OT and Autoclave
Medico Legal CME BOA June 7, 2015
Informed consent very important
Operate in exclusive ophthalmic OTs
OT swabs obsolete. Need to do air sampling every month. Keep records.
Autoclaving most important. Use B class autoclaves. Use ultrasonic cleaners for instruments. Vertical steam sterilizers are class S type. Not recommended.
99% bio burden removed by cleaning. Removal of biofilms. Ultrasonic cleaners.
Formaldehyde chambers not recommended
Proper OT cleaning more important than fumigation
Beware of infection from ACs. ACs cannot maintain air quality in OT. Temperature 20 to 22 degrees to inhibit bacterial growth.
Humidity control with dehumidifiers
Autoclaved instruments in peel pouches can be kept for 6 months in OT
ETOed items to be kept in store for at least 1 week to remove the residual ETO. Otherwise TASS can happen.
Keep records of OT cleaning, fumigation and autoclave
Clean face and feet with soap and water in camp surgeries
Professional indemnity necessary but time spent in court cases can never be recovered. Best to take preventive steps
Clinical and Establishment Act will become a reality. No need for the Shops and Establishment license for medical establishment
Consulting fee rate to be displayed in the OPD
No specification for OPD and OT of particular size
EMR will become a reality in future as is prevalent and compulsory in western countries
What is a Type-B (class B) autoclave?
Class B autoclave is used for sterilizing all objects (solid instruments, porous objects, and A and B hollow objects, both packaged and unpackaged); Class N autoclave used for sterilizing only unpacked solid instruments; Class S autoclave used for sterilizing unpackaged solid instruments plus any other of the types indicated for cycle B (to be specified by the maker)
Question
Dear All,
I would like to know how safe & effective is our conventional gravity autoclaves, which most of us have been using since ages, particularly in sterilising our reusable phacotubings,vit.sets,simcoe & other cannula etc.,since class-B vacuum autoclaves are said to be the ones to be used for such items(which very few are using to my knowledge).This aspect of sterilisation was not touched upon in the AIOS guidelines published in this forum.Are we not living with the false security by terms like longer holding time ,double autoclaving etc ?.May I request for your valuable response in terms of your experience and rationale. Thanks in advance,
Answer 1
Respected sir,
you are right about the need of class B autoclave. however the cost is Rs. 2.5 lacs onwards of imported machines and they do not have service backup. also the chamber is too small to incorporate all the instruments. so the need for gas autoclave for linen is a must and most of the solid instruments. thus the porous instruments can only be autoclaved now considerig the cost of the class B autoclave and the running cost and the indicater used it will be cost effective to limit the use of autoclavable tubings to few uses( it also helps to prevent surge seen in compliant old tubings!!!). keep three or more tubings. get them ETO sterilesed every 7 days(it is cheap).then autoclave them to removed the residual ETO( never use them directly to preventTASS) also allow the BSS to flow alittle more and the do tuning twice to remove any residual ETO. there is a promising indian class B autoclave of about 1.5 lacs and i am satisfied with its demo.
Answer 2
Remember autoclave is the best way to sterlise our equipment. Can you tell me how many times in last 2 years you have checked pressure guaze of your autoclave? We autoclave by keeping phaco tubing & hand pieces open in aluminum boxes but more important is cleaning of the same just after surgeries. If you clean after some time after surgeries then fluid inside which is contaminated with protein of lens material is good medium for organisms. So immediate cleaning is important. We use exclusively gas autoclave & our first cycle gets over in 35 minutes maximum & 2nd cycle takes only 23-25 minutes. As it is gas autoclave you need small amount of water for cycle which gets hot quickly . We regularly check pressure guage, leakage etc.
Type N vs. Type B Autoclave
- Each autoclave can be classified as a type N unit or a type B unit. Type N units do not use a vacuum to remove air from the sterilization chamber, whereas type B units do use a vacuum pump. The difference in operation means type N autoclaves are suitable for a specific type of loadfor solid, unwrapped instruments. Type B autoclaves can be used on wrapped and hollow instruments, which means a piece of equipment can be sterilized now for use later.
Class B autoclave from Tuttnauer. 23 litres. Only for insturments and the drape towel. Rest all disposable including gowns. Ultrasonic instrument cleaner once a month.
SA-260MA 24 L B-class. From Biovision. 2 lakhs in 2012. 6 sets of instruments plus linen.