Dear Collegue

I am a GP in a practice that works from 6 different sites. As a consequence to have a bench top autoclave at each site is impractical both because of logistical difficulties and the enormous expense this would entail. It is also simply not practical to take instruments out to each site. We require sterile instruments for the following purposes

cervical speculae
simple skin surgery (superficial lumps and bumps only) ie scalpel blade
handles, forceps etc

We have modern hot air sterilisers at each site which are always run at the higher temperatures for at least one hour.

Please could you advise on the following and/or point me in the direction of persons who could give the necessary answers

1. Is this form of sterilisation adequate for the purposes described? (assuming instruments have been properly cleaned and prepared beforehand)
2. Is there any way the instruments can be pre-packaged so that they can be placed in the steriliser, sterilised and then removed from the steriliser in these packets. Thus we could have a supply of prepackaged sterile instruments available at all times. (like the paper and plastic envelopes that can be used in an autoclave. Clearly because of the higher temperatures these paper envelopes are not suitable in hot air ovens)

I am most grateful for any response to these queries. Please could you send any reply yo my e mail address [email protected]
Thank you
Yours Sincerely


Dr. Roger Leary MBBS MRCGP. DRCOG
UK General Practitioner

Roger,

there are a number of responses to your question. The use of dry-heat sterilization was phased out some time ago. Steam remains the preferred medium for sterilizing instruments because of both its efficacy and its speed. The new requirements for dry-heat sterilization has raised the exposure time at 160 C to 2 hours. The dry-heat cycle must therefore take account of heating the worst part of the worst load to this temperature, holding for 2 hours and then allowing the slowest item to cool to an acceptable temperature. Cycle times in excess of 4 hours are not unknown.

Unquestionably, the preferred solution would be to re-process all devices locally in a transportable sterilizer having cleaned the instruments beforehand (with validation) and then steam sterilize in a cycle of approximately 20 minutes. The traditional transportable sterilizer is designed for unwrapped instruments for immediate use. The re-processing of wrapped or hollow instruments required some time after re-processing will require the use of a sterilizer with an active air-removal stage dedicated to this type of load or load usage.

If these facilities are not available within the site (as appears from your question) then you have two options. Firstly you can purchase them or secondly you can obtain the provision of sterile goods from a hospital sterile services department with sterilizers designed to process your load types with the ability to be stored etc.

If the latter option is taken you will need to discuss the accreditation of the department with respect to their ability to supply you as an external customer.

Either option is going to be costly but, as a patient's advocate I would argue that the provision of validated safe medical devices will always cost less than the possible consequences of any alternative.

Please forgive the length of reply but the question does raise many implications of local/distant sterilization

Please let me know if I have misunderstood either your question or your situation.

peter hooper
Authorised Person (Sterilizers)
banbury - uk

Good day Roger,

After reviewing Peter Hooper's response, if you are still of a mind to use the dry heat sterilizers, then the answer to your question #2:
Aluminum foil is a packaging medium that will withstand the high heat of sterilization without burning and will maintain the sterility of the items processed.

Regards, Pete