Introduction
In the modern era, high level of importance has been given to avoid the cross infection between the patient or from doctor to the patient. In earlier days most of the equipment was used with simple sterilization techniques, now various techniques have come in practice to avoid such infections. The single use consumables have changed the scenario thus the need of the sterilization and should be used whenever it is possible.1 Although the disposable or single use materials have come in the market these have its own disadvantages like, it may not be a cost effective material which is a challenging in developing country, and it will add more wastage to the nature and thus polluting it.2 Lastly it is impossible to make certain materials as a disposable single use material especially like larger machines which are taking care of patients. Thus the authors describe most commonly used anesthesia and critical care equipment sterilization technique which is important for the nurses and doctors taking care of patients using lifesaving equipment.
Table 1
Decontamination
It is a process where the debris over the equipment is removed from running water provided the equipment is compatible for the same.
Disinfection
Various techniques have been come in practice to disinfect the equipment, may it be either chemical or by heating process. Invariably the chemical disinfection is considered to destroy both gram positive and negative bacteria and lipophilic viruses. It is important to consider sporicidal disinfectants when critical or semi-critical equipment is considered. Gluteraldehyde (2%) and chlorine containing solutions are commonly used for high level disinfection. Alcohol (60-80%), hypochloride (1%) solutions can be used to kill vegetative bacteria, fungi and some viruses. Non chemical disinfection is done by Pasteurization technique which is considered to be an intermediate level of disinfection. The materials are exposed to a temperature of 77o C over a period of 30 minutes.8
Sterilization
It is a technique where no life of an organism is seen over the equipment after particular technique. It involves destruction of all viable organisms. In the ancient days steam sterilization technique was commonly used. In the present day also various developing and underdeveloped countries are dependent on this technique. In this technique the equipment are made to expose to a heat of 121o C or 134o C depending on type of contact period i.e normal mode (15 min) or flash mode (3min) respectively. Since it is time consuming process one should not be in hurry to take out materials, else there will be mechanical hazards and incomplete sterilization is seen. Many organisms get destroyed with the exposure to a temperature more than 100o C which can be obtained with pressure effect within the chamber. If the equipment tolerates higher degree of temperature then it is ideal to increase the temperature. An adequate spacing should be ensured since penetration of the steam is very important in this procedure. It is the most effective and safe technique to ensure the safety of patient to avoid cross infection. This technique is used for the equipment which can withstand the temperature. As the technology improved plasma sterilization, ethylene oxide sterilization and gluteraldehyde sterilization came into picture.7 summarizes the type of sterilization that can be used for the anesthetic and critical care equipment.
Sterilization and Quality Control
Every hospital must have an infection control team. The leader of the team should be from the microbiology department and the team members should include one clinician, one nursing staff and one from administrative officer. The team responsibility is to identify the lacunas in day to day clinical practice and educate, sensitize the healthcare workers regularly. There should be a regular audit and discussion should be made with clinical heads. The quality control of the sterilization should be done with three ways, viz, biological, chemical and mechanical. Biological tests are more superior as they include testing the viability of non-pathogenic organism post sterilization.9 The chemical method uses, indicators where the physical state or the color change is appreciated with the sterilization.10 The mechanical mode includes use of thermometer or other gadgets to ensure particular temperature or pressure is achieved. Although it may not be cost effective, it is ideal to include all 3 to ensure adequate sterilization.11 One should always ensure with the manufacturer to understand the type of sterilization required for that particular equipment.12
Conclusion
The sterilization technique is an important topic and is neglected to teach for postgraduate students. In developing and underdeveloped countries to make cost effectiveness there will be repeated use of healthcare instrument and patients are bound to get cross infection, especially this is in concern with anesthesia and critical care services. One should get updated with sterilization technique and never ignore it. It should be the part of patient care and safety.
