Have you spent millions of dollars on your surgical instruments? Are you true to the cause of providing quality care to your patients? If yes, you must be concerned about keeping your instruments in top-notch condition while ensuring longevity and precision. Buying high-end surgical tools is one thing, but handling them properly is another. If you are not doing it right, even the most expensive instruments will not offer accuracy in your dental practice. Every clinic has its own way of sterilizing the instruments to remove contamination. But are you doing it right?

Proper autoclave settings for surgical instruments play a key role in sterilization. This article will provide insights and tips for adopting correct autoclave settings in your practice. Let’s dive in!

Science Behind Autoclave Sterilization

Autoclave sterilization is performed to eliminate bacteria, viruses, and other germs that reside on used surgical instruments. There are different ways to remove such contaminants, such as disinfection. Disinfection, without a doubt, removes dust and germs, but bacterial spores may still survive. The World Health Organization suggests autoclaving surgical instruments to maintain cleanliness. Here are a few recommendations for instrument processing:

• Each technician should process 1,500–2,000 sets of instruments per year (WHO).
• The sterile processing unit must minimize contamination risks.
• Instruments should move from more contaminated areas to less contaminated areas before storage.
• Surfaces should be smooth and made of nonporous material, like stainless steel, for easy cleaning.
• Flooring should have gentle slopes to prevent debris accumulation.
• Adequate ventilation is essential for effective sterilization.

Key Factors in Autoclave Settings for Surgical Instruments

Autoclaving relies heavily on direct steam contact with instruments at the correct temperature and pressure for a specific duration. From needles to probes, surgeons handle these instruments daily. However, it has been observed that technicians are still often unaware of the essential factors required for successful autoclaving. Here are the key factors to consider for achieving optimal autoclave settings for surgical instruments:

Ideal Steam Quality

The best steam for sterilization is dry saturated steam with a dryness fraction of ≥97%, as excess moisture can reduce sterilization efficacy.

Pressure

Pressure helps achieve the high temperatures needed to eliminate microorganisms quickly and effectively.

Temperature

The two most common sterilization temperatures are:

• 121°C (250°F) for standard sterilization cycles.
• 132°C (270°F) for faster sterilization in certain conditions.

Exposure Time

• 30 minutes at 121°C (250°F) in a gravity displacement sterilizer.
• 4 minutes at 132°C (270°F) in a prevacuum sterilizer.

Consistency of Temperature and Time

High temperatures must be maintained consistently throughout the cycle to ensure complete sterilization.

Variability in Sterilization Requirements

The required time can vary based on:

• The type of material (e.g., metal vs. plastic or rubber).
• Whether the item is wrapped or unwrapped.
• The type of sterilizer being used (e.g., gravity displacement vs. pre-vacuum sterilizer).

Common Autoclave Mistakes to Avoid

Professionals sometimes unknowingly shorten the lifespan of instruments by making common mistakes during autoclaving. Here are the don’ts to help avoid those mistakes:

• Overloading the Autoclave: Overloading will hinder the steam from reaching all surfaces of the instruments, increasing the risk of contamination and damage to surgical tools. Maintain proper spacing while autoclaving.
• Placing Unnecessary Instruments: Avoid placing instruments that are not designed for the autoclave process. Improper wraps, pouches, or even gauze can be hazardous for the instruments.
• Autoclaving Unsuitable Materials: Do not autoclave materials that cannot withstand higher temperatures and pressures. Paper cloths, rubber gloves, or towels should not be placed in autoclave as they can lead to contamination of other objects.
• Items Touching the Sides: Items placed in the chamber must not touch the walls or sides, as this can interfere with the overall steam circulation.

Best Practices for Autoclaving Surgical Instruments

The right autoclave settings for surgical instruments can enhance their longevity. Here are the actionable guidelines for professionals to follow:

Follow Manufacturer’s Guidelines

Forget about what you did with the last autoclave. Look at the manufacturer’s guidelines for safety. You should understand the guidelines for instruments as well, as it is necessary to load and sterilize instruments properly.

Pre-cleaning is Compulsory

Cleaning and disinfecting the instruments is necessary before sterilization. Trained professionals must follow guidelines from the Centers for Disease Control and Prevention (CDC) to ensure producibility.

Consider Spacing

Proper spacing is needed to avoid over-tightening the environment. Arrange items in the right manner to make enough space for steam circulation. Place heavy items at the bottom and lighter items at the top, and choose racks to maximize the space available.

Choose the Right Conditions

• Stainless Steel Instruments: Sterilize at 121°C to 134°C with a pressure of 15-30 psi for 20-30 minutes, depending on the cycle.
• Plastic Instruments or Rubber Components: Use lower temperatures (below 121°C) and consult the tool's manual to avoid warping.

Use Chemical/Biological Indicators

To identify the immediate quality of sterilization, use chemical or biological indicators.

Use Protective Cases for Delicate Instruments

For sharp or fragile instruments like scalpels, use protective cases or wrap them in sterilization pouches to prevent blades from becoming dull. Instruments with hinges should be opened or disassembled before autoclaving to allow steam penetration.

Instrument Maintenance Post-Autoclave

Now that you are familiar with the dos and don’ts of the autoclave process, it is important to understand how post-autoclave maintenance can increase the longevity of your instruments.

Allow Instruments to Cool Gradually

Avoid immersing freshly sterilized instruments in cold water to speed up cooling. Rapid temperature changes can cause materials to warp or crack. Instead, let tools cool in a clean, dry environment.

Wipe Off Spots

The spots left on the instruments after autoclave are usually harmless; simply wipe them off with a soft cloth. However, beware of discoloration and stains as these may indicate initial corrosion or rusting. In such cases, consider whether you should dispose of the instrument or order a new one.

Inspect and Lubricate Hinged Instruments

Instruments with hinges, such as forceps or scissors, require regular inspection for proper function. Use instrument-grade lubricant to keep hinges moving smoothly, especially after multiple sterilization cycles. Avoid using oil-based lubricants, which can interfere with sterilization.

Store Instruments Properly

Surgical instruments should be stored in a dry, sterile environment to prevent contamination. Use dedicated trays or cabinets with dividers to avoid contact between instruments, minimizing the risk of scratching or dulling.

Conclusion

Using the proper autoclave settings for surgical instruments, along with the best techniques, enhances their longevity. Implementing these practices will greatly support the reputation of your clinic while protecting your investment. To achieve optimal autoclaving, follow Artman Instruments' guidelines for instrument care.