Brian W Skellie – Sharing ideas
For brevity, I suggest that you use all sterile disposable single use items, however if you are to reprocess used instruments: Classes Publications
In the current 2013 edition of the APP Procedure Manual, I helped correct the previously confusing references to Statim autoclaves.
The current 2013 version of the guidelines refer to the Statim and the acceptable use of unwrapped sterilization methods.
Sterilization Methods:
Benchtop Sterilization
- Steam under pressure (saturated steam/steam autoclave): 220-270 kpa pressure at 132° Centigrade (270° Fahrenheit) for 3-40 minutes depending on cycle.
- Steam autoclave process types
- Steam flush-pressure pulse (type S):
“Another design in steam sterilization is a steam flush-pressure pulsing process, which removes air rapidly by repeatedly alternating a steam flush and a pressure pulse above atmospheric pressure. Air is rapidly removed from the load as with the prevacuum sterilizer, but air leaks do not affect this process because the steam in the sterilizing chamber is always above atmospheric pressure. Typical sterilization temperatures and times are 132°C to 135°C with 3 to 4 minutes exposure time for porous loads and instruments.” The Statim is an example of a type S steam flush pressure pulse autoclave, which is acceptable for sterilization.
Aseptic Field
The actual procedure surface is referred to as an “aseptic field,” and is a sterilized surface that becomes exposed to air contact only at the beginning of the piercing procedure. The aseptic field used by most piercers is the sterile inside surface of a freshly opened large autoclave or sterile glove package, Statim cassette, rigid sterilization container, or sterilized tray. Once the package is opened, sterile tools, needles, jewelry, and disposables can be dropped onto the inside surface for use. The exterior of sterilized packages such as those containing the jewelry should not touch the aseptic field; the contents should be carefully dispensed onto it.
DISPOSABLE SUPPLIES
To minimize the risk of cross-contamination and to ensure that piercing room procedures are as clean as possible, many components of the tray setup must be disposable. Unless supplies are purchased presterilized* or will be sterilized in an autoclave immediately prior to the procedure, all disposables must be individually packaged in autoclave bags, sterilized, and remain intact in their pouches stored in enclosed, nonporous drawers or containers until use. Disposable materials that must be sterilized include: marking implements, piercing needles, corks or synthetic stoppers, elastic bands, swabs, and gauze.
* This includes only FDA-cleared items that are commercially sterilized according to accepted medical standards. The supplier must make documentation of appropriate sterilization available.
If a product is not labeled for surgical preparation, it really doesn’t matter how good of a hand and body soap or cleanser it is. It would only be a really strong hand wash product, or possibly aftercare for our purposes.
Choose a product that has claims as a “surgical skin preparation” because “scrub” alone is only the first step as cleaning. A two step “scrub then paint” process is appropriate and advised by CDC. That involves a solvent or detergent scrub to clean followed by the surgical antiseptic to kill microbes to an irreducible minimum level of contamination.
I’m still looking for a universal surgical preparation agent, and have not found anything on the market that is both proven and FDA approved other than PVP-I, CHG based products and alcohol. I don’t want to recommend anything unless it is tested and labeled for the purpose. 
MULTIsteril: A brief review. Let’s automate the cleaning process to eliminate risk
A bit about how automated instrument washers work
A useful device for arranging your instruments for washing in a Hydrim : Available here Instrument Cradle for Sterilization.
