nonperforating device when securing surgical equipment (eg, tubing, cords) to the drapes. * Consider any item that falls below the level of the sterile field to be contaminated. * Several different kinds of sterile drapes are used in the perioperative environment. OPENING AND HANDLING STERILE ITEMS * Inspect the packaging of sterile items for: - sterility of the contents, as noted on the packaging - package and product integrity - the expiration date, when applicable - chemical indicator changes (eg, color change) * Present sterile items directly to the scrubbed person or place them securely on the sterile field. * Present heavy or sharp items directly to the scrubbed person or place them on a separate surface. * Inspect rigid sterilization containers for intact, secure latch filters; intact external locks, valves, and tamper-evident devices; and the correct color change to external chemical indicators. * Examine wrapped sterile packages for intact tape and the correct color change for the external chemical indicator before opening. * Examine paper-plastic pouches (ie, peel pouches) for intact seals and chemical indicators. * Prevent items from sliding over the unsterile edges of the pouch by pulling back on the flaps without touching the inside of the package. * Inspect instruments for retained bioburden and debris after they are opened to the sterile field. * Consider instruments to be contaminated if debris, moisture (except when immediate-use sterilization cycles are used), or damage is present. * When a contaminated instrument is found, consider the entire instrument set to be contaminated. * Transfer medications and solutions to the sterile field by: - opening them as close as possible to the time of use - transferring them in a slow, controlled manner using a sterile transfer device (eg, sterile vial spike) and in accordance with the manufacturer's IFU - only removing the medication vial stopper if it is designed for removal - pouring them in a container that is near the sterile table's edge or held by the scrubbed person - pouring them only once * Inspecting items (eg, peel packed items, wrapped sterile packages) before they are presented to the sterile field helps determine if the item is sterile or if its damaged or compromised. MAINTAINING THE STERILE FIELD * Cover the sterile field with a drape in a way that prevents contamination if the sterile field will not be used immediately (eg, procedural delay). * Refer to the organization's standard procedure regarding circumstances that might necessitate the sterile field being covered, how it is covered, and the length of time it should be covered. * If the OR has a unidirectional air delivery system, position the surgical site and instrument tables within the airflow curtain. * Place heater-cooler devices (HCDs) outside the air curtain of the unidirectional air delivery system and direct the airflow exhaust away from the sterile field. * Educate perioperative team members on the safe use of HCDs and the interventions to decrease the risk of infections associated with those devices. * Implement isolation technique as part of a surgical site infection bundle during colorectal surgeries. * Use a wound protector for open or hand-assisted abdominal procedures in which the gastrointestinal or biliary tract is accessed. * Prevent the risk of cross contamination when using a C-arm by: - considering the top of the C-arm drape to be contaminated immediately after draping - maintaining sterility of

SARS-CoV-2, and several other microorganisms, may be present in nasopharyngeal and salivary secretions in patients treated in dental practices, so an appropriate clinical behavior is required in order to avoid the dangerous spread of infections. COVID-19 could also be spread when patients touches a contaminated surface with infected droplets and then touch their nose, mouth, or eyes. It is time to consider a dental practice quite similar to a hospital surgery room, where particular attention should be addressed to problems related to the spreading of infections due to air and surface contamination. The effectiveness of conventional cleaning and disinfection procedures may be limited by several factors; first of all, human operator dependence seems to be the weak aspect of all procedures. The improvement of these conventional methods requires the modification of human behavior, which is difficult to achieve and sustain. As alternative sterilization methods, there are some that do not depend on the operator, because they are based on devices that perform the entire procedure on their own, with minimal human intervention. In conclusion, continued efforts to improve the traditional manual disinfection of surfaces are needed, so dentists should consider combining the use of proper disinfectants and no-touch decontamination technologies to improve sterilization procedures.

Background Reusable medical devices in healthcare facilities are decontaminated and reprocessed following standard practices before each clinical procedure. Reprocessing of critical medical devices (those used for invasive clinical procedures) comprises several processes including sterilization, which provides the highest level of decontamination. Steam sterilization is the most used sterilization procedure across the globe. Noncompliance with standards addressing reprocessing of medical devices may lead to inadequate sterilization and thus increase the risk of person-to-person or environmental transmission of pathogens in healthcare facilities. We conducted nationwide multicenter clustered audits to understand the compliance of primary- and secondary-care public hospitals in Nepal with the standard practices for medical device reprocessing, including steam sterilization. Methods We developed an audit tool to assess compliance of hospitals with the standard practices for medical device reprocessing including steam sterilization. Altogether, 189 medical device reprocessing cycles which included steam sterilization were assessed in 13 primary and secondary care public hospitals in Nepal using the audit tool. Percentage compliance was calculated for each standard practice. Mean percentage compliances were obtained for overall primary and secondary care hospitals and for each hospital type, specific hospital and process involved. Results For all primary and secondary care hospitals in Nepal, the mean percentage compliance with the standard practices for medical device reprocessing including steam sterilization was 25.9% (95% CI 21.0–30.8%). The lower the level of care provided by the hospitals, the lower was the mean percentage compliance, and the difference in the means across the hospital types was statistically significant ( p  < 0.01). The mean percentage compliance of individual hospitals ranged from 14.7 to 46.0%. The hospitals had better compliance with the practices for cleaning of used devices and transport and storage of sterilized devices compared with the practices for other processes of the medical device reprocessing cycle. Conclusion The primary and secondary care hospitals in Nepal had poor compliance with the standard practices for steam sterilization and reprocessing of medical devices. Interventions to improve compliance of the hospitals are immediately required to minimize the risks of person-to-person or environmental transmission of pathogens through inadequately reprocessed medical devices.

The PCDs are kept in the most critical area of a sterilizer for the worst-case scenario (ie, lowest acceptable temperature or shortest acceptable exposure time). [...]if a single Bowie-Dick or a biological indicator can monitor the entire load for sterility assurance, then there is no reason to keep an internal chemical indicator in every set. According to the international standard, all type V or VI indicators are called ‘integrating’ or ‘emulating’ indicators, and they can only specify the constant concentration of steam with time and temperature. Only those indicators have defined sated value (SV) according to EN ISO 11140-1. [...]if an HPCD with a type II chemical indicator monitoring air removal, temperature-time-integral (F0 value) and condensation of steam to water is added to the type V or VI chemical indicator (as a dummy pack) in every cycle, then this monitoring is a better alternative to releasing the sterile load than including the internal chemical indicator in every set.

ABSTRACT Objective: To construct and validate an instrument to assess events related to maintaining the sterility of processed healthcare products. Methods: This methodological study developed the instrument through analysis by a panel of experts, focusing on the integrity of commonly used packaging: spunbond-meltblown-spunbond and medical-grade paper. The instrument was analyzed using the Content Validity Index and Content Validity Ratio (≥ 0.80) and modified Kappa (≥ 0.74). The instrument underwent pre-testing. Results: Six experienced professionals participated in the expert panel. After two rounds, the final version of the instrument contained five dimensions. In the pre-test, 30 nursing professionals participated, of whom 86.67% considered the instrument good, and 90% found it understandable. Conclusion: The construction and validation followed literature recommendations. The instrument is available, aiding in the safe use of processed healthcare products. RESUMEN Objetivo: Construir y validar instrumento para evaluar evento relacionado a manutención de la esterilidad de productos para salud procesados. Métodos: Estudio metodológico para desarrollar instrumento mediante análisis por comité de jueces. Considerado como aspecto rector la integridad de envases más utilizados en la práctica: de no tejido y de papel grado quírurgico. Realizado análisis por Índice de Validez de Contenido y Razón de Validez de Contenido ≥ 0,80 y Kappa modificado ≥ 0,74. Sometido el instrumento a pre-prueba. Resultados: Participaron del comité de jueces seis profesionales experientes en la temática. Trás dos rondas, fue constituída la versión final del instrumento, conteniendo cinco dimensiones. En la pre-prueba, participaron 30 profesionales de enfermería, en que 86,67% consideraron el instrumento bueno; y 90%, comprensible. Conclusion: La construcción y validación siguió las recomendaciones de la literatura. El instrumento está disponible para ser utilizado, auxiliando el uso seguro del producto para salud. RESUMO Objetivo: Construir e validar instrumento para avaliar evento relacionado à manutenção da esterilidade de produtos para saúde processados. Métodos: Estudo metodológico para desenvolver instrumento mediante análise por comitê de juízes. Considerou-se como aspecto norteador a integridade das embalagens mais utilizadas na prática: a de não tecido e a de papel grau cirúrgico. A análise foi realizada pelo Índice de Validade de Conteúdo, Razão de Validade de Conteúdo ≥ 0,80 e Kappa modificado ≥ 0,74. Submeteu-se o instrumento ao pré-teste. Resultados: Participaram do comitê de juízes seis profissionais experientes na temática. Após duas rodadas, chegou-se à versão final do instrumento, contendo cinco dimensões. No pré-teste, participaram 30 profissionais de enfermagem, dos quais 86,67% consideraram o instrumento bom; e 90%, compreensível. Conclusões: A construção e validação seguiu as recomendações da literatura. O instrumento está disponível para ser utilizado, auxiliando no uso seguro do produto para saúde.