Autoclave loading/unloading, chemical sterilization, and professional responsibilities

Loading the autoclave

Prepare all packs and arrange the load in a way that allows maximum circulation of steam and heat. Articles should be resting on their edges and should not be crowded. Placing the packs in stainless steel racks prevents the packing of the autoclave too tightly. Instruments may be autoclaved unwrapped if they do not need to be sterile when used later. For example, although vaginal specula do not need to be sterilized for use (the vagina is a body cavity that is naturally open to the external environment), they must be sanitized and sterilized to prevent cross-contamination among patients. They can be placed unwrapped on a perforated stainless-steel tray in the autoclave and then stored in a clean area for future use.

Unloading guidelines

When the autoclave’s sterilization cycle is complete, the pressure should be released according to the manufacturer’s guidelines. Once the pressure gauge reads “0,” the medical assistant should stand behind the door and, with heat-resistant gloves, open the door approximately one-quarter of an inch. Allow the load to dry for at least 15 minutes (this time varies according to the type of autoclave and the size of the load). Packs can act as a sponge, attracting outside moisture and microorganisms. Touching a wet pack allows microorganisms on your hands to penetrate the wrappings, making the contents of the pack nonsterile. Dry, wrapped packs may be removed with clean, dry hands, but it is safer to wear heat-resistant gloves to reduce the possibility of burns from the hot instruments inside the packs. If possible, allow all packs to cool in the autoclave with the door open. Place the packs on a dry, dust-free surface inside an enclosed cupboard or drawer for storage. Do not place the packs on cold surfaces because hot packs may cause condensation, and moisture will contaminate the contents.

Guidelines for unloading an autoclave

• Stand behind the door when opening it to prevent accidental steam burns.
• Slowly open the door only a crack, allowing the items to cool for 15 to 20 minutes before removing them.
• If for any reason the integrity of the sterilization process is in question, the load should be considered contaminated and autoclaved again. Reasons for concern include the following:
• If a load fails to convert a sterilization indicator strip (autoclave tape), this indicates that the autoclave is not working properly.

Shelf life of sterilized packs

The CDC no longer identifies specific time limits for the shelf life of sterilized packs. The general recommendation is that as long as the sterilized items are stored so that the packaging material remains intact and undamaged, then the pack is considered sterile. All sterile packs should be stored on dry, dust-free, covered shelves or in drawers. Some facilities continue to date every sterilized package and use shelf-life practices, such as first in, first out; other facilities have switched to event-related practices. With event-related practices, items remain sterile until some event causes contamination (e.g., a pack becomes wet or packing material is torn). The quality of the packaging material, storage conditions, and how much the packs are handled all affect the possibility of contamination. Therefore, sterile packs should be inspected before they are used to verify the integrity of the wrapping material. Any package that is wet, torn, dropped on the floor, or damaged in any way should be sanitized, disinfected, wrapped in new autoclave paper, or placed in new autoclave pouches, and autoclaved again.

Chemical sterilization

In the medical office, chemical sterilization is used for instruments that cannot be exposed to the high temperatures of steam sterilization. The sterilizing chemical solution must be mixed exactly according to the instructions on the bottle. The solution must be marked with the date of preparation and expiration. Materials to be sterilized must be submerged in this chemical bath with a closed lid for 8 hours or longer. Items are removed with sterile forceps and must be rinsed with water to remove all traces of the chemical before the items are used on a patient. You must avoid skin contact with the sterilizing solution because it is very caustic.

The use of chemicals for sterilization is not very practical in the ambulatory facility. The instruments or equipment cannot be wrapped during processing in the liquid chemical. Once they are removed from the liquid, they are no longer considered sterile. In addition, because of the caustic nature of the chemicals, instruments must be rinsed with water after removal from the chemical fluid. This water is typically not sterile. However, high-level chemical disinfectants do have a place in healthcare. They can be used on instruments (e.g., endoscopes) that would be damaged by autoclaving. Because of the limitations of using liquid chemicals for sterilization, their use should be restricted to reprocessing critical devices that are heat sensitive and incompatible with other sterilization methods.

Assisting with a minor surgical procedure can be an exciting role a medical assistant. Having an understanding of the minor surgery room, the solutions and medications used, the instruments and supplies needed, and how to maintain surgical asepsis will make you a valuable asset.

Patient coaching

Patients may have questions about the instruments the provider will use, and the medical assistant can help allay patients’ fears by answering these questions. Explaining how the patient will be prepared for the procedure, how the procedure will be performed, and what to expect afterward helps make the procedure go more smoothly and encourages the patient to follow the provider’s advice and orders.

Legal and ethical issues

It is important for patient health that medical assistants ensure that all instruments used in procedures are sterile. The sterilization process begins with sanitization. No shortcuts should be taken when prepping instruments for sterilization. It might be easier to overlook the damaged sterilization pack but using instruments from that pack could lead to an infection, which in turn could lead to a lawsuit.

Professional behaviors

Performing medical assistant duties responsibly and accurately is crucial in the surgical area of the ambulatory care setting. The provider relies on the medical assistant to have the appropriate supplies and instruments available before a procedure begins. To achieve this goal, the medical assistant must have a working knowledge of the typical instruments and supplies used in the facility, in addition to an understanding of the types of instruments needed for each procedure. Medical assistants must make sure tasks are completed according to the facility’s policies and procedures so they are able to assist the provider and protect the patient.