REPORT ON PREPARATION PACKAGING AND STORAGE OF

THEATRE INSTRUMENTS AND APPARATUS

PREPARED BY;

MUCHUNKU VICTOR MURERI

DPOTT/M-0007/THI/24

ON MONDAY FEBRUARY 10TH, 2025

1
TABLE OF CONTENTS

Introduction................................................................................................................................4

Scope.........................................................................................................................................5

Objectives..................................................................................................................................6

Materials and equipment.........................................................................................................7

Procedure for preparation.....................................................................................................9

Quality control...........................................................................................................................15

Common issues and their solutions..........................................................................................16

Conclusion....................................................................................................................................17

2
INTRODUCTION

Sterilization is the statistical or complete destruction of all microorganisms including the

most resistant bacteria and spores. Sterilization can be achieved through various means,
including heat, chemicals, irradiation, high pressure, and filtration. Sterilization is distinct
from disinfection, sanitization, and pasteurization, in that those methods reduce rather than
eliminate all forms of life and biological agents present. After sterilization, fluid or an object
is referred to as being sterile or aseptic. In general, surgical instruments and medications that
enter an already aseptic part of the body (such as the bloodstream, or penetrating the skin)
must be sterile. Examples of such instruments include scalpels, hypodermic needles, and
artificial pacemakers.
Preparation of injectable medications and intravenous solutions for fluid replacement
therapy requires not only sterility but also well-designed containers to prevent entry of
adventitious agents after initial product sterilization.
Most medical and surgical devices used in healthcare facilities are made of materials that
can undergo steam sterilization. However, since 1950, there has been an increase in medical
devices and instruments made of materials (e.g., plastics) that require low-temperature
sterilization.
Medical professionals are legally obligated to provide patients with a standard of care. One
of the key requirements for meeting this standard of care is the proper sterilization of
medical equipment.

3
Proper preparation and sterilization is essential before any surgical procedure so as;

1. To reduce the risk of infection due to breach of host barriers

2. Ensure the safe transportation of equipment which need to be packed and

assembled for sterilization.

3. To prevent the spread of nosocomial infection.

4. To ensure patient's safety.

5. To extend the lifespan of instruments.

SCOPE

In this report we're going to cover on;

1. Preparation, packaging and storage of Thiâtre instruments and apparatus.

2. Materials and equipment for sterilization.

3. Procedure for sterilization.

4. Mode of sterilization.

5. Advantages of the method chose over other methods.

6. The disadvantage of the method used over other methods.

7. Quality control.

8. Common issues in an operation theatre and their solutions

4
 OBJECTIVES

1. main modes of preparing instruments.

The main modes of preparing instruments are;
1. Chemical sterilization

2. Steam sterilization.

3. Dry heat sterilization.

After sterilization, Instruments are prepared on a metal tray which is covered by a sterile
drape to the rim of the tray. The metal tray should be placed at least a meter (1m)
from the walls and the person passing instruments from the unsterile area should be
fifty centimeters(50cm) from it.

The specific goals of preparing instruments are to;

1. To prevent the spread of nosocomial infection.

2. To ensure patient's safety.

3. To extend the lifespan of instruments.

4. To reduce the cost of health care spending.

5. To reduce the hospital stay of patients.

5
 MATERIALS AND EQUIPMENTS

Theatre instruments and equipments are classified into different categories to;

1. Improve work flow during a surgical procedure.

2. Ease identification of instruments.

3. Ease the organization of the theatre.

The different categories of theatre instruments are;

Accessories.

These are instruments that do not fall into any other categories.(e.g., harmonic scalpel,
mallet, diathemy machine and screwdrivers.)

Clamping and occluding instruments.

They are instruments used to compress vessels and other tubular structures to
prevent the flow of blood and other body fluids.(e.g., Kelly forceps, Crile forceps,
Mixter forceps and Adson/clamp forceps)

Cutting and dissecting instruments.

They are used to cut, dissect and incise. They include; straight and curved mayo scissors,
Metzenbaum scissors and lister bandage scissors

Grasping and holding instruments.

They are used to grip and manipulate bony tissues. They include; plain and toothed
tissue forceps, DeBakey tissue forceps and plain Adson tissue forceps.

6
Probing and dilating instruments.
They are used to explore anatomical openings by increasing their diameter. They include hanks,
bakes.

Retracting and exposing instruments.

They are used to hold back/pull aside wound edges to gain access to surgical site, they
include, army navy retractor Deaver retractor and Senn retractor.

Suturing and stapling instruments.

They are used to ligate, repair and approximate tissues during surgical procedures. They include,
stapling devices, Crile wood needle holder and surgical clip applier

Suctioning and aspirating instruments.

Used to remove blood, fluid and debris in a surgical area. They include, pool suctioning
tube and fraizer suctioning tube

Viewing instruments.
They allow visualization of structures /cavities. They include nasal speculum and endoscopic
camera

7
 PROCEDURE FOR PREPARATION

In this area we're going to;

1. Describe the cleaning procedure before sterilization

2. How to inspect instruments and check for damage.

3. Explain the importance of assembling instruments.

4. The sterilization method used and its parameters.

5. Methods of storing the sterilized instruments.

8
CLEANING PROCESS

The first step in the cleaning process is to take the instruments to the sterilization room,
placing them in closed containers to avoid accidents. This procedure should be carried
out as safely as possible, always wearing the appropriate personal protective
equipment.

The use of closed containers or crates has several advantages: it allows the process to be
carried out in a single step, protecting the instruments and facilitating organization,
storage and inventory, with a single package.

If you do not want to clean the instruments immediately, it is advisable to soak them in an
enzymatic detergent to prevent the dirt from drying out, which would make
subsequent cleaning more difficult. The liquid for soaking them in must be lukewarm;
if it is too hot, the proteins in the organic matter may coagulate, making cleaning
more difficult. Be sure to use approved cleaning solutions and cleaning brushes as
commercial products not intended for use with surgical instruments can cause damage
and/or limit cleaning effectiveness.

There are two ways to carry out the instrument cleaning process:
 Manual

 Mechanical, using ultrasonic tanks or thermodisinfectors

9
 Mechanical cleaning is a safer practice for staff and a more effective process over
manual cleaning. Therefore, whenever possible, mechanically clean instruments,
using warm water and a neutral ph.

Instruments are first washed in running water to remove debris and blood on the
instruments. Hey are then after washed in jik water as per manufacturer's instructions
for 10-15 minutes. After exposing them in jik water, they are then washed in soapy
water before being rinsed on running water again. Instruments are there after
allowed to air dry before packaging,

INSPECTION
Each instrument should be critically inspected after each cleaning for residual debris or
damage. Instruments should be checked individually as needed and never sterilize a
“dirty” instrument. In addition, instruments are checked for proper functionality and
lubricated as required by the instrument manufacturer. Hinged instruments with stiff
joints may be a sign of inadequate cleaning.

ASSEMBLING.

Instrument packaging should be done in a clean and low contamination area, using
approved products such as;

• Sterilization pouch

• Sterilization wrap
• Sterilization container.

Sterilization pouches are for packaging loose instruments and small, light weight items.
Paper/plastic pouches allow you to see the contents and come with a build in adhesive
strip for seal sealing. It is important to remove all excess air, prior to sealing the

10
 sterilization pouch. For quality assurance, be sure to include a chemical indicator
inside each pouch as this will verify sterilization parameters were met inside, as well
as outside the pouch (time, temperature and sterilant contact). For quality
assurance, include a chemical indicator inside to verify the sterilant reached the inside
of the package. Wrap in a way that allows sterile presentation and aseptic and delivery
of the surgical pack or kit. Sterilization indicator tape should be used to secure the
wrapper. Heavier wraps should be placed on the lower shelf of the sterilizer and
pouches (being lighter) on the top, on edge. This enables moisture to drain out without
wetting other items in the load

STERILIZATION

Saturated steam under pressure is one of the oldest methods used to sterilize surgical
instruments. Steam sterilization is process of choice, because it is efficient, fast, and
inexpensive. By heating distilled water under pressure, moist heat is created and
rapidly kills microorganisms. Some common steam sterilizer cycle parameters are:

1. • 250°F/121°C for 30 min (Gravity)

2. • 270°F/132°C for 10 min (Gravity)

3. • 270°F/132°C for 4 min (DAR) Gravity = Gravity Displacement; DAR = Dynamic

Air Removal

Dry times are additional and can be from 15 to 30 minutes, depending on load
There are three (3) different types of steam sterilizers:

a) Gravity Displacement

b) Pre-vacuum

11
 c) Steam Flush Pressure Pulse (SFPP)

Gravity displacement sterilizers heat the water which converts it to steam and pushes
the air out the drain gradually. This is called “passive air removal”. Pre-vacuum
sterilizers heat water and convert it to steam; however, they use a vacuum pump to
quickly remove the air which allows for faster cycles. This is called “dynamic air
removal”. Because pre- vacuum steam sterilizers rely on a pump to remove air, an air
removal test called Bowie-Dick test should be performed daily.

The loading technique should ne considered carefully because if the load is too
dense/improperly placed, air may become trapped in the pockets. Items in the air
pockets will not be properly sterilized.

The following loading techniques were considered;

 Instruments ban with mesh were placed flat on the shelf of the sterilizer.

 Linen packs were placed on their sides because of their density.

 All items which had a smooth surface in which water could collect easily were
placed on the bottom of the load to prevent water from dripping onto other
instruments.

 Packs and instruments were placed in a way that they do not touch/come
into contact with each other.

STORAGE
Sterile items were stored in a manner that reduces the potential for contamination. The
shelf-life of sterile items is event related and depends on the quality of the packaging
material, storage conditions and amount of handling. Sterile packages were always
handled with care to avoid re-contamination. In order to avoid compromising the
sterility of instruments the following were considered; I avoid dragging, crushing,
bending, compressing or puncturing. I clearly inspected the sterile packages before

12
 storage. Package that was damaged, wet or opened were not used during the
packaging of the sterile packs.

QUALITY CONTROL

Sterility assurance of processed instruments was routinely verified using three (3) types of
indicators:

a) Physical

b) Chemical

c) Biological 32 Quality Assurance

Physical indicators are the time, temperature and pressure gauges built into
sterilizers. These readings were recorded for every cycle and verified prior to
unloading the sterilizer.

Chemical indicators are on the outside and inside of all packages to verify they
have been processed. The outside can be a single parameter indicator, i.e. change with
heat alone; however, the internal should be multi-parameter requiring more than just
heat to make it pass.

Biological indicators provided the highest level of sterility assurance. Sterilizers

should be tested at least weekly, and every load that contains an implant. An
unprocessed Control test, from the same was included Test Pack was used to monitor
large sterilizers when processing packaged instruments.

COMMON ISSUES AND THEIR SOLUTIONS

Despite understanding of instrument handling and maintenance of sterility, there are a number of
common complications associated with the use of these surgical instruments in an operation
theatre.

13
 One of the most common complications is infection. Infection can occur when the
instruments are not properly cleaned and disinfected before use. This can be avoided by proper
sterilization and cleaning of instrument.

Injuries also are most common in an operating room. They can be avoided by proper storage of
and handling of theatre instruments.

CONCLUSSION

Even with the best healthcare in clinical facilities, accidents, infections, or other
unwanted outcomes sometimes happen. Patient safety issues are wide-ranging. Some
of the patient safety issues include;

 Infections as a result of medical procedures.

 Resistance to antibiotics, developed through overmedication.

 Slip-and-fall accidents among patients in a hospital or long-term care facility.

 Failure to implement personal protective equipment at appropriate times.

 Failure to ensure proper standards of sanitization in clinical facilities or

patient rooms.

 Errors with the prescription, administration, or management of medications

 Care transition and discharge problems, usually stemming from poor

communication.

Therefore, proper preparation of instruments and apparatus should be adhered to so as to;

 Reduce the risk of infection to the patient.

 Improve patient overall outcome.

14
 Reduce the cost of health care spending.

 Prevent legal implications.

 Protect the facilities reputation.

15