1. Cleaning, Packaging and Sterilization of Instruments
Provided by:
McKesson Corporation
McKesson Medical-Surgical
Richmond, VA

2. Continuing Education Program
Following established protocols for
instrument processing is an important
aspect of modern health care as it helps
to minimize the patient’s risk for
infection of the surgical site.
This program reviews the most current
recommended practices for instrument
processing and is approved through
two national sterile processing
organizations.
IAHCSMM and CBSPD offer certification programs for sterile processing personnel

3. SPECIAL UPDATE The Centers for Medicare & Medicaid Services (CMS)
has recently revised their Survey and Certification
document to include more stringent audits in the areas
of infection control and sterilization.
Areas of emphasis include:
Compliance with nationally recognized standards documents.
Formal training in areas of infection control and sterilization.
Compliant cleaning, sterilization and monitoring procedures.
Established criteria for flash sterilization.
Reference:
CMS Infection Control Surveyor Worksheet, Exhibit 351, 2009

4. SPECIAL UPDATE The Accreditation Association for Ambulatory
Healthcare (AAAHC) added an infection control chapter
to their standards handbook.
Infection control highlights included:
“Adhering to standards, guidelines, and manufacturer’s
instructions for cleaning, disinfection, and sterilization
of instruments, equipment, supplies, and implants.”
Reference:
OR Manager Magazine, Volume 26, Number 2, 2010.

5. INSTRUMENT PROCESSING
There are six (6) recommended
steps for Instrument Processing:
Cleaning
Inspection
Packaging
Sterilization
Storage & Delivery
6. Quality Assurance

6. STEP 1 - CLEANING Cleaning of instruments should
be performed in a designated
area, immediately after the
surgical procedure.
Quick cleaning removes blood
or debris much easier, and can
minimize corrosion, pitting or
instrument staining.

7. STEP 1 - CLEANING Whenever possible, it is best to
mechanically clean instruments
with an ultrasonic or washer
using a neutral pH detergent.
Mechanical cleaning has been
proven to be up to 16 times
more effective over manual
cleaning.

8. STEP 1 - CLEANING Ultrasonic cleaners use high
frequency sound waves to
create microscopic bubbles
that collapse.
This “cavitation” process is
very effective in getting into
the serrations, box locks and
crevices of instruments.

9. STEP 1 - CLEANING After cleaning, thoroughly
rinse instruments with tap
water to ensure loosened
debris and detergents are
removed.
If the tap water is of poor
quality, consider using
treated water as a final rinse
to avoid instrument staining.

10. STEP 2 - INSPECTION Each instrument must be critically inspected after
each cleaning for residual
debris or damage.
Replace instruments as
needed and never sterilize
a “dirty” instrument.

11. STEP 2 - INSPECTION In addition, check each instrument for proper
function and lubricate
those that have “metal
to metal” action.
Instruments with stiff
joints could be a sign
of inadequate cleaning.

12. STEP 3 - PACKAGING Instrument packaging should be done in a clean, low
contamination area using only
FDA approved materials,
such as:
Sterilization pouches
Sterilization wrappers
Sterilization containers

13. STEP 3 - PACKAGING Sterilization pouches are for
packaging single instruments
and small, light weight items.
Paper/plastic pouches allow
the user to see the packaged
instruments and are available
in multiple sizes for use with
Steam or EO gas sterilization
processes.

14. STEP 3 - PACKAGING When packaging instruments,
be sure to select an appropriate
size pouch and to place hinged
instruments in an open position
to allow sterilant contact.
For quality control, be sure to
include a chemical indicator
inside and a lot label outside.

15. STEP 3 - PACKAGING
To assist sterilization and aid drying, always place pouches facing each other and on edge using a pouch divider.
Inexpensive pouch dividers are available for small and large sterilizers.

16. STEP 3 - PACKAGING Sterilization wrap is used for
packaging instrument cassettes
and/or trays.
To allow sterilant to reach the
instruments and to not trap air
inside the package, cassettes
and trays should be perforated.
Wrap should be snug to prevent low spots that could collect
condensate, but not too tight to cause strike through.

17. STEP 3 - PACKAGING Instrument trays should be
double wrapped to maintain
sterility per the wrap mfg’s
instructions for use.
wrapped in a way that allows
for sterile presentation of the
processed items.

18. STEP 3 - PACKAGING Wrapped packs should be sealed
with 1”, 3/4” or ½” sterilization
indicator tape.
For quality control, be sure to
include a chemical indicator
inside and a lot label outside.
Class 5
Class 4

19. STEP 3 - PACKAGING Wrapped packs (being heavier)
should be placed on the lower
shelf of the sterilizer.
Loading heavier items on the
bottom shelf and lighter items
on the top, enables condensate
to drain out without wetting
other items in the load.
To maintain sterility, packages need to be visibly dry before transporting to a sterile storage area

20. STEP 3 - PACKAGING Sterilization containers can be
used to process instruments or
sets. Containers offer excellent
protection during storage and
transport to the sterile field.
As with wrapped trays, loading
containers on the bottom shelf
and lighter items on the top,
enables condensate to drain
away from lighter packages.
Some rigid containers can be stacked during sterilization; however, all can be stacked during storage to save space

21. STEP 4 - STERILIZATION Steam sterilization is CDC
recommended as the process
of choice whenever possible.
Steam under pressure is
considered safe, fast and the
most cost effective sterilization
method for health care
facilities.
Gravity displacement and pre-vacuum are the two common types of steam sterilizers

22. STEP 4 - STERILIZATION Steam sterilizers are Class II
medical devices subject to FDA
approval per a 510(k) clearance
letter.
They are available in a wide
variety of shapes and sizes for
sterilization of heat-stable
instruments.

23. STEP 4 - STERILIZATION Always process according
to the sterilizer or instrument
manufacturer’s validated
Instructions For Use (IFU).
Some common steam cycle
parameters are:
250°F/121°C for 30 minutes
270°F/132°C for 10 minutes
273°F/135°C for 4 minutes

24. STEP 4 - STERILIZATION Not all instruments can be processed
at these common steam cycles.
Therefore, it is critical that you have
each device mfg’s IFU that details
the cycle parameters (exposure time
and temperature), along with the
mode (gravity, prevacuum, steam
flush pressure-pulse).

25. STEP 5 – Storage & Delivery
Sterile items should be stored in a
manner that reduces the potential
for contamination.
The shelf-life of sterile packages
is event related and depends on
the quality of the packaging
material, storage conditions and
amount of handling.

26. STEP 5 – Storage & Delivery
Sterile packages should always be
handled with care. Avoid dragging,
crushing, bending, compressing or
puncturing, as this will compromise
the sterility of the contents.
Be sure to inspect sterile packages
before distributing. Do not use any
package that is damaged, wet or
opened.

27. STEP 5 – Storage & Delivery
Sterility maintenance bags
(dust covers) may be used
to protect items that could
be subjected to
environmental challenges
or multiple handling
before use.
Should be 2-3 mils thick and applied ASAP after sterilization and after the item has cooled.

28. STEP 6 – Quality Assurance
Chemical indicators should be located
on the outside/inside of each package
to visibly show they have been
processed.
Biological indicators should be run
at least weekly to verify sterilization
and recorded as part of your formal
Infection Control – QA program.

29. STEP 6 – Quality Assurance
Chemical Indicators are available
in tape, card and strip formats for
use with all processes.
These devices change color as
indicated, for the process they
are monitoring.

30. STEP 6 – Quality Assurance
Most large steam sterilizers
are prevacuum and require
an air removal check before
using. This daily test is done
with a Bowie-Dick test pack.
Most table top sterilizers are
gravity displacement and do
not require this special test;
however, prevacuum table top
sterilizers are now available.

31. STEP 6 – Quality Assurance
Test Procedure:
Place a Bowie-Dick test pack on
the lowest shelf, over the drain in
an empty chamber at 273°F for
3.5 or 4 minutes.
After processing, the indicator
sheet inside the test pack must
show a uniform color change to
pass.
A shortened cycle omitting dry time should be run first to properly heat up the sterilizer.

32. STEP 6 – Quality Assurance
Biological Indicators are processed along
with a load for sterilizer verification. For
steam sterilizers, users purchase a 55-60°C
incubator and biological indicator vials.
Sterilizer failure is noted if the BI grows
during incubation. Growth is observed by
a color change in the media from purple
to yellow.

33. STEP 6 – Quality Assurance
Biological Indicators can also be
sent to an outside Lab for 3rd party
documentation.
Mail-in systems use BI strips and
pre-paid mailer envelopes. Users
simply run the BI strip and then
mail. A Lab Report is returned and
placed on a “password protected”
website:

34. STEP 6 – Quality Assurance
While sterilizers can and do
mechanically fail, human error
is the leading cause of sterilizer
failure.
Cold start
Wrong cycle
Overloading
Improper packaging
After processing, the BI strip is mailed to an outside Laboratory for incubation. After hrs, a formal Lab Report is returned to verify steam sterilization

35. McKesson thanks you for taking the time to review…
The six (6) recommended steps
for Instrument processing:
Cleaning
Inspection
Packaging
Sterilization
Storage & Delivery
6. Quality Assurance

36. CE Certificate Available
This continuing education program
was developed and produced by
SPSmedical Supply Corp. for the
McKesson Corporation.
Customers who view this program
may request a complimentary CE
Certificate from SPSmedical.

37. SPSmedical Supply Corp.
The largest sterilizer testing
laboratory in North America with
over 60 sterilizers SPSmedical
serves on multiple AAMI
sterilization standards committees
and provides Seminar speakers to
health care organizations.
For technical questions and CE Certificates, please call: or

38. References & Resources
Association for the Advancement of Medical Instrumentation
1110 North Glebe Road, Suite 220, Arlington, VA
Fax:
Association of periOperative Registered Nurses
2170 South Parker Road, Suite 300 Denver, CO
Certification Board for Sterile Processing & Distribution
2 Industrial Park, Suite 3 Alpha, NJ 08865
International Assoc. of Healthcare Central Service Materiel Management
213 W. Institute Place, Suite Chicago, IL 60610
Fax:

39. McKesson Brand Sterility Assurance Products

40. McKesson Brand Sterility Assurance Products
To assist users in meeting their sterility assurance needs, contact
your local McKesson Representative for the following McKesson
brand quality products:
PACKAGING MONITORING
Self-Seal Sterilization Pouches • Chemical Indicators
Sterilization Indicator Tape • Biological Indicators
Record Keeping Systems • Bowie Dick Test Packs
• Incubators/Record Books

41. McKesson Brand Sterile Packaging Products
Self-Seal Pouches
73-SSP ” x 9”
73-SSP ” x 10”
73-SSP ” x 13”
73-SSP387 8” x 16”
73-SSP391 12” x 18”

42. McKesson Brand Sterile Packaging Products
Sterilization Tape
73-ST048 3/4” x 60 yds
73-ST036 1” x 60 yds
73-BT048 3/4” x 60 yds
73-BT036 1” x 60 yds
73-GT036 1” x 60 yds
Label Applicator 73-MDG001 Load Record Label 73-URL012 Load Record Card 73-DLC250 Records Envelope 73-LEB100

43. McKesson Brand Sterilization Monitoring Products
Chemical Indicators
73-SIS ” Steam Strip
73-SIL ” Steam Strip
73-GIL ” EO Strip
73-DMS ” Dual Strip
Chemical Integrators
73-SSI100 Steam (100 pk)
73-SSI1000 Steam (1,000 pk)
73-STP025 Steam Test Pack
Daily Air Removal Test
73-SBD030 Bowie-Dick Test Pack

44. McKesson Brand Sterilization Monitoring Products
Biological Indicators
73-SCS025 Steam vial (25 bx)
73-SCS100 Steam vial (100 bx)
73-SBT025 Steam Test Pack w/25 controls
73-SBT255 Steam Test Pack w/5 controls
73-NDB °C Dry Block Incubator, 11 mm
73-PP012 Mail-In System (12 bx)
73-PP052 Mail-In System (52 bx)