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The Physics, Clinical Measurement and Equipment of Anaesthetic Practice for the FRCA$
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Patrick Magee and Mark Tooley

Print publication date: 2011

Print ISBN-13: 9780199595150

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199595150.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 19 June 2021

Cleaning and Sterilisation of Equipment

Cleaning and Sterilisation of Equipment

Chapter 30 Cleaning and Sterilisation of Equipment
The Physics, Clinical Measurement and Equipment of Anaesthetic Practice for the FRCA

Patrick Magee

Mark Tooley

Oxford University Press

Although a proportion of anaesthetic and surgical equipment is disposable nowadays, there is still a significant amount of cleaning and sterilisation required, and with the emergence of new organisms, the methods used have come under closer scrutiny. It is worth noting, in passing, that hand cleanliness of staff coming into contact with patients has also come under close scrutiny in recent years. Cleaning of equipment involves the physical removal of as much of the infectious agent as possible, usually using water and a detergent, and is an important precursor to disinfection or sterilisation. It can be done manually where automated devices are unavailable. Ultrasonic washers are sometimes used, as are irrigation pumps for flushing out the lumina of tubes. There is a difference in definition between disinfection and sterilisation. Disinfection is merely the killing of non-spore producing micro-organisms. It kills most bacteria except mycobacteria and spores, and it kills some fungi and some viruses. A higher level of disinfection ensures the destruction of mycobacteria, and most fungi and viruses. Sterilisation is required to kill all micro-organisms, including spores, fungi and viruses. Prions are, however, resistant to most sterilisation procedures. To disinfect or sterilise the modes of heat, chemicals or radiation are used. Moist heat is much more efficacious at coagulating bacterial protein than dry heat, which requires higher temperatures for longer periods to guarantee effect. Moist heat achieves this by increasing the permeability of the organism’s cellular structure to the heat. A hot water washer or low temperature steam applied to instruments for fifteen minutes kills bacteria, but not spores. Higher temperatures are achievable by pressurising the steriliser (Boyle’s law). The modern autoclave uses steam at 134°C and 2 bar, when 3½ minutes is sufficient to kill all organisms, providing the steam can reach the instruments; however, to dry the equipment, the steam is removed and replaced with sterile air, the total cycle time being 10 minutes. Rubber and plastic materials degenerate after some time with this regime, and a combination of 121°C for fifteen minutes, or 115°C for thirty minutes can be used instead.

Keywords:   autoclaves, chemical sterilisation, cleaning of equipment, disinfection, povidone iodine, prions, skin sterilisation, sterilisation of equipment

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