This document provides a brief history of sterilization from ancient times to modern advances. It discusses key figures like Semmelweis, Lister, Pasteur and their contributions to understanding infection and developing sterilization techniques like antisepsis, asepsis and the autoclave. The document also outlines the development of various sterilization methods and technologies over time, from boiling and steam to chemicals, radiation and plasma sterilization. It notes standards and classifications established for classifying medical devices based on sterilization needs.

1. A Brief History of Sterilization
With Brian Skellie
Piercing Experience
www.piercers.com

2. About your presenter
➢Independent distributor of
SciCan STATIM & Bravo
sterilizers: piercers.com
➢APP Member & former
President: safepiercing.org
➢ASTM International Member
Committee F04 on Medical and
Surgical Materials and Devices:
astm.org

3. Ancient Times
● In ancient times,
demons and evil
spirits were thought to
be the cause of
pestilence and
infection.
● Methods involving
witchcraft and magic
were used to drive
them away.

4. Egypt (3,000 BCE)
● Antiseptics such as pitch or tar, resins and
aromatics were widely used in embalming
bodies even before they had written language.
● Observed the antiseptic value of dryness
resulting from the use of certain chemicals such
as niter and common salt.
● Became so skillful in the art of embalming that
mummies of thousands of years old are still in
good condition.

5. Mosaic Law (circa 1450 BCE)
● First to prescribe a system of purification by fire
● Developed the first system for the purification of
infected premises described in books of
Leviticus, Numbers and Deuteronomy
● The stern mandates given by the Mosaic law
formed the basis of the first sanitary code and
the various systems of purification of the
succeeding ages.

6. Greece (550 BCE)
● Greek Infantry men
known as hoplite fought
naked if they could not
afford armor
● Observed that pieces of
clothing carried into a
wound by a penetrating
sword or spear point
were more likely to
cause infection.

7. Ancient Greece
● The fumes of burning
chemicals were also
used by the ancients
for deodorizing and
disinfecting purposes.
● Of early importance
was sulfur, apparently
the first of the useful
chemicals to be
mentioned.
In the Odyssey, the
following passage may
be found:
To the nurse Eurycleia
then said he:
“Bring cleansing sulfur,
aged dame, to me
And fire, that I may
purify the hall.”

8. Hippocrates of Cos (460-377 BCE)
● First to separate
medicine from
philosophy
● Disproved the idea
that disease was
punishment for sin.
● Advocated irrigation
of wounds with wine
or boiled water,
foreshadowing
asepsis.

9. Galen (130-200 CE)
A Greek who practiced medicine in Rome
● Boiled instruments
used in caring for
wounded Roman
gladiators.
● Most distinguished
physician after
Hippocrates

10. Galen (130-200 CE)
A Greek who practiced medicine in Rome
● His writings and those of Hippocrates
were the established authority for
medicine for many centuries.

11. The Middle Ages (900 - 1500 CE)
● Progress from the
standpoint of
noteworthy
contributions having a
direct bearing on the
development of the
art of sterilization was
virtually in a standstill.
● Filth, pestilence, and
the plague ravaged all
Europe.

12. The Middle Ages (900 - 1500 CE)
● Attempts were made to combat the pestilence
in hospitals and infected houses using:
− cleansing solutions
− aeration
− the smoke of burning straw
− fumes of vinegar, sulfur, antimony, and arsenic.

13. The Renaissance

14. Denis Papin (1680)
French physicist
● Invents the “Digester”
● First pressure cooker

15. Basics of steam under pressure
● Pressure cookers work by creating a tight seal
between pot and lid.
● This seal traps the air inside the pot as it gets
heated.
● As the air gets heated, it expands but because
it is trapped, pressure increases.
● As pressure increases, so does the boiling point
of the water inside.

16. Basics of steam under pressure 2
● An increase of about 15 pounds per square inch
(psi) above standard atmospheric pressure (a
typical pressure-cooker setting) boosts the
water boiling point from its normal 212°F
(100°C) to about 250°F (121°C).
● The superheated steam trapped in the cooker
circulates around the items inside quickly
penetrating them, or in the case of food, quickly
cooking it.

17. Antonj van Leeuwenhoek (1683)
Dutch linen draper (fabric merchant)
● Develops the
microscope
● Proves the existence
of microorganisms
Volvox photographs © Wim van Egmond 2003

18. Dr. Johann Julius Walbaum (1758)
German Physician
● The earliest recorded instance of the use of
surgical glove
● Gloves used to deliver babies
− Formed from the intestines of a sheep
− (Rubber had not yet been discovered)

19. Nicolas Appert (1795)
French chef
● Invents airtight food preservation
● Canning meats and vegetables in jars sealed
with pitch then boiling them.
● He wins prize offered by Napoleon for a way to
prevent military food supplies from spoiling

20. The Modern Era

21. Ignaz Semmelweis (1847)
Hungarian obstetrician
● Advocated the value
of hand washing and
fingernail scrubbing
● Used antiseptic
chlorinated lime
solution
● Proposed avoiding
decaying organic
matter

22. Semmelweis reflex
● Empirical evidence without theoretical
acceptance
● Automatic dismissal or rejection of scientific
information "without thought, inspection or
experiment"
● Despite various publications of results where
hand-washing reduced mortality to below 1%,
antiseptic practice earned widespread
acceptance only years after his death, when
Louis Pasteur confirmed the germ theory

23. Louis Pasteur (1862)
Father of modern Microbiology
● Proposed the Germ
theory of disease
● Develops disinfection
and sterilization
processes
● Pasteurization –
process to slow food
spoilage

24. Joseph Lister (1867)
English physician
● Credited as father of
antiseptic surgery
● Reduced the mortality
rate of his patients by
using a carbolic
solution spray as he
operated

25. Antiseptic Surgery
● Used in the wound,
on the articles in
contact with the
wound and on the
hands of the
operating team.
Carbolic acid, phenol

26. Charles Chamberland (1876)
● Worked with Louis Pasteur
● Developed first autoclave sterilization process

27. John Tyndall (1876)
English Physicist
● Discovered heat resistant bacteria
● Based on this discovery, he later originated the
method of fractional sterilization by
discontinuous (intermittent) heating.
− Tyndallisation:
● Subjects are heated and cooled repeatedly to shock and
kill spores
● Later found unreliable for resistant organisms

28. Robert Koch (1881)
German Physician
● The research of Koch
and his associates on
the disinfecting
properties of steam
and hot air mark the
beginning of the
science of disinfection
and sterilization.
● They devised the first
non-pressure flowing
steam sterilizer.

29. Sterilization by boiling instituted (1881)
● Everything used during an operation, including
linens, dressings, and gowns was boiled,
although some surgeons still believed Lister’s
method to be adequate.
● Lethal to most vegetative bacteria and viruses
− Later found ineffective against prions and many
bacterial and fungal spores

30. Ernst von Bergmann (1885)
German (Latvian) physician
● First used the steam
sterilizer for the
sterilization of surgical
instruments and
dressings.
● Marked beginning of
aseptic surgery

31. Gustav Neuber (1886)
German Surgeon
● First modern aseptic
operating room
● Introduced mercury
chloride in it to clean
his apron.
● Advocated scrubbing
the furniture with
disinfectant and
sterilizing everything
in contact with the
wounds
The end of the operating theater

32. William Stuart Halsted (1889)
American Surgeon
● Introduced surgical
glove at Johns
Hopkins Hospital
● To remedy complaints
of dermatitis caused
by the strong
chemical disinfectants
used to perform hand
scrubs

33. First rigid instrument containers
● Originally made of stainless steel by Aesculap
in Germany.
● In the early 1900′s, responding to the needs of
the military hospitals and aid stations, Aesculap
manufactured chrome-plated containers for safe
transport of sterile instruments.

34. Rigid instrument containers
● Reusable textile filters were introduced in the
1930′s, replacing valves and sliding vents.
● Rubber gaskets were added shortly thereafter
to ensure a proper seal between the lid and the
bottom.
● In the 1960′s anodized aluminum replaces
stainless steel, providing optimal heat retention
and distribution.
● The lightweight construction also allows for
easy handling and stacking.

35. Adoption of Sterilization Advances
● During the period of 1885 to 1900 the Germans
made many notable contributions to the
principles governing steam sterilization and
chemical disinfection.
● Widespread application of these principles,
including their adaptation to sterilizing
equipment, did not, however, take place until
some thirty years later with the introduction of
the modern temperature-controlled sterilizer
- a product of American manufacturers.

36. Instrument Advances
● During the late 1800′s, surgical instrument
design was radically changed when antiseptic
and aseptic surgical techniques became the
norm.
● Newly instituted sterilization procedures called
for smooth instruments that could withstand
high heat and that could be disassembled
quickly to expose germ-harboring joints and
recesses.

37. Instrument Advances
● Ornate carved ivory
and wood handles
that decorated earlier
instruments were
eliminated.
● Also banished were
leather cases, lined
with silk or velvet
● Replaced by canvas
bags that could be
sterilized along
everything else.

38. Example of Sterilizers
● 1906 - Steam
sterilizers in use in a
laboratory preparing
tuberculosis serum in
Marburg, Germany.

39. Early type of hot air sterilizer
● Used in
bacteriological
laboratories at the
turn of the century.
● German designed, it
had a double wall,
and it attempted to
circulate gas-heated
hot air by gravity
convection.
Later proven ineffective for
resistant organisms.
photo Getinge-Castle

40. Early steam autoclave (1933)
● Based on the Kny-
Sprague design.
● Equipped with a dial
top operating valve
● Performance could be
controlled by
measurement by a
thermometer located
in the discharge outlet
at the bottom of the
chamber ●photo Getinge-Castle

41. A flowing steam sterilizer unit
from the 1940′s.
● Flowing steam was
still used until mid-
twentieth century.
● Replaced by
autoclave sterilization

42. Microwave radiation (1947)
● Percy Spencer, a
Raytheon engineer,
discovers that
microwave energy
could be used to cook
food, leading to
development of the
microwave oven.

43. Ozone disinfection (early 1900's)
● Use of Ozone for
potable water
treatment begins in
Europe.
● Presently, about 90%
of all European
municipal water
systems use Ozone
treatment.

44. Ethylene Oxide Gas (1940's)
● Used as a fumigant for
insects in the early
twentieth century,
ethylene oxide was
recognized as an
antibacterial agent
around 1929, when it
was used to sterilize
imported spices and furs.
● It has been employed as
a sterilizing agent in
industry and hospitals
since the 1940's.

45. Ionizing Radiation (1940's)
● Sterilization by
irradiation developed
thereafter.
● Used for commercial
sterilization of surgical
supplies.
● Cobalt-60 gamma
irradiation source
Blue light is radiation source.

46. Glutaraldehyde Chemical Sterilant (1963)
● First chemical solution approved by the
Environmental Protection Agency (EPA) as a
sterilant for heat-sensitive instruments.

47. Ozone Sterilizer (1989)
● An ozone sterilizer for
health care
applications,
developed by Life
Support,Inc., of Erie,
Pennsylvania, was
cleared for marketing
by the FDA.

48. Peracetic Acid Sterilizer (1989)
● Steris System 1, a
low temperature
system for
endoscopic devices
enters the U.S.
marketplace.

49. Statim High Speed Steam Sterilizer (1989)
● The STATIM 2000
high speed steam
autoclave was also
introduced into the
U.S. by SciCan, Inc.,
Toronto, Ontario
● Larger capacity units
followed
● S Models EN13060
compliant

50. Plasma Sterilizer (1993)
● In 1993, the FDA
approves the Sterrad
Sterilizer, a plasma
sterilizing system, for
use in the U.S.
● Hydrogen Peroxide
gas converted to
plasma in a vacuum
by microwave
● No toxic byproducts

51. Principles set the standards (1956)
● Principles and Methods of Sterilization in Health
Care Sciences by J.J. Perkins was published.
● This textbook established the standards and
methodology for processing and sterilization of
reusable medical devices.

52. Earle H Spaulding (1968)
American Physician
Proposed that how an object will be disinfected or sterilized
depended on the object’s intended use.
Spaulding's classification system:
● CRITICAL - objects which enter normally sterile tissue or
the vascular system or through which blood flows should
be sterile.
● SEMICRITICAL - objects that touch mucous
membranes or skin that is not intact require a
disinfection process (high-level disinfection [HLD])
that kills all microorganisms but high numbers of
bacterial spores.
● NONCRITICAL -objects that touch only intact skin
require low-level disinfection.

55. William Rutala (1994)
American Physician working with the CDC
Characteristics of an Ideal Sterilization Method
● Highly efficacious
● Rapidly active
● Strong penetrability
● Materials compatibility
● Non-toxic
● Organic material resistance
● Adaptability
● Monitoring capability
● Cost-effective
Schneider PM. Low-temperature sterilization alternatives in the 1990s. Tappi Journal. 1994;77:115-119

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