Adaptation of the WHO's "Infection control standard precautions in healthcare" to GMLF Hospital, Chilakalapalli Village, India which is located in a remote area with little available resources. This work was part of the Master's Internship in Global Health and Cooperation, Autonomous University of Barcelona.

1. STERILISATION WITH STEAM
AUTOCLAVE
AT GMLF HOSPITAL,
CHILAKALAPALLI, INDIA
Maria Noemi Croci
BSc (Hons) Nursing – Adult
Internship in M.S. Global
Health and Cooperation

2. WHAT IS
STERILISATION?

3. STERILISATION IS THE PROCESS THAT
ALLOWS TO OBTAIN THE COMPLETE ABSENCE
OF GERMS AND SPORES ON AN INANIMATE
OBJECT
STERILISATION CAN BE ACHIEVED IN
DIFFERENT WAYS, THE EASIEST IS WITH
STEAM AUTOCLAVE

4. EVERY OBJECT HAS ON ITSELF A CERTAIN
NUMBER OF MICROORGANISMS...
WHICH ONE OF THIS TWO SCISSORS WILL
HAVE MORE MICROORGANISMS ON IT?

5. FOR THIS REASON, IT IS IMPORTANT TO
PROCESS THE SPOILED/USED INSTRUMENTS
BEFORE WE PUT THEM IN THE AUTOCLAVE
WHAT IS THE
STERILISATION
PROCESS?!?!

6. THE WHOLE STERILISATION PROCESS
CONSISTS OF:
1. COLLECTION 2. DECONTAMINATION
3. WASHING4. DRYING
5. AUTOCLAVING 6. STORAGE

7. INSTRUMENTS PROCESS BEFORE
AUTOCLAVING = COLLECTION +
DECONTAMINATION + WASHING + DRYING

8. WHY ARE WE USING 2 DIFFERENT BASINS?
ONE FOR COLLECTION
AND
DECONTAMINATIONONE FOR WASHING

9. 1. COLLECTION
COLLECTION IS DONE WHERE
INSTRUMENTS ARE USED
(DRESSING ROOM).
THEN INSTRUMENTS WILL BE
CARRIED AND PROCESSED IN THE
WASHING ROOM (ALSO KNOWN AS
DIRTY ROOM).

10. 2. DECONTAMINATION
RINSE THE INSTRUMENTS CAREFULLY WITH WATER
IN THE BASIN TO REMOVE TRACES OF BLOOD, SKIN,
PUS (IN THE WASHING ROOM NOT IN THE
DRESSING ROOM)

11. 2. DECONTAMINATION
CAREFULLY REMOVE WATER
FROM THE BASIN IN THE
WASHING ROOM (NOT IN THE
DRESSING ROOM)

12. 2. DECONTAMINATION
FOR EVERY LITRE OF
WATER ADD 2 TEASPOONS
OF 30% BLEACH POWDER

13. IT WOULD BE NICE TO HAVE
THIS TAP REPAIRED: IT
WOULD MAKE THINGS MUCH
EASIER FOR PEOPLE WHO
WORK WITH IT!

14. IN THIS PHASE THE MAJORITY OF
DANGEROUS GERMS WILL BE
KILLED OR INACTIVATED SO IT
WILL BE SAFER FOR YOU TO
HANDLE THEM LATER (IN THE
WASHING PHASE).
BLEACH DAMAGES INSTRUMENTS
(RUST). TAKE CARE OF THEM
BECAUSE THEY ARE EXPENSIVE!
2. DECONTAMINATION
KEEP THE INSTRUMENTS IN THE WATER AND BLEACH
SOLUTION FOR NOT MORE THAN 10 MINUTES.

15. 2. DECONTAMINATION
AFTER 10 MINUTES REMOVE
THE WATER AND BLEACH
SOLUTION AND RINSE WITH
WATER

16. 3. WASHING
CHANGE BASIN!
ADD WATER AND
LIQUID SOAP TO THE
BASIN

17. BECAUSE:
A) IT IS IMPORTANT TO DIFFERENTIATE
THE TWO DIFFERENT PHASES OF
DECONTAMINATION AND WASHING.
B) WE ALSO WANT TO BE SURE THAT
WE DO NOT COME IN CONTACT WITH
GERMS THAT MIGHT HAVE RESISTED
DURING DECONTAMINATION
3. WASHING WHY DO I HAVE
TO CHANGE
BASIN?

18. 3. WASHING
WASH INSTRUMENTS
WITH WATER, SOAP AND
A BRUSH (A
TOOTHBRUSH IS
PERFECT FOR THIS)

19. 3. WASHING
RINSE CLEAN INSTRUMENTS
WITH WATER

20. 3. WASHING
NEED FOR
LONG AND
RESISTANT
PLASTIC
GLOVES
=
SAFETY
FOR THE
PERSON
WHO IS
CLEANING!
SAFETY FIRST

21. 3. WASHING
POTENCIAL SPILLAGE OF
HIGHLY CORROSIVE BLEACH
SOLUTION OR INFECTIOUS
MATERIAL
=
NEED FOR PROTECTIVE
GOGGLES AND MASK TO
PROTECT THE EYES AND
MUCOSAE OF WORKERS

22. ALLOW THE
INSTRUMENTS TO DRY
ON AIR.
LEAVE SCISSORS AND
FORCEPS OPEN.
ONCE A MONTH PUT A
DROP OF COCONUT
OIL ON JOINTS AND
REMOVE THE EXCESS
WITH A CLEAN TOWEL
TO KEEP THE JOINTS
OILED.
4. DRYING

23. 5. AUTOCLAVING
MANOMETER
STEAM VALVE
STEAM
RELEASER
VACUUM
RELEASER
EMERGENCY
VALVE

24. 5. AUTOCLAVING
PUT THE DRY
INSTRUMENTS IN THE
AUTOCLAVE BIN AND
OPEN THE BIN’S HOLES
TO ALLOW THE STEAM
TO ENTER IN THE BIN

25. YOU WILL HAVE READY TO USE STERILE PADS
AND COTTON DURING THE DRESSING ROUND
=
BETTER QUALITY OF CARE AND REDUCED
TIME SPENT TO PREPARE MATERIALS DURING
DRESSING ROUND
5. AUTOCLAVING
ALWAYS PREPARE A STOCK OF COTTON AND
PADS TO PUT IN THE AUTOCLAVE
IF YOU HAVE IT READY YOU CAN PUT IT AS WELL
IN THE AUTOCLAVE WITH THE INSTRUMENTS

26. FILL UP THE AUTOCLAVE WITH WATER
WATER SHOULD TOTALLY SUBMERGE THE HEATING
SYSTEM BUT BE CAREFUL NOT TO OVERFILL THE
AUTOCLAVE WITH WATER
5. AUTOCLAVING

27. DO NOT OVERFILL THE AUTOCLAVE: WATER
SHOULD NEVER GET IN CONTACT WITH THE
BIN
5. AUTOCLAVING

28. 5. AUTOCLAVING
DISTILLED WATER OR DEMINERALISED WATER
SHOULD BE USED
RAIN WATER IS A VALID ALTERNATIVE AS IT IS FREE
AND NATURALLY WITHOUT MINERALS (FIND A WAY
TO COLLECT AND STORE IT!)

29. 5. AUTOCLAVING
● FILL UP THE AUTOCLAVE WITH WATER
● INSERT THE AUTOCLAVE BIN IN THE CHAMBER - ALWAYS
ENSURE THAT THE BIN’S HOLE ARE OPEN: THIS WILL ALLOW
THE STEAM PRODUCED INSIDE THE AUTOCLAVE TO
PENETRATE INSIDE THE BIN AND STERILISE THE MATERIAL

30. 5. AUTOCLAVING
CLOSE THE AUTOCLAVE LID PROPERLY AND CHECK
THAT THE STEAM RELEASE AND VACUUM RELEASE ARE
CLOSED TOO.
● PLUG IN THE AUTOCLAVE (ELECTRIC AUTOCLAVE)
OR
● PUT IT ON THE STOVE AND LIGHT THE FIRE (STOVE
AUTOCLAVE)

31. 5. AUTOCLAVING
WHEN THE AUTOCLAVE IS PLUGGED IN OR ON
THE STOVE HEAT AND PRESSURE WILL BE
PRODUCED INSIDE THE CHAMBER.

32. 5. AUTOCLAVING
IS FROM THIS MOMENT THAT YOU HAVE
TO START TO PAY ATTENTION TO THE
MANOMETER.
PRESSURE WILL BE AT ZERO “0”

33. 5. AUTOCLAVING
AFTER A CERTAIN AMOUNT OF TIME, THE PRESSURE WILL
START TO GO UP.
REMEMBER:
5 - 10 PSI OF
PRESSURE IS
NOT ENOUGH

34. THE PRINCIPLE OF STERILISATION IN AUTOCLAVE IS BASED ON THE DIRECT
RELATIONSHIP BETWEEN PRESSURE AND HEAT.
THE MORE PRESSURE YOU HAVE THE HIGHER TEMPERATURE YOU GET.
WATER BOILS AT 212°F = 100°C AT NORMAL PRESSURE (ZERO “0”PSI)
TEMPERATURE NEEDED FOR STERILISATION IS 250°F=121°C.
AT NORMAL PRESSURE YOU COULD NEVER ACHIEVE IT.
TO REACH A HIGHER TEMPERATURE THAN 212°F YOU NEED TO INCREASE
THE PRESSURE.
THE AUTOCLAVE IS A MACHINE THAT ALLOWS HIGHER PRESSURE TO BE
REACHED = 15 PSI AND THEREFORE A HIGHER TEMPERATURE = 250°F
5. AUTOCLAVING

35. 5. AUTOCLAVING
15 PSI = 250 °F (121°C)
WHEN THE AUTOCLAVE REACHES 15 PSI PRESSURE LEAVE IT
WORK FOR 20 MINUTES (PLUGGED IN OR ON THE FIRE)
15 PSI
STEAM WILL ALSO EXIT FROM THE
STEAM VALVE

36. 5. AUTOCLAVING
WHAT IF I DON’T
KNOW EXACTLY
WHEN THE
AUTOCLAVE
REACHED 15 PSI?
DON’T PANIC: START
COUNTING FROM THE
MOMENT YOU
REALISED THE
AUTOCLAVE REACHED
15 PSI

37. 5. AUTOCLAVING
AFTER 20 MINUTES YOU CAN UNPLUG THE
AUTOCLAVE AND OPEN THE VALUUM
RELEASER. WATER AND STEAM WILL COME
OUT

38. 5. AUTOCLAVING
WHEN THE WATER AND STEAM STOP TO COME OUT CLOSE THE
VACUUM RELEASER AND WAIT 10 MINUTES. THIS WILL ALLOW THE
INSTRUMENTS TO DRY.
CLOSE AND WAIT
FOR 10 MINUTES

39. 5. AUTOCLAVING
AFTER 10 MINUTES OPEN THE
STEAM RELEASER AND WAIT FOR
ALL THE REMAINING SEAM TO
COME OUT
WHEN ALL THE STEAM HAS COME
OUT CLOSE THE STEAM RELEASER

40. AUTOCLAVING PROCESS IS NOW FINISHED, BUT BEFORE YOU OPEN THE
AUTOCLAVE’S LID CHECK THAT THE PRESSURE IS AT ZERO “0” PSI
5. AUTOCLAVING

41. IF THE PRESSURE IS ZERO “0” OPEN THE LID VERY
CAREFULLY TO AVOID BURNS!
5. AUTOCLAVING

42. 6. STORAGE
WAIT FOR THE AUTOCLAVE BIN TO COOL
DOWN AND TAKE IT OUT FROM THE
AUTOCLAVE.
NOW CLOSE THE HOLES OF THE BIN TO
PRESERVE STERILITY.

43. STERILISATION IS A SPECIFIC AND METICULOUS
PROCESS:
STERILE:
ONLY IF THESE PHASES ARE
PERFORMED:
1. COLLECTION
2. DECONTAMINATION
3. CLEANING
4. DRYING
5. AUTOCLAVING
6. STORAGE
FOLLOWING SPECIFIC TIMING
AND PROCEDURE.
NOT STERILE:
ANY PROCESS DIFFERENT FROM
THE ONE ILLUSTRATED ABOVE.

44. DON’T EVEN TRY WITH
THE ELECTRIC
AUTOCLAVE, USE THE
STOVE AUTOCLAVE!
WHAT IF ONE DAY THE ELECTRICITY
SUPPLY IS UNRELIABLE?

45. WHAT IF THERE IS A
SUDDEN POWER CUT?
CHECK THAT THE PRESSURE
DOESN’T GO BELOW 15 PSI. IF IT
GOES BELOW YOU HAVE TO
START COUNTING AGAIN FOR
THE 20 MINUTES WHEN IT
COMES BACK UP TO 15 PSI
(WHEN ELECTRICITY COMES
BACK)

46. IN THIS CASE MOVE
ALL THE AUTOCLAVE’S
BINS
TO THE STOVE
AUTOCLAVE AND USE
THAT ONE!
WHAT IF THE
ELECTRICITY NEVER
COMES BACK?

47. IF GETTING DISTILLED WATER IS AN ISSUE… AND IT IS ALSO
DRY SEASON…
IT IS VERY IMPORTANT YOU CARE FOR THE HEATING
SYSTEM TO AVID THE FORMATION OF LIMESCALE (WHITE
CALCIUM HARD DEPOSIT) THAT YOU GET EVERY TIME YOU
USE TAP WATER...
TO DO SO YOU CAN SIMPLY USE VINEGAR!
BUT REMEMBER THIS IS AN EXTREME MEASURE AND THE
USE OF RAIN WATER SHOULD ALWAYS BE PREFERRED TO
TAP WATER.
COST
EFFECTIVENESS:
30 RUPEES
BOTTLE USED 3
TIMES

48. REMOVE THE GAUZE AND VINEGAR AFTER
A FEW HOURS, LIMESCALE WILL ALSO
COME OFF EASILY.

49. 1. PLEASE REPORT IT
2. USE BACKUP AUTOCLAVE
(STOVE ONE)
MALFUNCTIONING OR BREAK DOWN
PERSON IN CHARGE OF
STERILISATION
PERSON IN CHARGE OF
THE HOSPITAL
1. PLEASE TAKE ACTION TO
REPAIR IT
2. PLEASE SUGGEST TO USE
BACKUP AUTOCLAVE
(STOVE ONE)

50. FOR AUTOCLAVING: ALL THE INFORMATION WAS TAKEN FROM THE
INSTRUCTIONS PRINTED ON THE SIDE OF THE AUTOCLAVE
FOR DECONTAMINATION AND CLEANING:
● ENGENDERHEATH INFECTION CONTROL MANUAL, FREE
DOWNLOAD AT https://www.engenderhealth.org/files/pubs/qi/ip/ip-
ref-eng-07.pdf
● WHO DECONTAMINATION AND REPROCESSING OF MEDICAL
DEVICES FOR HEALTHCARE FACILITIES, FREE DOWNLOAD AT
http://apps.who.int/iris/bitstream/handle/10665/250232/9789241549851-
eng.pdf;sequence=1
● HOW TO PREPARE 0.5% BLEACH SOLUTION: Collecting, preserving
and shipping specimens for the diagnosis of avian influenza A(H5N1)
virus infection. ANNEX 7, FREE DOWNLOAD AT:
:http://www.who.int/ihr/publications/CDS_EPR_ARO_2006_1.pdf?ua=
1