Sterilisation

EMTs have systems in place to ensure sterility of equipment, consumables and devices as appropriate.

The processes of sterilization and decontamination are complex, requiring specific infrastructure, equipment and process. Sterilization and decontamination of instruments and medical devices play a very important role in the prevention of health-care associated infections.53 Any EMT that plans to reuse instruments and medical devices must have the ability to decontaminate them safely, applying steps indicated in the standard life-cycle of decontamination.

1. Establish safe procedures for staff working in the sterilization area in terms of appropriate PPE, usage of the autoclave and handling surgical trays/sharps.
2. Training and routine practices should be part of staff education to prevent exposure to blood and body fluids.
3. Establish a system for traceability and quality control, documentation and record keeping of all steps of the decontamination cycle including contingency for system and equipment failure.
4. Sterilization area should be divided in areas (to wash, check and maintain, prepare, pack and sterilize instruments and equipment) with a clear unidirectional workflow from dirty to clean.
5. Establish a grey water management system with treatment before disposal.

Type 1

• • Basic steam autoclave or disposable material

Type 2 and 3

• • Complete surgical autoclave with traceability
  • Mechanical control of temperature and humidity in the sterilization area
  • Redundancy of power supply

1. Establish mechanic control of temperature and humidity in the sterilization area and avoid turbulent airflow.
2. Consider the principle of central sterilization with a specified area near the OT if available.
3. Sterilization algorithm showing the steps should be visible and displayed in the sterilization area.

• Consider the option of single-use sterile instruments, although careful consideration should be given in terms of logistics requirements, staffing, training and costs.
• Disassemble devices, so that all surfaces can be cleaned and disinfected, irrespective of the cleaning method chosen. Facilities with minimal resources can adequately clean and prepare devices for sterilization with effective manual cleaning processes.