Exemplary embodiments of the present disclosure relate to a method and apparatus for sterilization and more particularly to a method and apparatus for sterilization of instruments, wherein a ratio of venting pass through area to volume of the sterilization container is at least a given value, and wherein the given value in select configurations can provide a drying time of less than 30 minutes and in select configurations less than 15 minutes.
Sterilization is a term referring to any process that eliminates (removes) or kills microbial life, including transmissible agents (such as fungi, bacteria, viruses, or spore forms) present on a surface, or contained in a fluid, or in medication, or in a compound such as biological culture media. Sterilization can be achieved by applying heat, chemicals, irradiation, high pressure, and filtration or combinations thereof.
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 sterilized to a high sterility assurance level. Examples of such instruments include scalpels, hypodermic needles and implantable medical devices (IMD), such as artificial pacemakers.
A widely used method for heat sterilization is the autoclave, sometimes referred to as a sterilizer. Autoclaves commonly use steam heated to 121-134° C. To achieve a degree of sterility, a holding time of at least 15 minutes at 121° C. at 100 kPA, or 3 minutes at 134° C. at 100 kPa is required. Additional sterilizing time is usually required for liquids and instruments packed in layers of cloth, as they may take longer to reach the required temperature.
One method of sterilization involves passing steam through a container. For effective sterilization, steam needs to penetrate the container load uniformly. Accordingly, the container must not be overcrowded, and the lids of bottles and containers must be left ajar. During the initial heating of the container, residual air must be removed. Indicators should be placed in the most difficult places for the steam to reach to ensure that steam actually penetrates there.
A filter is typically placed over the vent to keep particles or extraneous materials from entering the container before, during or after the sterilizing process. Once the sterilizing process is completed, the filter needs to be removed and inspected by medical professionals to verify the integrity of the sterilizing process was maintained. If it is discovered during inspection that the filter did not remain intact, the sterilizing process has to be repeated with a new filter. Further, if moisture is present in the container, the load would be rejected by the user and sent for reprocessing. Thus, a sufficient drying time, wherein there is no visible moisture on the sterilized medical instruments, is needed before the sterilization processing is complete.
The amount of drying time needed to achieve a dry load can be significant. Dry time can add several minutes to the total processing time in order to achieve a load where the instruments are dry. Further, heavier loads, for example, those with a large metal mass, can cause moisture to be maintained inside the container after the sterilization cycle is complete. Thus, weight limits may be required to avoid wet, unsterilized loads after processing. In existing devices, a sterilization cycle may run for 4 minutes at 270° F., followed by at least a 30 minute dry cycle. These containers have relatively small vent area to volume ratios, wherein an area of the vent is small compared to the internal volume of the container. For example, in the S.C.O.R.E.S. container labelled by PMBS, LLC of Stockton N.J., the ratio of the area of the vent to volume is approximately 0.004-0.006 in2 per in3. These vent area to volume ratios limit circulation through the container, contribute to the longer dry times required for achieving a dry load, and significantly limit the weight of the load that can be placed into the container.
What is needed, then, is a sterilization container for retaining surgical instruments in a sterilizer that has improved circulation and evaporation and shorter drying times.
In view of the foregoing, a sterilization container for retaining a surgical instrument in a sterilizer is provided.
A first exemplary embodiment provides a sterilization container for retaining surgical instruments in a sterilizer. The sterilization container comprises an enclosing wall and a door defining an interior volume sized to receive at least one instrument tray, at least one of the enclosing wall and the door defining a venting pass through area, and a filter occluding the venting pass through area, wherein a ratio of the venting pass through area to the interior volume is at least 0.008 inch2 per inch3, and in select configurations at least 0.016 inch2 per inch3, and in further configurations greater than 0.02 inch2 per inch3. In further configurations, the ratio of the venting pass through area to the interior volume is between least 0.008 inch2 per inch3 and 0.2 inch2 per inch3 and in select configurations between 0.016 inch2 per inch3, and 0.2 inch2 per inch3.
The enclosing wall of the sterilization container can be any of a variety of configurations, such as but not limited to defining polygonal containers, containers with curvilinear walls or combinations thereof. For purposes of description, the sterilization container has been set for in terms of walls forming the enclosing wall. Thus, in a further configuration, the sterilization container comprises an enclosing wall having a plurality of walls and a door defining an interior volume sized to receive at least one instrument tray, at least one of the walls and the door defining a venting pass through area, and a filter occluding the venting passage area, wherein a ratio of the venting pass through area to the interior volume is at least 0.008 inch2 per inch3, and in select configurations at least 0.16 inch2 per inch3, and in further configurations greater than 0.2 inch2 per inch3.
Further, the configurations are set forth in terms of a sterilization container, which encompasses a sterilization cabinet.
Another exemplary embodiment provides a method of drying contents in a sterilization container, the method comprising sterilizing contents in a sterilization container having an enclosing wall, such as a plurality of walls, and a door defining an interior volume sized to receive at least one instrument tray retaining the contents, venting the sterilization container through a venting pass through area having a filter occluding the venting passage area, wherein a ratio of the venting pass through area to the interior volume is at least 0.008 inch2 per inch3, and obtaining a drying of the contents in the sterilizing cabinet in less than 30 minutes and in select configurations less than 15 minutes.
A further exemplary embodiment provides a sterilization container for retaining surgical instruments in a sterilizer, the sterilization container comprising an enclosing wall, such as a plurality of walls and a door defining an interior volume sized to receive at least one instrument tray, at least one of the enclosing wall and the door defining a venting pass through area, and a filter occluding the venting passage area, the sterilization container having a ratio of the venting pass through area to the interior volume sufficient to provide a drying time of less than 30 minutes and in select configurations less than 15 minutes.
In the medical field, it is of the utmost importance that medical instruments are sterilized prior to any medical procedure. This drastically helps prevent the spread of infectious materials. In the marketplace, there are a wide variety of devices that provide for sterilization of medical instruments through the use of a sterilizing agent, such as steam. Instrument trays can be wrapped in a cloth or paper that acts as a filter, allowing the tray to be sterilized, then delivered to the operating room. Alternatively, a rigid container can contain the instrument tray. The device (e.g., a rigid container, sterilization container or cabinet) contains at least one vent for venting the steam used to sterilize the contents of the device. A disposable filter usually covers these vents. The filters have two major purposes. First, the filters prevent extraneous materials from entering the sterilizing device during and after the sterilization cycle. Second, the filters allow sterilizing steam to enter and exit the sterilizing device (sterilization container). Thus, the sterilization container can retain the sterilized medical instruments within the container and protected from the environment by the filters sealing the vents. The filter can be made of any type of porous paper or cellulose type material. In other embodiments, the filter is made of polymeric substances, such as polypropylene or a combination such as plasticized paper as known in the art. The filter is required to be both porous and dense enough to allow the passage of a sterilizing agent, such as steam, through its membrane, but also resilient enough to not rip or tear during a sterilizing cycle or during insertion/clamping into operable position. Although the present description is set forth in terms of a paper-like filter, the filter can be a tortuous path or even a valve that acts as a check valve permitting the venting of the sterilization container without permitting passage of extraneous materials into the sterilization container.
Referring to
The term sterilization cabinet 100 encompasses any device capable of retaining the medical instruments subjected to the sterilization procedure, wherein the cabinet 100 can receive and retain at least one tray, with the tray retaining at least one medical instrument. The sterilization cabinet 100 can retain the medical instruments in the sterilized condition after the sterilization process. The term sterilization container also includes sterilizing cabinets for sterilizing medical instruments, surgical devices and the like. The term sterilizer includes, but is not limited to, a housing or device defining an interior retaining the sterilization container and in which a controlled environment is create to impart a desired sterilization. Sterilizers include autoclaves; hot air ovens; ethylene oxide; low temperature steam, steam, high pressure steam and formaldehyde; sporicidal chemicals; irradiation; chlorine dioxide (CD) gas sterilization; hydrogen peroxide; vaporized hydrogen peroxide; hydrogen peroxide plasma; electron beam and gas plasma devices.
The sterilization cabinet 100 includes an enclosing wall which defines an interior volume, wherein the enclosing wall can include a plurality of sidewalls, a top wall and a bottom wall. The walls can be planar or curvilinear and can be oriented to define a rectilinear volume, cubic volume or round or curved volume. For purposes of the present disclosure, the enclosing wall is set forth as the plurality of sidewalls, the top wall and the bottom wall, along with a door. It is understood the enclosing wall can include or cooperate with a door to at least partially define the interior volume. In one configuration the sterilization cabinet 100 includes the enclosing wall having the plurality of sidewalls, the top wall and the bottom wall, along with a door or doors 102, vents 104, and in certain configurations filter holder 106, primary filter 108, secondary filter 110, sterilization cabinet frame 112 and legs 114. Door or doors 102 are able to open and close for access to the interior of sterilizing cabinet 100. Door or doors 102 are physically connected to sterilization cabinet frame 112. Door or doors 102 can be attached through the use of a hinge or hinges which allows the doors to swing open. Alternatively, door or doors 102 can be removable from sterilization cabinet 100 through the use of clamps (not shown in
Sterilization cabinet 100 in one embodiment provides for four vents 104. However, it should be appreciated that exemplary embodiments of sterilizing cabinet 100 are not limited to four vents. The sterilization cabinet 100 may include a fewer number or a greater number of vents 104. The vents 104 can define a venting pass through area 140 of the sterilizing cabinet 100. It should be appreciated that vents 104 can provide numerous small openings for the passage of sterilizing steam or heat. The small openings in vents 104 can be holes or slits. Alternatively, vents 104 can be fenestrated. By “venting pass through area” it is meant to refer to the total available area for the ingress and egress of a gas to or from the interior volume of the sterilizing cabinet 100. Exemplary embodiments of sterilization cabinet 100 can include one or more vents so long as the venting pass through area to volume ratio is equal to or greater than 0.008 inch2 per inch3, or 1 inch2:125 inch3, and in select configurations between 0.02-0.2 inch2 per inch3, or between 1 inch:50 inch3 and 1 inch2:5 inch3, and in further configurations between 0.16-0.2 inch2 per inch3, or 4 inch:25 inch3 and 1 inch:5 inch3.
The term “dry time” or “drying time” means the time required to provide no visible moisture in the sterilization container or on the sterilized medical instrument (or tray or wrapping, if used), as set forth in the governing regulations. For example, as set forth in AAMI ST79 Comprehensive guide to steam sterilization and sterility assurance in health care facilities (AAMI/CDV-2 ST79), visible moisture left in (interior) or on (exterior) a package or tray within the sterilization container after sterilization and the proper cooling (drying) period should be considered a wet pack. Further, if moisture is present on or in two or more packages the load should be considered a wet load. The moisture may be in the form of visible dampness, droplets, or puddles of water on or within a pack (or instrument or tray). If wet packs are observed in the processing area they should not be released. If wet packs are observed in the user area (e.g., in the OR) they should not be used.
By “venting pass through area to volume ratio,” it is meant the ratio of the total venting pass through area 140 of a sterilizing cabinet 100 to the interior volume of the sterilization cabinet 100 ratio. Thus, for example, a sterilizing cabinet 100 as shown in
The sterilization cabinet 100 can retain multiple trays holding medical instruments and, because of the high venting pass through area to volume ratio, has a drying time of less than 30 minutes, and more specifically, between 10-15 minutes, and even more specifically 10 minutes. In one configuration, the sterilizing cabinet 100 can hold up to 15 trays and each tray holds up to 25 lbs of material to be sterilized. In a configuration of the invention, the dry time of less than 30 minutes includes multiple trays loaded into the sterilization cabinet 100, the trays holding a total of 140 lbs or less of material to be sterilized, and in select configurations less than 15 minutes dry time.
These high venting pass through area to volume ratios reduce the drying time required after the sterilization cycle. The sterilization cabinet 100 can hold multiple trays holding instruments and, because of the high venting pass through area to volume ratio, have a drying time of less than 30 minutes, and more specifically, between 10-15 minutes, and even more specifically 10 minutes. These trays can each hold up to 25 lbs of material to be sterilized. In a configuration of the invention, the dry time of less than 30 minutes includes multiple trays loaded into the sterilization cabinet 100, the trays holding a total of 140 lbs or less.
In yet another exemplary embodiment, as shown in
In this embodiment, filter door 606 forms a seal with sterilization cabinet 100 at the edges of the open portion of the sterilization cabinet frame 112, such that any sterilizing steam that enters or exits sterilizing cabinet 100 during a sterilization cycle must pass through filter door 606 and primary filter 106. Likewise, filter door 610 forms a seal with filter door 606 such that any sterilizing steam that exits sterilizing cabinet 100 and primary filter 108 must pass through filter door 610 and secondary filter 110. As shown in
Alternatively, for the sterilization container of
Exemplary embodiments of sterilization cabinet 100 can include one or more vents so long as the venting pass through area to volume ratio is equal to or greater than 0.008 inch2 per inch3, or 1 square inch:125 cubic inches, and in select configurations between 0.02-0.2 inch2 per inch3, or between 1 square inch:50 cubic inches and 1 square inch:5 cubic inches, and in further configurations between 0.16-0.2 inch2 per inch3, or 4 square inches:25 cubic inches and 1 square inch:5 cubic inches.
The high venting pass through area to volume ratio reduces the drying time required after the sterilization cycle. The sterilization cabinet 100 can hold multiple trays holding instruments and, because of the venting pass through area to volume ratio, have a drying time of less than 30 minutes, and more specifically, between 10-15 minutes, and even more specifically 10 minutes. In select configurations, the drying time can be as little as 5 minutes. In one configuration, the sterilization cabinet 100 holds up to 15 trays, each tray holding up to 25 lbs. In a configuration of the disclosure, the drying time of less than 30 minutes includes multiple trays loaded into the sterilization cabinet 100, the trays holding a total of 140 lbs or less.
In another exemplary embodiment, as shown in
The sterilization cabinet 2202, 2502, 2602 may have a fenestrated door 2506, 2612 holding a filter 2510, 2306, 1302, 1402,1502, 1602, 1700. In one configuration, the filter 2510, 2306, 1302, 1402, 1502, 1602, 1700 is a single-use filter. The sterilization cabinet 22022502, 2602 is designed to be used in a steam autoclave and may hold multiple open trays containing surgical instruments. Trays within the container 2202, 2502, 2602 may be separated by spacers 902 having dividers or lips 904 along the edges of spacer 902 and throughout the midsection of spacer 902 to ensure separation and maximum steam exposure. The sterilization cabinet 2202, 2502, and 2602 has been validated to sterilize 375 lbs. of instruments along with the spacers 902. The validation was conducted with 15 instrument trays at 25 lbs. Actual expected loads in hospital settings are likely to be less. For example, loads in a hospital setting are more typically 140 lbs or less, and even more typically approximately 110 lbs. It should be appreciated that sterilized instruments can be stored for up to 30 days within the closed (intact filters) sterilization container.
The sterilization cabinet 2202, 2502, 2602 is loaded into the sterilizer, for example, an autoclave, with a transfer carriage (not shown).
The use of a single-use disposable filter cartridge 1302, 1402, 1502, 1602, 1700 installed in the fenestrated door 2506, 2612 eliminates the need for a sealed gasket found on prior systems. The omission of a reusable gasket eliminates contamination risks due to failed reusable gaskets. It is understood the single use disposable filter can be used with a separate or integral cartridge.
The sterilization cabinet 2202, 2502, 2602 is indicated for enclosing other medical devices that are to be sterilized by a healthcare provider. It is intended to allow sterilization of the enclosed materials and maintain sterility for up to 30 days until used. The sterilization cabinet 2202, 2502, 2602 is intended to be used in pre-vacuum steam sterilizers with a prevacuum cycle of 270° F. (132° C.) and exposure time of 4 minutes. The sterilization cabinet 2202, 2502, 2602 is intended to be used with Turbett Surgical filters.
Validation was done using three trays per level and a maximum instrument load of 25 lbs. per tray. The validation load included six 1 mm×500 mm lumens and six 3 mm×400 mm lumens. The total weight of instruments and trays validated is 375 lbs. The trays holding instruments within the sterilizing cabinet 100 were uncovered, perforated or wire mesh general delivery trays.
The principal material of construction of the sterilization cabinet 2202, 2502, 2602 may be stainless steel and aluminum. However, it should be appreciated that other materials may be used. In one configuration, the overall size is 34″×24″×22″. The empty container 210 weighs approximately 136 lbs. It is thus a relatively large container, typically associated with a transfer cart. In this configuration, the venting pass through area includes 905 holes, each having a diameter of approximately 0.74 inches, thus providing a venting pass through area of 398.2 (approximately 400) square inches. Thus, in an exemplary embodiment, the where the volume is approximately 17,952, cubic inches based on the overall size, the venting pass through area to volume ratio is approximately 0.022 inch2 per inch3 or 11 square inches:500 cubic inches. If internal dimensions provide a volume of approximately 14,846 cubic inches, the venting pass through area to volume ratio is approximately 0.027 inch2 per inch3 or 27 square inches:1000 cubic inches. It should be appreciated that exemplary embodiments of the sterilization cabinet can be other dimensions, shapes and sizes that provide similar vent to volume ratios, wherein the ratio is at least approximately 0.022 inch2 per inch3 or 11 square inches:500 cubic inches, and in select configurations between 0.008-0.21 inch2 per inch3, (1 square inch:125 cubic inches and 21 square inches:100 cubic inches) and in further configurations, between 0.16-0.2 inch2 per inch3 (4 square inches:25 cubic inches and 1 square inch:5 cubic inches). That is, the sterilization container, such as the cabinet may be configured of any shape or size so long as the venting pass through area has dimensions corresponding to the volume to provide the desired vent area to volume ratio. Similarly, the venting area may have many shapes, sizes and/or locations on the sterilization cabinet, so long as the venting area and volume meet the vent pass through area to volume ratios.
Technological Characteristics:
The sterilization cabinet 2202, 2502, 2602 has been validated to sterilize 375 lbs. of instruments along with the spacers 902. The validation was conducted with 15 instrument trays at 25 lbs. each to represent the most challenging case. The validations included thermal profile, sterilization efficacy, and drying in a pre-vacuum steam sterilizer. Sterilized instruments can be stored for up to 30 days within the closed container.
The sterilization cabinet 2202, 2502, 2602 is constructed of 304 stainless steel sheet metal on a rigid stainless steel frame. The sterilization container, such as the cabinet opens from the side for easy placement and retrieval of surgical trays. In one configuration, a sidewall is omitted to define a door way or opening to the cabinet for inserting and removing trays (medical instruments). A filter 1700 comprised of 1 or 2 layers of filter paper 1704, 1706 and a compressible gasket 1702 is placed between the door and the cabinet, such that a portion of the filter or gasket is disposed between the door and the cabinet to form a sealed interface. After use (the sterilization process and removal of the trays (the sterilized medical instruments), the filter 1700 having the compressible gasket 1702 is discarded.
The following testing was conducted to establish substantial equivalence and efficacy:
Turning now to
Exemplary embodiments of sterilization cabinet 2202 can include a single vent or a plurality of vents to define the venting pass through area, so long as the venting pass through area to volume ratio between 0.008-0.21 inch2 per inch3 (or 1 square inch:125 cubic inches and 21 square inches:1000 cubic inches) and in select configurations between 0.16-0.21 inch2 per inch3 (or 4 square inches:25 cubic inches and 21 square inches:1000 cubic inches), or in further configurations equal to or greater than 0.021 inch2 per inch3 or 21 square inches:1000 cubic inches.
The high venting pass through area to volume ratio reduces the drying time required after the sterilization cycle. That is, assuming multiple trays of medical instruments in a sterilization cabinet 100, for example, up to 15 trays, are placed in a sterilizer device, such as an autoclave, the sterilization cabinet 2202, with the venting pass through area to volume ratio of 0.021 per inch, would require a dry time of less than 30 minutes, and more specifically approximately 10-15 minutes, and even more specifically, 10 minutes. In one configuration, a dry time of less than 15 minutes is provided when a ratio of the venting pass through area to the interior volume of the sterilization cabinet 2202 is between 0.008-0.21 inch2 per inch3 (or 1 square inch:125 cubic inches and 21 square inches:1000 cubic inches). In another configuration, the drying time is approximately 10 minutes for up to 140 lbs of medical instruments arranged in the sterilization cabinet 2202 on multiple trays.
In one configuration, the sterilization container has dimensions of approximately 34 inch by 22 inch by 24 inch and the door has 869 holes at 0.766″ diameter and 32 holes at 0.5″ diameter. Thus, the vented pass through area is 400 inch2 plus approximately 6 inch2. Thus, the ratio of the venting pass through area to the interior volume of the sterilization cabinet is approximately 406 inch2 to 17952 inch3 or 0.0226 inch2 per inch3.
As shown in
In one configuration, the total venting pass through area 3008 of the sidewalls 3002 and top wall 3006 to the interior volume of the sterilization cabinet 3000 ratio is greater than 0.008 inch2 per inch3. The high venting pass through area to volume ratio is sufficient to provide a dry time of 30 minutes or less, and more preferably 15 minutes, and even more preferably 10 minutes. In one configuration, these drying times are achieved when 140 lbs of medical instruments are loaded on trays in the sterilization cabinet 3000. The venting pass through areas 3008 of the sterilization cabinet 3000 may be smaller or larger, of a different shape, or provided on a different location of the sidewalls, top wall, bottom wall, and/or door, or include a plurality of holes or a fenestrated grid throughout its center, provided, however, that the venting pass through area to volume ratio is greater than 0.008 inch2 per inch3 (or 1 square inch:125 cubic inches).
The present system is distinguished from prior trays which were wrapped with filter media, then disposed in an autoclave and transported to the surgical field after the sterilization process, in that there is no sterilizing container having a plurality of sidewalls and an opening for receiving an instrument tray, with a filter occluding a venting pass through area and the ratio of venting pass through area to volume of the sterilizing container being at least 0.008 inch2 per inch3 (or 1 square inch:125 cubic inches) and in further configurations the ratio being from 0.16 to 6 inch2 per inch3 (or 4 square inches:25 cubic inches to 6 square inches:1 cubic inch).
Further, the sterilization container of the present system can accommodate trays with instruments or devices in the tray, wherein the instruments or devices may or may not be wrapped with filter paper and the tray may or may not be wrapped with filter paper. Thus, it is contemplated the sterilization container can retain unwrapped trays with instruments or devices, wrapped trays with instruments or devices, unwrapped instruments or devices as well as wrapped instruments or devices wherein the ratio of the venting pass through area to volume of the sterilization container provides drying times less than 30 minutes and in select configurations less than 15 minutes after the sterilization cycle.
While select configurations may include a drain for passing condensate from the interior of the sterilization container, it is contemplated that other configurations having the present ratio of venting pass through area to volume can provide the reduced drying time (such as 10 minutes) without draining the condensation. In a further configuration, the floor of the sterilization container can be configured to collect or pool condensation within the container.
Number | Name | Date | Kind |
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3925043 | Matrone et al. | Dec 1975 | A |
5369892 | Dhaemers | Dec 1994 | A |
5968459 | Nalepa | Oct 1999 | A |
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20180221803 A1 | Aug 2018 | US |
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62482170 | Apr 2017 | US | |
62482683 | Apr 2017 | US | |
62483008 | Apr 2017 | US |
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Parent | 14584751 | Dec 2014 | US |
Child | 15461895 | US |
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Parent | 15461895 | Mar 2017 | US |
Child | 15946442 | US | |
Parent | 14167691 | Jan 2014 | US |
Child | 14584751 | US |