Sterilization ManualAuthors: Silvia I. Acosta-Gnass & Valeska de Andrade Stempliuk

This is the updated 2009 version of the sterilization manual, published by PAHO Headquarters to inform health workers about the simple protocols and procedures that have been developed to prevent hospital-acquired infections both inside and outside the sterilization plant. The guidelines included in this manual show the steps to follow in cleaning, preparing, sterilizing, storing and transporting hospital equipment so as to obtain sterile material. It is very important to be aware of this information in order to provide patients with safe health care.

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Prior to World War II, the sterilization plant was the "good right arm" of the operating room, the dressing room where hospital auxiliaries (primarily women) met to fold gauze and prepare bandages. In the postwar period, there emerged a need for a medical and surgical sterilization plant in all hospitals. Its primary responsibility was to sterilize instruments and equipment; but in time, other functions were added. (Wenzel, R. 1993)

The end of the 1970s brought about the following goal: The objective of the sterilization plant would be to provide a service to improve patient care and maintain high standards of medical practice. It would also collaborate with hospital administration to protect personnel from infections or accidents, thus providing a safe environment for employees. (Wenzel, R. 1993)

The sterilization plant plays a very important role in prevention hospital (nosocomial) infections, because infections contracted during hospital stays have been associated with inappropriate disinfection of reusable objects including endoscopic equipment, the respiratory equipment, transducers, and reusable hemodialysis equipment. Recently, there has been a controversy with regard to reprocessing expensive medical devices (for example, probes without lumen for cardiac electrophysiology) labeled by the manufacturer as "single-use." If the decision is made to re-use a disposable device, the institution in charge must demonstrate that the safety, effectiveness, and integrity of the product have not been compromised in the process.

In addition, sterilization plant services are responsible for collecting, receiving, processing, storing, and distributing objects and equipment used for patient care throughout the hospital.

The purpose of this manual is to inform health workers on the protocols and simple procedures that have been developed to prevent hospital infections both inside and outside the sterilization plant. It was published at PAHO Headquarters.

The guidelines included in this handbook show which steps to follow in cleaning, preparing, sterilizing, storing, and transporting hospital equipment so as to guarantee sterile material—awareness of which is crucial in providing patients with safe health care.

sterilization toolsTable of Contents

  • Preface | Introduction
  • Physical Areas & Personnel of the Sterilization Plant
  • Personal Protective Equipment
  • Hand Washing
  • Cleaning of Materials
  • Preparing & Packaging Materials
  • Basic Guidelines for Disinfection & Sterilization
  • Disinfection
  • Sterilization
  • Correctly Loading the Sterilizer
  • Handling, Transporting, & Storing Materials
  • Methods for Controlling the Sterilization Process
  • Failures in the Sterilization Process
  • Validating the Sterilization Process
  • Quality Indicators for the Sterilization Plant
  • Re-Use of a Single-Use Medical Device
  • Environmental Cleaning & Disinfection of the Sterilization Plant
  • Occupational Hazards
  • Waste Management
  • Terms Related to Sterilization
  • Bibliography

This publication was made possible thanks to the sponsorship and cooperation of the Office of Sustainable Regional Development, Latin American and Caribbean Bureau, United States Agency for International Development (USAID).