Sterilization and Disinfection: Common Mistakes to Avoid!

Mistakes can be costly – not only to your practice but also to patients. Each step in sterilization and disinfection is important and must be followed to ensure a safe practice and patient environment. This article will focus on common mistakes found and how to prevent them.

One of the most common mistakes found is removing wet packages from the sterilizer. Wet packages are not considered sterile. Wet packages have moisture in them and are subject to “wicking”. Wicking allows microorganisms to enter through the packaging and results in recontamination of the sterile instruments. Wet packs can also cause corrosion of the instruments. It is essential that wet packs are identified, repackaged, and re-sterilized.

Common causes of wet packs include improper loading, insufficient drying time, or issues with the autoclave itself. Improper loading such as overloading or incorrect placement are the most common means of wet packages, and this is an operator error. Autoclaves should never be overloaded this prevents airflow and drying. Pouches should be placed in the autoclave, following manufacturer instructions for use to allow drying. This means they must not be close together or overlapping. The items should be arranged so all surfaces will be directly exposed to the sterilizing agent. The Centers for Disease Control (CDC) recommends the following in loading a sterilizer: perforated trays should be placed so the tray is parallel to the shelf; nonperforated containers should be placed on their edge; and peel packs should be placed on edge in perforated or mesh bottom racks or baskets. Peel packs on their edge are placed paper to plastic in the rack. Follow those instructions for use of the autoclave if laying the pouches down in the tray whether it is plastic or paper side up.

Autoclave issues such as poor steam quality, draining issues or autoclave malfunction should be addressed with your service techs to correct these problems. Poor steam quality traps the steam and can contribute to wet packages. Clogged or partially clogged drains can prevent proper drainage of condensation and, lastly, the autoclave may have a broken valve which could also be the cause.

Another common mistake is not folding the pouches correctly. The plastic/peel pack must be sealed on the perforation. Sealing the pouches correctly helps to maintain sterility of the contents, thus ensuring they remain safe for use. The proper seal prevents contamination by microorganisms, air, and moisture to the contents. A properly sealed package is essential for effective sterilization; it allows the sterilizing agent to penetrate the pack and reach all surfaces of the items inside. Lastly, a properly sealed package ensures aseptic presentation allowing healthcare professionals to open and use the contents without contaminating the contents inside the pack.

All packages, bagged, or wrapped instruments should be opened at the point of use. Opening the packages directly at the chairside, when patients are seated, helps maintain sterility and prevents cross-contamination. It also gives the patients assurance that the instruments have been sterilized and are safe for use.

A few other common errors found in healthcare are touching keyboards in operatories with contaminated gloves, not having on gloves when removing contaminated laundry from laundry basket, and disinfectant wipe containers left open.

Keyboards can become contaminated with bacteria, potentially leading to the spread of pathogens. The risk to patients and workers remains a subject of ongoing research. However, studies indicate that keyboards show high contamination often with pathogens like MRSA and E. coli. Barriers can be used to prevent contamination. Barriers must be changed between patients or when touched with contaminated gloves and hands. There are infection control keyboards specifically designed for easier cleaning that are becoming popular in healthcare. CDC recommends regular cleaning of frequently touched surfaces such as keyboards. There are hospital-grade disinfectants that are safe to use on electronic devices. However, it is crucial that you follow the manufacturer’s guidelines for the disinfectant and the keyboard to ensure proper cleaning and to prevent damage to the keyboard.

Healthcare workers must wear appropriate personal protective equipment (PPE), such as gloves when removing contaminated laundry from the laundry basket. Remember, jackets are soiled with blood or other potentially infectious materials. They should be laundered according to the practice’s infection control protocols. When the healthcare worker has removed PPE, hands must be washed thoroughly according to CDC.

Lastly, a common error in healthcare is disinfectant wipe containers that are left open. This will cause the wipes to dry out, reducing their effectiveness and potentially contaminating the remaining wipes. Proper storage with the container sealed is crucial to maintain the wipes moisture and disinfectant properties. Leaving the container open, the liquid will evaporate, thus drying the wipes out. To prevent drying the wipes out and contaminating the remaining wipes, the container should be closed tightly after each use.

Your practice must have infection control protocols in place and following these, along with CDC and other agencies recommendations, will make for less mistakes and a safe, healthful environment for all.