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Sterilisation for mobile work

Discussion in 'General Issues and Discussion Forum' started by akn102, Jun 11, 2008.

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  1. akn102

    akn102 Active Member

    Members do not see these Ads. Sign Up.
    I hope someone can give me some advice. I've just acquired an autoclave (gone from a little top loading one to a larger Little Sister to comply with need for printer etc). The only snag is this. I've got the plastic trays with lids for mobile work I didn't think the perforated ones were appropriate for mobile work. Only the engineer who came out and serviced the machine when I got it says you can't put solid boxes in it as it'll come up with an error (guessing trapped steam?). So I then thought ok I'll get some perforated boxes as I keep all sterile instruments in a separate sealed box in the car - only problem then is the lids they are all solid. I'm not entirely happy about using perforated boxes. Would be very interested to know what others do about this??

    Many thanks
  2. Admin2

    Admin2 Administrator Staff Member

  3. pgcarter

    pgcarter Well-Known Member

    I use self sealing bags in the autoclave and carry the sterile sets in these bags in a clean plastic box....works fine and is accepted practice in Aus
  4. pgcarter

    pgcarter Well-Known Member

    I use self sealing bags in the autoclave and carry the sterile sets in these bags in a clean plastic box....works fine and is accepted practice in Aus
  5. DTT

    DTT Well-Known Member

    I assume you use a vacuum autoclave ??

    It sounds like Amanda has not?? in which case she cannot sterilise in bags.

    Just my thoughts


  6. pgcarter

    pgcarter Well-Known Member

    iN Aus the regs say displacement autoclave for bags is OK. A B class Vacuum autoclave is only required for tubular equipment like dental drill handpieces etc. Next time I buy an autoclave I intend to buy B class.......
  7. kitos

    kitos Active Member

    I autoclave (non vac Little Sister) instruments on the metal autoclave trays and then tip instruments into solid blue instrument boxes (one set per patient obv). I clean out these boxes with Trionic D wipes which kill just about everything (but are so soft on my hands :) )

    You could also soak the boxes in between time in Presept solution if you wanted to make absolutely certain.

    Best wishes
  8. DTT

    DTT Well-Known Member

    Hi Again

    Then I think Amanda must check the regulations/recommendations for her country as they obviously vary.

    Over here Sterilising of hollow or wrapped instruments ( including sterilisation bags) can only be done in a vacuum autoclave.


  9. akn102

    akn102 Active Member

    Hello again,
    No it isn't a vacuum autoclave so I can't use bags. I am well versed with the regulations regarding the need to sterilise. Its the autoclave manufacturers guidance that you can't use solid boxes because trapped steam will cause an 'error' on the autoclave and thus a failure to complete the cycle. I'm therefore forced to use perforated boxes which I don't particularly like doing as I take the view that i like sterilised instruments in a solid box for obvious reasons. At the moment I'm keeping all the sterilised instruments in a clean box well separated from anything else. I just wondered what other people do?? Thought perhaps someone had come up with a clever way round this?

  10. pgcarter

    pgcarter Well-Known Member

    The makers of many different types of autoclave say its fine to use bags in displacement autoclaves.....mine is Euroclave 23S from Germany.....why would one be different if they all do basically 2 bars pressure for 5 minutes or so? .... maybe physics and biology work different in the UK?
    Regards Phill
  11. DTT

    DTT Well-Known Member

    Hi Phil

    Just in case something is being lost in translation

    is a "displacement autoclave" what we term a Vacuum autoclave by any chance ??

    ( just a thought):confused:

    I use a Prestige Century 3 Vacuum Autoclave and the manufacturer and the regulatory bodies and all recommendations I have read state the "a vacuum autoclave is the ONLY means of sterilising wrapped or hollow instruments".

    NON Vacuum Type is not effective for sterilising in bags as Amanda states.

    Perhaps we have more stringent regulation in the UK ??

    Out of interest mine takes after self testing, 3 minutes @ 135 degrees at between 2.22 and 2.36 Bar. the Hold time is 02.00 mins . The complete cycle takes 1 hour 7 minutes to complete (as of the last print out)

  12. AndyBru

    AndyBru Member

    So what do you do for working in a nursing home when you have 20 -30 persons to see in a day?? Cant carry a little sister there can we. Any suggestions to meet the regulations!

  13. DTT

    DTT Well-Known Member

    Irrespective of the manufacturer, pouched instruments are the way to go Andy, just out of interest again , I have just had my service renewal in from prestige .... £666.23 for 2 service visits per year:eek:

    Please no-one tell me I charge too much for my services in future :butcher:
  14. AndyBru

    AndyBru Member

    Agree bagged equipment is best for dom work however if your working in nursing home or such you may have upto 30 persons to deal with, i dont have 30 sets of equipment so will need another way forward. I use the prest 2000 reasonably portable.
  15. Dido

    Dido Active Member

    I am amazed that you can manage to treat 30 pts a day in a nursing home. How do you cope with all the record-keeping, lifting, bending, decontamination etc

    Don't you get back trouble ?!

  16. Debalem

    Debalem Member

    Hi andy
    This is a problem for me too. I work in lots of residential care homes and use as many sets of instruments as I have. After that disposable are the answer. This is a costly and inconvenient solution and it is about time someone invented a portable autoclave that complies with regulations.
  17. Dido

    Dido Active Member

    Debalem & AndyBru,

    I was wondering how Pressure Vessel Insurance would cover a mobile autoclave?

    In the Baldwin HPC hearing there was a concern raised about moving an autoclave and upsetting the calibration.

    I think the obvious answer is a vacuum autoclave and bagged instruments.

  18. Graham

    Graham RIP

    For the price of a new autoclave you could probably buy the instruments you need to do your job properly and sterilize at home!
  19. DTT

    DTT Well-Known Member


    You do,


    Someone has stated a very real fact that is often missed on this site ,

    A PROFIT is an absolute necessity to a viable business.

    If you aint gettin that it's never gonna work .. only you will:rolleyes:
    Last edited: Feb 4, 2010
  20. kitos

    kitos Active Member

    Well said Derek.

    My major thought is that if someone is seeing 30 patients in one day then...

    a) their backs must be a hell of a lot stronger than mine doing Doms
    b) they must be...or should be earning so much money that they can afford to buy single use and
    c) how many instruments can you possibly need when you are dealing with that amount of patients? Nippers, file, scalpel maybe and burr?
    d) how many times are they seeing 30 patients/day in a month anyway?

    And as you say....how much are they charging? !

    Just a question of maths and a need to keep it easy as I see it.


    I mean it's all tax dedecutible anyway
  21. David Widdowson

    David Widdowson Active Member

    Not entirely relevant but may be of interest to UK practitioners.

    I ran a century 2 vacuum autoclave which decided to die. While waiting for the engineer my wife happened to be visiting a local GP surgery and mentioned that my autoclave was defunct. Oh, said the practice manager, we have one we don't use now if he wants it he can have it.
    Apparently GP's were "encouraged" to buy vacuum autoclaves a few years ago but have since been "encouraged" to use central NHS sterilization departments.
    Thus, leaving a lot of GP's with autoclaves they are loath to pay decomisioning costs on, so leave them sitting on benches unused.
    So for a very small donation to the GP's favourate charity I now have a replacement which the independent engineer was soon on hand to inspect and certify as OK.

    It is worth a phone call to your local GP to offer free removal!

    Also why pay Prestige exorbitant rates when there are independent inspection companies
    who will carry out repairs, contracts and certification?
  22. DTT

    DTT Well-Known Member

    Hi David

    Yes I had thought of that one. The problem is finding one that will re validate , calibrate and certify it as correct. I have had offers to service the machine but they will not commit in writing on the service record.

    The machine I have ( which I'm sure is the same sort of system to all other vacuum autoclaves) tests itself on every cycle which is shown on the print out. If any part fails the cycle is aborted by the machine so I wonder why I need 2 service visits per year ???

    The reason is to comply with manufacturers servicing instructions which I'm informed would make up an important point of law in the unlikely event of legal action being taken should I breach them.

    I chat with the engineers who tell me as a single practitioner the usage on my machine is very very light compared to the "department" ones so yes I agree with you but unless you know of anyone?? .....I paid the money Wednesday :eek:

    Oh and BTW if you are going to collect one from the GP , take a strong friend with you ,they weigh a ton !!!:D
  23. David Widdowson

    David Widdowson Active Member

    Hi DDT
    Yes they are a little heavy are they not - I have the pulled muscles to prove it!
    I use Independent Inspections of Watford 020 8421 3366. I have have used them for 10 years with different machines and never had a problem.
    Next year perhaps?
  24. DTT

    DTT Well-Known Member

    Hi David

    Bugger when that happens innit :D

    Thanks for the info, I will keep that on record for next year :eek:

    Aint it funny how the minute the cheques cleared it breaks, or someone come up with a better price :rolleyes:
    Thanks again
  25. R.E.G

    R.E.G Active Member

    Del, your old mate REG.

    I'm sure these vacuum autoclaves are wonderful, especially when they 'check' themselves.

    However my 'engineer' has explained that the only thing the inbuilt 'check' can check is the inbuilt check'.

    So in the very old computer saying 'rubbish in rubbish out', do the checks you have use external equipment to validate your machine or does the engineer rely on the machines 'computer' to give a series of 'tests'.

    This is very important especially when people rely on their 'daily checks'.

    Finally what is the justification for having to use a vacuum autoclave to process instruments for domiciliary practice?l

    Please not that they are sterile at the point of opening?

    Even in a clinical setting we are only using clinically clean instruments?

    So what is wrong with sterilizing instruments then bagging them for use with in a limited time frame?

  26. DTT

    DTT Well-Known Member

    Bobby how the devil are you :D

    Yep he's right, but then again bollox is bollox if you talk bollox innit??

    The engineer carries out his own tests with his own equipment and RE-VALIDATES the correct operation of the machine

    The manufacturer VALIDATES the correct operation of the appliance. If it's wrong.... down to them provided I have followed their code.

    C'mon Bob you argued against me on that one many times :bang:

    The second you open you door on your autoclave without bagged instruments (if you actually have one) you are in the clinically clean situation??

    Which I believe is 3 hours ??

    How many doms can you do in that time frame before you have to go back and re-sterilise ??

    The quote that prompted my response was 30 patients in a day on doms ??:eek:

    Gimme a break pleeeeeeese :rolleyes:
    Your old mate Del ;)
    Last edited: Feb 6, 2010
  27. R.E.G

    R.E.G Active Member

    Gimme a break pleeeeeeese :rolleyes:

    Del not having a go at you at all, just trying to debunk some of the myths surrounding decontamination, sterilization and autoclaves.

    First myth 2010 is not a date it's a document number.

    2nd myth instruments used in Podiatry are sterile they are not they have been sterilized, they are at the point of use clinically clean.

    3rd myth 3 hours to use instruments once exposed to the air. Depends who you read, however I have never seen any evidence to back up any of the assertions.

    So should we try to remember what the purpose of the decontamination process is? I do not believe it is to defend yourself in case of a court action, but to minimise the risk of cross infection.

    If you use a sterile blade to debride a callus and inadvertently cut someone no amount of vacuum autoclaving will stop that wound becoming infected by commencal bacteria on the patients own skin. That situation is avoided by our technique.

    Just my peculiar way of looking at the world and always asking why?

    And yes I agree 30 patients in a day in a home is going it a bit but quite doable if well organised.

  28. DTT

    DTT Well-Known Member

    Thank you and excuse me for my assumption you were.

    That applies to most surgical procedures. As soon as the instrument reaches the air it is contaminated in one way or another. The steralising and renders the instrument clinically clean at point of use and simply reduces the cross infection risk.

    I remember reading something about a 3 hour window for unpouched instruments,I cant remember exactly but it could well have been in another thread on here ??.

    I believe it is both Bob. If I have done everything possible to protect a patient from cross infection then I cannot be reasonably critisised in any court ,HPC hearing , or by anyone else.

    I have always tried to stay ahead of the game as far as my practice goes and as I have re-invested in more modern equipment and kept up with the current thinking in podiatry across the board. I have always tried to go for the best available to suit my / my patients needs hence the vacuum autoclave which at the time I got it was the best available. Times change ,thinking changes, I'm not convinced that there is anything better around for me at the moment. I also have many sets of instruments which means I only have to autoclave a couple of times a week now rather than several times daily which is an obvious time saver.

    I also think podiatry needs to look at itself and adopt a much more common sense approach to infection control. I believe a podiatrist without the knowledge or skills as an IPP will not survive because if a constant stream of infections eminate from that one source ,other pods ,GP's will soon notice and the word will spread very quickly to damage the reputation and the viability of practice.

    We have both been around a long time Bob and we have seen em come and seen em go =self regulating ??

    As an example,I was called in to sort out a group of nursing homes several years ago because virtually every patient that had been treated by their current pod had developed repeated sepsis on their feet and the home GP told the staff to contact me.

    It topped up she was taking her dogs to the homes leaving them in the car but "giving them a run" in between patients.

    She got the slingers the sepsis stopped normal service was resumed so as I say self regulating.

    It is also interesting to note ( unless I am alone in this) I haven't noticed a flood of septic toes coming in as a result of volunteers cutting nails with "contaminated nippers" have you ?? The odd one or two perhaps but.........
  29. Dido

    Dido Active Member


    It's too easy to blame the dog. It was more likely the pod's infection control protocols were lax.

    I wonder how she had time "in between patients"?

    I sometimes took my dog with me to work in an estate car, when I worked for the NHS. I always took him for a run at lunch-time and non of my patients got sepsis. That's because I got changed before I went dog-walking, and changed back again afterwards, washed hands etc.

    The bacteria that cause sepsis are rarely carried by dogs - unless they have an infected wound.

    See - www.allaboutpets.org.uk/factsheets/dog/health/dogs-and-human-health.aspx

    Last edited: Feb 8, 2010
  30. DTT

    DTT Well-Known Member


    I dont think that was the case in the instance I quoted hence the infections.

    Dogs are like it or not carriers of all sorts of nasty things why do you think they are not allowed in any patient treatment area's ??

    You may be a responsible dog owner , many are not, and the love me love my dog attitude is NOT shared by all of that you can be sure .
  31. George Brandy

    George Brandy Active Member

    Oh dear. This last 4 weeks a constant stream of infections has emanated from my practice with the patients presenting already infected and asking for help. One I can put down to poor care from another source, the others were as a direct result of patient bad luck combined with extreme climate -cold, damp feet for extended periods of time.

    It happens seasonally when we experience extremes of climate and no amount of infection control can prevent this happening, so Derek a wide sweeping generalisation perhaps shows confusion in your own knowledge?

    A common sense approach to infection control calls for more than the appropriate standard of decontamination for your practice, it also calls for knowledge of practice too.

    It scares the pants off me that the knowledge the HPC are working with comes from certain somebodies that perhaps do not practice, do not have a working knowledge of IPP and perhaps do not converse with the manufactures/engineers of said autoclaves.

    I firmly believe that no matter how scrupulus we are with our standards of infection control, ignorance of those working in patient defence will shoot bullets clean through them.

    How do I know when patient A comes in that they have the remnants of chewing gum stuck to the bottom of their shoe collecting a wild array of all sorts of tut and gubbins. How do I know if whatever tut and gubbins gets deposited within my working environment, my infection control deals with. I don't, I can't and won't. The lawyers know this.

    All I can do is have a formal policy in place for infection control relating to my practice, this includes decontamination, cleaning regime and personal hygiene.

    I tend to agree with Bob's approach but urge evidence of all aspects of infection control and the most amazing set of comprehensive notes you can muster plus an ability to write a good letter of referral if patients require antibiotic cover.

  32. DTT

    DTT Well-Known Member

    Exactly my point , The patient "came to you WITH an infection" not caused by your poor standards.

    I agree,that is all we can do .

    The statement wasn't made as a "generalisation" more an opinion. The knowledge I have is shown by my track record and decontamination / sterilisation protocols,traceable instruments print outs that self check the temperature and hold time pressures and the rest, regular service visits.

    I'm still waiting for the rush of patients that have been promised by you and yours George from the nail cutting volunteers using contaminated nippers to cut nails? Or perhaps the lawyers are massing and booking court time to prosecute them all and we haven't heard about it yet ??

    The point I'm making is whilst we are governed and use time and expense to carry out our procedures should we look around us more and use some common sense in the equation?

    And on that note

    You really must have an awful lot of time on your hands, common sense dictates make a record on the notes and send the patient off to ask for an AB of the GP,s choice. Most of my patients are quite capable of understanding and carrying out simple instructions, but yours may be different ?? I certainly don't have the time to write letters for simple requests which I'm sure my very busy GP's are thankful for as well.

    If the patient has difficulty a short note or on the back of a business card to refresh their memory is all that is needed

    Last edited: Feb 8, 2010
  33. George Brandy

    George Brandy Active Member

    OK Derek. Different GP's have different expectations. It would not go down too well locally if I sent a patient to ask their GP for antibiotics without a letter.

    I run a busy and effective practice. Any letters are processed by my receptionist, in reception, whilst I see my next patient. She is very good and produces a professional letter. I sign it and then it is placed in an envelope and taken to the GP's receptionist by patient. I always suggest that the patient gets the receptionist to read the letter. More often than not this usually results in a prescription being supplied within minutes of patient arrival at GP surgery.

    This method saves the GP both time and cost. It is simple and effective marketing. I also have created evidence to show that with patient consent I acted responsibly and communicated the need for antibiotics to the GP.

    If the patient chooses not to take the letter to the GP as instructed or delays in taking the letter resulting in a more serious problem then I have the paper chase to back up my defence.

    I have also provided evidence of a request for antibiotics for the GP.

    I find this approach professional.

    Last edited: Feb 8, 2010
  34. DTT

    DTT Well-Known Member

    Yes you are correct in your different approach .

    I know many of the GP's personally in my area and how busy they are. They respect me enough to know if a patient of mine rings their surgery telling them they have seen me and I have said they need AB's they are forthcoming, with a cursory exam from them and best wishes sent.

    I don't know if you work in a "country area" ?? by your replies I believe you must do.

    It is "different gravy" where I practice ALL GP's are hard pressed and short of time and respect practitioners they trust, hence the difference in practice.

    Both yours and my ways work in their own environments, probably not in each others.

    As I said in another thread you are involved in.......Networking to understand each others ways is the only way forward IMHO :empathy:

    Perhaps one day .........

  35. cornmerchant

    cornmerchant Well-Known Member

    I would say that George has it spot on for professionalism, and is covering himself at the same time. This was how we were trained, and I am sure it is how NHS referrals take place. Letter writing is a skill that should be perfected in any medical discipline.

    However, I too have adapted my approach to suit my practise.

    I can understand that you know all the GPs personally, but I am not sure how it saves them time if they still have to see the patient albeit a "cursory" glance.

    If I have a patient that needs antibiotics, I ring the practice myself, and speak to the receptionist or the GP and request them. The prescription is then provided as quickly as possible. I never send a patient off with a note scrawled on the back of a business card, as not only is it unprofessional, but it can get lost or the patient fail to follow through. This system works for me as I have built up good referral pathways and the GPs trust my diagnosis. It is also the quickest way to get the prescription written .

  36. George Brandy

    George Brandy Active Member

    Derek, my dear fellow, whilst your decontamination standards reach dizzy heights for general practice, your infection control policy appears lacking.

    I am still trying to fathom how a note on the back of a business card, along with personal friendships with GPs would stand up under a lawyers scrutiny. I just don't get it. When it comes to dog eat dog in a no win no fee situation I would rather rely on my approach to infection control than yours.

  37. Dido

    Dido Active Member

    I would follow CM's approach for doms and ring the GP practice myself. I would arrrange for the prescription to be left for collection by a carer/relative/neighbour. If the patient had mobility problems/problems with self-care, I would also ring the DNs and ask them to visit and redress the lesion within 3/4 days.

    For patients that come to the surgery I use GB's system. There is a preprinted form that can be used and the receptionist can give this to the patient to take to the GP practice.
    If the patient seems a bit unsure or confused, the receptionist would ring the surgery and make an appointment for them that day to see the Nurse Practitioner.

    So no need to bother the GP.

    In this way everyone knows what they are doing and there is a paper trail to show that all the bases have been covered.

  38. DTT

    DTT Well-Known Member


    Can you instance me one case where this has ever happened ??

    The bogy man cometh may have its place George but not I think over a pt asking for antibiotics and me giving them a reminder on a business card.
  39. DTT

    DTT Well-Known Member


    I'll leave that to your imagination as to whether the Rx is already waiting for them on their arrival at the Gp's surgery :D

    R U SURE :wacko: if they lose it don't you think they will ring me?? and they are the ones in pain and with the infection whats the probability they don't follow through?? and if they don't its their choice not to.

    You probably are aware I'm not a fan of the nanny state and expect common sense to be applied which it has been over many years in practice.

    And yes I still make the referral pathways with my common sense system.
  40. cornmerchant

    cornmerchant Well-Known Member


    I am so sorry , I do not understand , even in my imagination, how a prescription which is on the back of your business card can be waiting at the GPs when the patient arrives. Maybe the receptionist or the GP are psychic?

    I dont believe that complying to recommendations and regulations in a professional capacity is bowing to the nanny state.

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