Methods of reprocessing complex medical equipment

Abstract

The choice as to which of the two gaseous processes is best suited to individual hospital needs is a difficult one. Very few items are unable to tolerate 73 °C (LTSF) and these few can withstand 37 °C or 55 °C (EO). Unfortunately, LTSF is a ‘moist’ process and sterilizers have a poor history of providing sterilization without modification, and consequently few are used. Ethylene oxide is more reliable, but environmental hazards are greater and running costs high. Both processes are time-consuming and the use of sporicidal disinfectants such as glutaraldehyde is often the only practical alternative. Before purchasing any gaseous sterilizer it is essential to consider throughput and the availability of alternative processes. It may prove sensible to share facilities or at least offer a regional facility. It is certainly not worthwhile purchasing expensive gas sterilizers for reprocessing inexpensive single-use items or for those that require disinfection only. Low temperature steam is safe, inexpensive and no special environmental provisions are necessary. It is, however, not a sterilization process. Disinfectants, hot water and steam will continue to be the only suitable methods for reprocessing items outside the hospital sterile supply department or disinfection unit. Concern over the decontamination of blood-stained instruments following use on patients with hepatitis B or HIV has led to an upsurge of interest in boilers and inexpensive bench top ovens and autoclaves. Such processes are likely to prove more effective than disinfectants but should heat treatment prove impractical then 2% glutaraldehyde or 70% alcohol may be used. Two per cent glutaraldehyde is widely used for the disinfection of endoscopes but it is highly irritant and sensitizing. The use of automated systems for washing and disinfection should reduce staff exposure to the disinfectant and improve decontamination techniques. A comprehensive review of the process options given here and advice on the selection of washer disinfectors is available from the Editor of the CSC, Working Party Reports No 1 and No 2 (Mr B. J. Collins, Dudley Road Hospital, Birmingham, B18 7QH).