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Posted: 3/30/2012 5:34:49 PM EDT
i got a great deal on ebay for about 12 GI medical instruments (hemostats, forceps, scissors, needle holder, tweezers) for 9 bucks, because they were used/opened.

aside from the bandage scissors, i would like to sterilize...or at least, clean as best i can, before throwing them in the med bag. i have a vacuum food sealer, so i was thinking after whatever sterilizing/sanitizing i do, i can immediately seal them.

so, aside from an autoclave, whats the best at home procedure? the instruments are stainless (figured it was worth mentioning).
Link Posted: 3/30/2012 5:39:46 PM EDT
pressure canner. set it for 15 lbs and cook the cooties.
Link Posted: 3/30/2012 5:52:02 PM EDT
[Last Edit: 3/30/2012 5:53:28 PM EDT by Him]
Originally Posted By frozenny:
pressure canner. set it for 15 lbs and cook the cooties.


First post yet again.

A pressure cooker/canner is an autoclave.

Link Posted: 3/30/2012 6:05:30 PM EDT
[Last Edit: 3/30/2012 6:06:03 PM EDT by Bones45]
Originally Posted By Him:
Originally Posted By frozenny:
pressure canner. set it for 15 lbs and cook the cooties.


First post yet again.

A pressure cooker/canner is an autoclave.



True. Keep it at pressure for about an hour and it should be reasonably sterile, at least until you open it again. Of course, then you need to learn how to scrub properly, etc..

Infection control is a long chain.
Link Posted: 3/30/2012 6:51:58 PM EDT
Originally Posted By frozenny:
pressure canner. set it for 15 lbs and cook the cooties.
yeah, an autoclave is just a fancy pressure cooker. If you want a sterile set of instruments, soak for a while is warm soapy water... then clean well with a toothbrush and rinse thoroughly... run thru the dishwasher and add 1/3 cup of chlorox at the beginning... Then take the instruments and double wrap them in a clean cloth - like a dinner napkin. You can wrap the instruments individually or in a group to make a "kit". After the first warp, secure the cloth with masking tape (or if you want to be fancy, you can use autoclave indicator tape)... and then wrap again and secure wrap #2 with masking tape as well... Throw the wrapped instruments into a pressure cooker with about an inch or so of water at the bottom... put something else in the bottom of the pot so that the instruments are not actually in the water when you are "cooking" them... cook for about 30 minutes and then allow to cool/dry... when the package is cool and dry, you have a sterile package (interior) that you can store. Let the package sit out for a day or 2 to really dry completely and then you can vacuum pack if you like...

Enjoy!
Link Posted: 3/30/2012 7:29:10 PM EDT
[Last Edit: 3/30/2012 7:30:06 PM EDT by live-free-or-die]
Get some of these bags to keep them sterile.
CLICK HERE
Drop them in the bag, put the bag in a pressure cooker.
Link Posted: 3/30/2012 7:30:56 PM EDT
Great ideas above but just wanted to reiterate that a good soak in bleach solution before autoclave would be a good idea, just to make sure all the boogers are off of them. Maybe a good wipedown with acetone to make sure there isn't any oil, grease, etc. on them too. I'd hate to use hemostat for a medical purpose that someone was using before to hold gun patches or something.
Link Posted: 3/30/2012 8:30:43 PM EDT
Why not vacuum seal them before pressuring them?


I think the bags would stand that kind of heat.
Link Posted: 3/30/2012 8:45:16 PM EDT
Link Posted: 3/30/2012 8:47:24 PM EDT
Wouldnt just straight up boiling work?
Link Posted: 3/31/2012 1:59:33 AM EDT
Originally Posted By Pav56C:
Wouldnt just straight up boiling work?


My thoughts also. It works for everything else - why not this?

Link Posted: 3/31/2012 2:37:00 AM EDT
[Last Edit: 3/31/2012 2:39:41 AM EDT by billclo]
While it's a low risk, I recall reading about certain organisms can survive the autoclaving process, notably prions (the probable cause of Mad Cow Disease). The CDC recommends disposal of the instruments, especially in Neurosurgeries.

An excerpt from the CDC:

"Special Issues
Inactivation of Prions Prions are characterized by resistance to conventional inactivation procedures including irradiation, boiling, dry heat, and chemicals (formalin, betapropiolactone, alcohols). While prion infectivity in purified samples is diminished by prolonged digestion with proteases, results from boiling in sodium dodecyl sulfate and urea are variable. Likewise, denaturing organic solvents such as phenol or chaotropic reagents such as guanidine isothiocyanate have also resulted in greatly reduced but not complete inactivation. The use of conventional autoclaves as the sole treatment has not resulted in complete inactivation of prions.5 Formalin-fixed and paraffin-embedded tissues, especially of the brain, remain infectious. Some investigators recommend that formalin-fixed tissues from suspected cases of prion disease be immersed for 30 min in 96% formic acid or phenol before histopathologic processing (Table 9), but such treatment may severely distort the microscopic neuropathology.
The safest and most unambiguous method for ensuring that there is no
risk of residual infectivity on contaminated instruments and other materials
is to discard and destroy them by incineration.6 Current recommendations for inactivation of prions on instruments and other materials are based on the use
of sodium hypochlorite, NaOH, Environ LpH and the moist heat of autoclaving with combinations of heat and chemical being most effective (Table 9).5,6
Surgical Procedures Precautions for surgical procedures on patients
diagnosed with prion disease are outlined in an infection control guideline
for transmissible spongiform encephalopathies developed by a consultation convened by the WHO in 1999.6 Sterilization of reusable surgical instruments
and decontamination of surfaces should be performed in accordance with recommendations described by the CDC (www.cdc.gov) and the WHO
infection control guidelines.6 Table 9 summarizes the key recommendations
for decontamination of reusable instruments and surfaces. Contaminated disposable instruments or materials should be incinerated at 1000° C or greater."

Available here: CDC

I wouldn't use/buy any used instruments, personally. You cannot be SURE they are prion-free.

In an prolonged SHTF where you HAD to perform minor surgeries w/o sufficient disposal instruments, I guess home auto-claving is better than nothing at all. Hope you have a surgeon who is used to operating in Third-World operating room conditions though. I suspect a regular surgeon with no experience in primitive settings may have some problems adjusting.
Link Posted: 3/31/2012 4:30:29 AM EDT
[Last Edit: 3/31/2012 4:34:25 AM EDT by Some_Beach]

Originally Posted By Kibby:
Originally Posted By Pav56C:
Wouldnt just straight up boiling work?


My thoughts also. It works for everything else - why not this?


Won't kill bacterial spores. Lots of bacteria, noting Clostridium and Bacillus, can resist heat in spore form only to become reproductive later. Clostridium species cause gangrene, tetanus, C. diff. and botulism. Killing spores requires higher heat, thus a pressure caner.

Link Posted: 3/31/2012 4:33:24 AM EDT
just where is it that you will have a sterile environment in which to use these instruments?
Link Posted: 3/31/2012 4:40:45 AM EDT

Originally Posted By Some_Beach:
Great ideas above but just wanted to reiterate that a good soak in bleach solution before autoclave would be a good idea, just to make sure all the boogers are off of them. Maybe a good wipedown with acetone to make sure there isn't any oil, grease, etc. on them too. I'd hate to use hemostat for a medical purpose that someone was using before to hold gun patches or something.

This is important. Physically clean is the first step. The cases where AIDS got spread in the late 90's were where some plaque or "chunks" shall we say got left behind the helped protect the virus in an unexpected location. (Bone working tools I think.)

There's going to be a limit to how useful sterile tools will be. The room, the bedding, bandages, the scrub down procedures used by the "doc". etc.

I wouldn't worry too much about this. A sterile clamp isn't going to make a difference if you irrigated the wound in a basement somewhere and then put the person back in a bed with non sterilized sheets.

Sterile surgery takes a whole industry of people and steps to accomplish, they even have specialized buildings for it now called "hospitals". Picking one step done in a hospital and working the hell out of it isn't going to be useful if the rest of the procedures totally ignores modern microbial theory....
Link Posted: 3/31/2012 4:45:48 AM EDT

Originally Posted By billclo:
While it's a low risk, I recall reading about certain organisms can survive the autoclaving process, notably prions (the probable cause of Mad Cow Disease). The CDC recommends disposal of the instruments, especially in Neurosurgeries.

An excerpt from the CDC:

"Special Issues
Inactivation of Prions Prions are characterized by resistance to conventional inactivation procedures including irradiation, boiling, dry heat, and chemicals (formalin, betapropiolactone, alcohols). While prion infectivity in purified samples is diminished by prolonged digestion with proteases, results from boiling in sodium dodecyl sulfate and urea are variable. Likewise, denaturing organic solvents such as phenol or chaotropic reagents such as guanidine isothiocyanate have also resulted in greatly reduced but not complete inactivation. The use of conventional autoclaves as the sole treatment has not resulted in complete inactivation of prions.5 Formalin-fixed and paraffin-embedded tissues, especially of the brain, remain infectious. Some investigators recommend that formalin-fixed tissues from suspected cases of prion disease be immersed for 30 min in 96% formic acid or phenol before histopathologic processing (Table 9), but such treatment may severely distort the microscopic neuropathology.
The safest and most unambiguous method for ensuring that there is no
risk of residual infectivity on contaminated instruments and other materials
is to discard and destroy them by incineration.6 Current recommendations for inactivation of prions on instruments and other materials are based on the use
of sodium hypochlorite, NaOH, Environ LpH and the moist heat of autoclaving with combinations of heat and chemical being most effective (Table 9).5,6
Surgical Procedures Precautions for surgical procedures on patients
diagnosed with prion disease are outlined in an infection control guideline
for transmissible spongiform encephalopathies developed by a consultation convened by the WHO in 1999.6 Sterilization of reusable surgical instruments
and decontamination of surfaces should be performed in accordance with recommendations described by the CDC (www.cdc.gov) and the WHO
infection control guidelines.6 Table 9 summarizes the key recommendations
for decontamination of reusable instruments and surfaces. Contaminated disposable instruments or materials should be incinerated at 1000° C or greater."

Available here: CDC

I wouldn't use/buy any used instruments, personally. You cannot be SURE they are prion-free.

In an prolonged SHTF where you HAD to perform minor surgeries w/o sufficient disposal instruments, I guess home auto-claving is better than nothing at all. Hope you have a surgeon who is used to operating in Third-World operating room conditions though. I suspect a regular surgeon with no experience in primitive settings may have some problems adjusting.

Prions are a long term problem that may make this a trade off.

Still, you are 100% right. Used surgical tools are to be used in the kitchen, desk, from the toolbox or for crafts. New tools should be used on people.
Link Posted: 3/31/2012 5:28:51 AM EDT
Originally Posted By Kibby:
Originally Posted By Pav56C:
Wouldnt just straight up boiling work?


My thoughts also. It works for everything else - why not this?



Not hot enough to kill some spores.

Link Posted: 3/31/2012 5:39:45 AM EDT
Originally Posted By Him:
Originally Posted By Kibby:
Originally Posted By Pav56C:
Wouldnt just straight up boiling work?


My thoughts also. It works for everything else - why not this?



Not hot enough to kill some spores.



What about boiling then alcohol? I'm looking for a DIY shadetree-solution here, just in case it has to be done and there's no autoclave or pressure cookers available. What about baking in oven at 500F?

Link Posted: 3/31/2012 6:21:29 AM EDT
Originally Posted By Kibby:

What about boiling then alcohol? I'm looking for a DIY shadetree-solution here, just in case it has to be done and there's no autoclave or pressure cookers available. What about baking in oven at 500F?



If you are going to boil in alcohol, you had bloody well better have a hot plate, or other non-flame heat source.

As for the oven, I doubt if anything organic would survive 500 F, but I.m not sure about viruses, since they seem to be borderline "alive."
Link Posted: 3/31/2012 6:24:55 AM EDT
Take them to the local tattoo shop. The guy here autoclaves them for 8 bucks. 5 more bucks if you want them put in the sterilization pouches. The autoclave at the tat shops are inspected by the health dept, so its usually legit
Link Posted: 3/31/2012 6:33:22 AM EDT
I think the price is decent. It is likely what you bought are disposables. You would be amazed at all the instruments that are thrown away........one time use.....trash.

20% bleach and water is simple and very effective. Rinse them well afterwards. This is the technique we use when we are in the bush. It will pit the instruments if done repeatedly, but , that takes hundreds of cycles.
Link Posted: 3/31/2012 6:52:35 AM EDT
Originally Posted By Drsalee:
I think the price is decent. It is likely what you bought are disposables. You would be amazed at all the instruments that are thrown away........one time use.....trash.

20% bleach and water is simple and very effective. Rinse them well afterwards. This is the technique we use when we are in the bush. It will pit the instruments if done repeatedly, but , that takes hundreds of cycles.



Where to get 20% bleach?

Link Posted: 3/31/2012 6:55:37 AM EDT
Working in surgery for the last 12 years, I can say that if we ever had a case involving Prion exposure, you can be damn sure that we would do everything short of burn the surgical room down after we found out. Since 1996 there have been 4350 cases of prion disease reported in the united states as of Feb of this year. 6 of those cases were iatrogenic, or caused by medical treatment (Referance). Neurosurgery, Ophthalmic surgery, and ENT surgery are the main specialties at risk for transmission of prion disease.

What I am trying to get at is that though scary as hell be cause of the whole no known cure thing, much like HIV was up until recently (Yes I know it's not cured, but it's not a death sentence anymore, just ask Magic Johnson). All I am trying to get at is that prion disease on my medical instruments is officially the LAST thing you should think about.

Incidentally, looking at the above reference page from the National Prion Disease Pathology Surveillance Center, 2175 of the reported cases 1996 to Feb 2012 were sporadic (their word, I think spontaneous is more accurate), meaning that there was no "Infection". It was spontaneous, so if you are going to worry about contaminated equipment, you should also be worrying at least half as much that you will just suddenly come down with it.

More worry some is that there are surgical instrumentation available to folks that aren't educated about it. Yeah, yeah, I know "But it's SHTF". Thing is, I have scrubbed for 8 years before my nursing degree, and have assisted surgeons in many cases, from spine to eyes to c-sections, and I don't have many instruments at home . I KNOW that I can do more harm than good, even if there is no other recourse. We are a fiercely independent lot, us prepping types, but we can't be good at everything. Concrete guy do your new homes electrical panel anyone?

And finally, for those that soldier on against all the criticism, all the posts about pressure cooking, double wrapped instruments, and lost of scrubbing ate spot on. SEARS of all places has indicator strips that you can use to be assured that what you are using has been exposed to the conditions that SHOULD make it sterile (Found Here)

And finally, HERE you can find the recommended practices for steam sterilization as stated by the American Organization of Operating Room Nurses.

Then get a good copy of Alexander's Care of the Patient in Surgery, a copy of Tabers because it can explain things from the other books, maybe even Gray's Anatomy.

Ok, I realize that I am being kind of a Dick, but stop and think...


jim
Link Posted: 3/31/2012 8:55:04 AM EDT
i wasnt talking about printing out "How To Perform an Appendectomy At Home" from Wiki-How lol.

I guess the most invasive procedure these would be used for is suturing, and that wouldnt be until no shit SHTF, like the zombie bodies are piling up and blocking my door type of shit.
Link Posted: 3/31/2012 9:13:06 AM EDT
Originally Posted By EXPY37:
Originally Posted By Drsalee:
I think the price is decent. It is likely what you bought are disposables. You would be amazed at all the instruments that are thrown away........one time use.....trash.

20% bleach and water is simple and very effective. Rinse them well afterwards. This is the technique we use when we are in the bush. It will pit the instruments if done repeatedly, but , that takes hundreds of cycles.



Where to get 20% bleach?



Sorry. I meant 20% bleach to water. Household laundry bleach that is.

Link Posted: 3/31/2012 10:22:35 AM EDT
[Last Edit: 3/31/2012 10:25:59 AM EDT by Some_Beach]

Originally Posted By Him:
Originally Posted By Kibby:

What about boiling then alcohol? I'm looking for a DIY shadetree-solution here, just in case it has to be done and there's no autoclave or pressure cookers available. What about baking in oven at 500F?



If you are going to boil in alcohol, you had bloody well better have a hot plate, or other non-flame heat source.

As for the oven, I doubt if anything organic would survive 500 F, but I.m not sure about viruses, since they seem to be borderline "alive."

Really anything over 250 F is good, as you're denaturing proteins there, virus or otherwise but to kill spores with dry heat (oven) you need to get to 320 F. If you're dealing with stainless steel tools and a home oven, you can certainly go right on up. Heck, throw them in the self cleaning cycle and anything that was on them to begin with will be a small coating of carbon at the end.
Link Posted: 3/31/2012 10:36:43 AM EDT
Originally Posted By Kibby:
Originally Posted By Him:
Originally Posted By Kibby:
Originally Posted By Pav56C:
Wouldnt just straight up boiling work?


My thoughts also. It works for everything else - why not this?



Not hot enough to kill some spores.



What about boiling then alcohol? I'm looking for a DIY shadetree-solution here, just in case it has to be done and there's no autoclave or pressure cookers available. What about baking in oven at 500F?



No go, I'm an RN, my mom is an OR RN. Get a pressure canner...but really, most folks won't be able to keep the instruments sterile upon opening the pressure canner.
Link Posted: 3/31/2012 10:40:17 AM EDT
I read online someone suggested the vacuum sealing route with a shot of iso alcohol for long term storage. Thoughts? Will it corrode the stainless?
Link Posted: 3/31/2012 11:09:57 AM EDT
you need time and temp. to sterilize. the indicator strips only turn color when the proper temp has been reached, it can not tell how long. so just because the strip turned color does not mean it was properly sterilzied.

if SHTF then boil for at least 20 minutes and soak in alcohol for 30 ,minutes. Since you are more than likely NOT in an OR or sterile room the chance of making things worse using this method is rather moot point.
Link Posted: 3/31/2012 2:29:16 PM EDT

Originally Posted By NapeSticksToKids:
I read online someone suggested the vacuum sealing route with a shot of iso alcohol for long term storage. Thoughts? Will it corrode the stainless?

No good as iso has water. You could use Everclear or denatured alcohol, but it still has a small percentage of water. Alcohol is hygroscopic so as soon as you open a new container, it starts absorbing water.
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