Sterilizing Equipment

There are multiple different options for sterilizing equipment. The most common methods of sterilization used for surgical tools are steam sterilization, dry heat sterilization, or chemical sterilization.

Steam Sterilization:

This method utilizes an autoclave to sterilize your tools. You will need an autoclave, distilled water, and autoclave pouches. The steps:

1. Wash/scrub your instruments with soap and water to remove large debris/blood (a toothbrush makes a good scrubbing device to clean the teeth of forceps and other instruments)
2. Soak in a chemical disinfectant (such as Citrus II, Cavicide, Grafco Tincture of Green Soap, etc) according to instructions (most require a 10 minute soak to disinfect)
3. Rinse and dry
4. Place inside autoclave sterilization pouch and seal (important to seal properly so there are no openings – DO NOT fold the pouch over to make it artificially smaller) and place the pouch inside the autoclave. It is important not to overlap the pouches. If you have a lot of tools to autoclave at once you can purchase a rack to hold your pouches vertically to allow you to fit more into your autoclave (for example: https://www.keysurgical.com/products/sterile-processing/packaging-and-preparation/peel-pouch-sterilization-racks)
5. Sterilize in autoclave per autoclave instructions (typically 15 PSI at 250° F for 30-60 minutes)
6. Let cool (most autoclaves will have a “heated dry” feature – but if not, allow to air dry within the closed autoclave (you may need to “crack” the seal on the door to help release the pressure so your tools will dry, but do not completely open until dry to minimize exposure to air).

NOTE: This can be done with a pressure cooker as long as it can reach 15 PSI and 250° F - to do this put about 1-2 inches of sterile water in the bottom of the pressure cooker, place a metal tray in the bottom to keep your instruments out of the water, place your bagged instruments on the tray and “cook” at 15 PSI and 250° F for 30 minutes, then turn off the heat and let it cool on its own. DO NOT remove the lid until the pressure and temperature have returned to near normal to prevent injury to yourself and your tools.

Dry Heat Sterilization:

This method can be used if you do not have access to an autoclave, but it can take longer, requires higher temperatures than steam sterilization, and you need specific dry heat bags instead of typical autoclave bags. The steps:

1. Wash/scrub your instruments with soap and water to remove large debris/blood (a toothbrush makes a good scrubbing device to clean the teeth of forceps and other instruments)
2. Soak in a chemical disinfectant (such as Citrus II, Cavicide, Grafco Tincture of Green Soap, etc) according to instructions (most require a 10 minute soak to disinfect)
3. Rinse and dry (it is more important to dry here than with steam sterilization – any residual water will prevent proper sterilization)
4. Place inside a DRY HEAT sterilization pouch (these are NOT the same as autoclave pouches) and seal (important to seal properly so there are no openings – DO NOT fold the pouch over to make it artificially smaller) and place the pouch inside an oven
5. Bake the instruments at 170° C (340° F) for an hour (note – they must be exposed to this temperature for at least 1 hour – do NOT start the timer until temp has been reached)
6. Turn off the oven and let cool

Chemical Sterilization:

Although chemical sterilization is an option, it is typically reserved for items that cannot be exposed to high temperatures such as rubber, plastics, and glass. Hydrogen peroxide or bleach are the two most commonly used methods, but you can also use Phthalaldehyde, Paracetic Acid, Glutaraldehyde and Formaldehyde, or ozone. If you are going to use any of those chemicals, ensure you have appropriate safety practices in place. As bleach and hydrogen peroxide are readily available and relatively safe, they are the most commonly utilized processes in small offices. For bleach or hydrogen peroxide sterilization, the steps are:

1. Wash/scrub your instruments with soap and water to remove large debris/blood (a toothbrush makes a good scrubbing device to clean the teeth of forceps and other instruments)
2. Soak in a chemical disinfectant (such as Citrus II, Cavicide, Grafco Tincture of Green Soap, etc) according to instructions (most require a 10 minute soak to disinfect)
3. Rinse
4. Place in a tray and cover with sterilization solution (bleach or hydrogen peroxide) for 20 minutes (typically a 10 minute soak will disinfect but a 20 minute soak is needed for sterilization) – ensure that tools are not touching as the solution must touch all surfaces. NOTE – bleach is highly corrosive to steal so it is not recommended for steel/stainless steal instruments
5. Wearing sterile gloves, remove the instruments, rinse, and dry. Place inside an autoclave pouch (or similar closed container) to preserve sterilization