These pouches are placed the wrong way inside the autoclave. Despite their high cost, autoclaves don’t get a lot of love and attention. Yet, they are cursed at as soon as they don’t do their job. Before things go wrong, a little bit of common sense and TLC can save you a lot of trouble… and money. We talked to several autoclave technicians and repairmen.* This article outlines their best recommendations to ensure a smooth and steady relationship with your autoclave. Let’s start with what you put in it. The biggest offense in the autoclave world is using tap water. Do you really know what your sterilization teammates are pouring into your autoclave? Accumulation of minerals from tap water can clog the drain valve, filters, and pipes. Distilled water helps extend the life of your machine by preventing mineral buildup. Depending on how busy your practice is and how heavily you use your autoclave, you may need huge quantities of water bottles. If it becomes too much of a hassle, or too costly, you could purchase a distiller for a few hundred dollars. Make sure the distiller’s quality is high enough that it truly provides distilled water. Ensure there always is enough water in the reservoir. Some autoclaves conveniently indicate the minimum and maximum water level required. Don’t overfill the reservoir beyond 75 percent of its holding capacity. Using too little or too much water can seriously damage your machine. The autoclave should be filled only when in the off position. This single pouch is placed the correct way on an autoclave tray. Regular maintenance is critical for keeping your autoclave working smoothly and properly. Each manufacturer has slightly different recommendations. As such, store the guidelines specific to the model you use in a location that is easily accessible to all team members. This helps ensure the machine’s appropriate use, maintenance, and cleaning. Daily maintenance Before each use, when the autoclave is cold, inspect the door gasket for damage and cleanliness. Look for signs of debris and corrosion, and wipe the gasket with a damp cloth. Make sure the water level is appropriate for the next cycle—not too low and not too high. After each cycle, carefully inspect the autoclave tape for a change in color. When a chemical (a simple paper strip that changes colors) or biological (a live bacterial culture that should be killed during a sterilization cycle) indicator is added to the autoclave, double check that it has “turned.” Keep an eye on the highest temperature and the pressure level, as well as the duration of the sterilization cycle and the drying cycle. Look for any water or a steam leak during or after each cycle. A leak is an outright sign of a malfunction that should be addressed right away. Listen for abnormal sounds. Weekly maintenance Ensuring your autoclave is in proper working order on a weekly basis is more involved than its daily upkeep. Only clean the chamber with a product specifically recommended by the manufacturer and follow all its guidelines exactly. This typically requires placing a cleaning product at the bottom of a cold chamber, and running several cycles on an empty autoclave. The specific sequence is recommended by the manufacturer. Drain the water, wipe the inside with a nonabrasive cloth, and refill the reservoir. Always wear protective gear to avoid burns by the hot metal or exposure to chemicals. Trays are often neglected. Be sure to wipe them weekly. A biological indicator can be used to confirm the efficacy of your autoclave. This may be a legal requirement in your state, so it is wise to check the guidelines to verify how often this test should be performed. This maintenance routine should be performed once weekly or every 20 to 30 cycles, depending on how busy your practice is. Do you know how to load? Having an autoclave in good working condition is just the beginning. You also need to ensure your teammates know how to load instruments and packs correctly for optimal results. An autoclave should never be overloaded. It is better to run two cycles with smaller loads, than a single cycle with an autoclave filled to the brim. Sadly, overloading happens much more frequently than practitioners realize. Pouches should not be stacked horizontally. Instead, they should be placed flat and sterilized one at a time. This is called “single height loading.” If you place a pouch flat, the paper side should face up, and the plastic side should face down. This allows moisture to escape through the paper side (hot air goes up). Pouches placed vertically (i.e. side by side on a rack) should have enough air between them to allow for ventilation. You can purchase commercial racks made for this purpose. Pouches should not touch the inner sides of the autoclave, as the inside gets hot and can burn them. Ensure instruments are clean and dry before wrapping them. At the end of a cycle, the door should be open as soon as possible to allow the equipment to dry and to prevent items from burning due to excessive heat exposure. Instrument packs should not touch each other in the autoclave so that steam can circulate between them. Remember that sterilization tape only means the surface of a pack was sterilized. It does not ensure the deepest part of the pack is sterile. This is the reason why a sterilization strip must be placed deep inside a pack (not in the top layer, as is often done). Following these simple guidelines will help ensure true sterilization has been accomplished. Annual maintenance This photo illustrates the correct way to place pouches in an autoclave rack. It is recommended to have your autoclave serviced at least once a year by a certified technician. This could be done more often in case of heavy use. At a minimum, the door gasket, bellows, filters, and valves should be replaced yearly. The maintenance technician should also ensure the proper temperature and pressure are generated. Further, they should always confirm that cycles are running appropriately to ensure true sterilization of surgical instruments. “If you and your team follow appropriate protocols and treat your autoclave with respect, the rest is up to the electronics of the machine,” said one autoclave technician we spoke with. Your autoclave is the unsung hero of the surgery department. It keeps your instruments sterile and your patients safe. Treat it with the respect it deserves, and it will return the favor for many years to come. * Many thanks to Korby at Didage Sales Co. in Warsaw, Ind.; Steve Vogel at Muhlenberg Medical Repair in Mohnton, Pa; and Eric Tymchyshyn, at E.T. Biomedical Services in Orwigsburg, Pa. Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified, is a board-certified veterinary surgeon and author. His traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. You can visit his websites at www.DrPhilZeltzman.com and www.VeterinariansInParadise.com. Kelly Serfas, a certified veterinary technician (CVT) in Bethlehem, Pa, contributed to this article.
