This prevents the egg from reaching the uterus and also keeps the sperm from reaching the egg. Tubal ligation is effective immediately after the procedure. Nonsurgical sterilization may take up to three months to be effective as the scar tissue forms.
Results for both procedures are typically permanent with small risk of failure. How is female sterilization performed? A doctor must perform your sterilization. Tubal ligation For a tubal ligation, you will need anesthesia. Your doctor inflates your abdomen with gas and makes a small incision to access your reproductive organs with the laparoscope.
Then they seal your fallopian tubes. The doctor may do this by: cutting and folding the tubes removing sections of the tubes blocking the tubes with bands or clips Some sterilization procedures require only one instrument and incision, while others require two. Discuss the specific procedure with your doctor in advance. Nonsurgical sterilization Essure Currently, one device has been used for nonsurgical female sterilization. It consists of two tiny metal coils.
One is inserted into each fallopian tube through the vagina and cervix. Eventually, scar tissue forms around the coils and blocks the fallopian tubes. Essure has been recalled in the United States, effective December 31, In April , the U. Patients had reported pain, bleeding, and allergic reactions. Also, there have been instances of the implant puncturing the uterus or shifting out of place.
More than 16, U. The FDA has acknowledged that there have been serious problems associated with the contraceptive and has ordered additional warnings and safety studies. Recovery from female sterilization. Most people are discharged that same day, normally within two hours. An ideal sterilization wrap would successfully address barrier effectiveness, penetrability i. Unacceptable packaging for use with ETO e.
In central processing, double wrapping can be done sequentially or nonsequentially i. Wrapping should be done in such a manner to avoid tenting and gapping. The sequential wrap uses two sheets of the standard sterilization wrap, one wrapped after the other.
This procedure creates a package within a package. The nonsequential process uses two sheets wrapped at the same time so that the wrapping needs to be performed only once. This latter method provides multiple layers of protection of surgical instruments from contamination and saves time since wrapping is done only once. Multiple layers are still common practice due to the rigors of handling within the facility even though the barrier efficacy of a single sheet of wrap has improved over the years Written and illustrated procedures for preparation of items to be packaged should be readily available and used by personnel when packaging procedures are performed All items to be sterilized should be arranged so all surfaces will be directly exposed to the sterilizing agent.
Thus, loading procedures must allow for free circulation of steam or another sterilant around each item. There are several important basic principles for loading a sterilizer: allow for proper sterilant circulation; perforated trays should be placed so the tray is parallel to the shelf; nonperforated containers should be placed on their edge e.
Studies in the early s suggested that wrapped surgical trays remained sterile for varying periods depending on the type of material used to wrap the trays. Safe storage times for sterile packs vary with the porosity of the wrapper and storage conditions e. The 3-mil polyethylene is applied after sterilization to extend the shelf life for infrequently used items Supplies wrapped in double-thickness muslin comprising four layers, or equivalent, remain sterile for at least 30 days.
Any item that has been sterilized should not be used after the expiration date has been exceeded or if the sterilized package is wet, torn, or punctured. Although some hospitals continue to date every sterilized product and use the time-related shelf-life practice, many hospitals have switched to an event-related shelf-life practice.
This latter practice recognizes that the product should remain sterile until some event causes the item to become contaminated e. Event-related factors that contribute to the contamination of a product include bioburden i. There are data that support the event-related shelf-life practice One study examined the effect of time on the sterile integrity of paper envelopes, peel pouches, and nylon sleeves. The most important finding was the absence of a trend toward an increased rate of contamination over time for any pack when placed in covered storage Another evaluated the effectiveness of event-related outdating by microbiologically testing sterilized items.
During the 2-year study period, all of the items tested were sterile Thus, contamination of a sterile item is event-related and the probability of contamination increases with increased handling Following the sterilization process, medical and surgical devices must be handled using aseptic technique in order to prevent contamination. Sterile supplies should be stored far enough from the floor 8 to 10 inches , the ceiling 5 inches unless near a sprinkler head [18 inches from sprinkler head] , and the outside walls 2 inches to allow for adequate air circulation, ease of cleaning, and compliance with local fire codes e.
Medical and surgical supplies should not be stored under sinks or in other locations where they can become wet. Sterile items that become wet are considered contaminated because moisture brings with it microorganisms from the air and surfaces. Closed or covered cabinets are ideal but open shelving may be used for storage. Any package that has fallen or been dropped on the floor must be inspected for damage to the packaging and contents if the items are breakable. If the package is heat-sealed in impervious plastic and the seal is still intact, the package should be considered not contaminated.
If undamaged, items packaged in plastic need not be reprocessed. The sterilization procedure should be monitored routinely by using a combination of mechanical, chemical, and biological indicators to evaluate the sterilizing conditions and indirectly the microbiologic status of the processed items. The mechanical monitors for steam sterilization include the daily assessment of cycle time and temperature by examining the temperature record chart or computer printout and an assessment of pressure via the pressure gauge.
Generally, two essential elements for ETO sterilization i. Chemical indicators are convenient, are inexpensive, and indicate that the item has been exposed to the sterilization process. In one study, chemical indicators were more likely than biological indicators to inaccurately indicate sterilization at marginal sterilization times e. Chemical indicators should be used in conjunction with biological indicators, but based on current studies should not replace them because they indicate sterilization at marginal sterilization time and because only a biological indicator consisting of resistant spores can measure the microbial killing power of the sterilization process.
Chemical indicators are affixed on the outside of each pack to show that the package has been processed through a sterilization cycle, but these indicators do not prove sterilization has been achieved. Preferably, a chemical indicator also should be placed on the inside of each pack to verify sterilant penetration. Like other sterilization systems, the steam cycle is monitored by mechanical, chemical, and biological monitors.
Steam sterilizers usually are monitored using a printout or graphically by measuring temperature, the time at the temperature, and pressure. Typically, chemical indicators are affixed to the outside and incorporated into the pack to monitor the temperature or time and temperature. The effectiveness of steam sterilization is monitored with a biological indicator containing spores of Geobacillus stearothermophilus formerly Bacillus stearothermophilus.
Positive spore test results are a relatively rare event and can be attributed to operator error, inadequate steam delivery, or equipment malfunction. Portable table-top steam sterilizers are used in outpatient, dental, and rural clinics. The ability of the sterilizer to reach physical parameters necessary to achieve sterilization should be monitored by mechanical, chemical, and biological indicators.
The oldest and most recognized agent for inactivation of microorganisms is heat. Because a D-value can be determined at various temperatures, a subscript is used to designate the exposure temperature i.
D C -values for Geobacillus stearothermophilus used to monitor the steam sterilization process range from 1 to 2 minutes. Heat-resistant nonspore-forming bacteria, yeasts, and fungi have such low D C values that they cannot be experimentally measured. Moist heat destroys microorganisms by the irreversible coagulation and denaturation of enzymes and structural proteins. These autoclaves start the sterilization phase after the required temperature inside the pressure vessel of the autoclave has been reached.
The equilibration time required for the liquid to also reach the required temperature is not taken into consideration. The liquids thus never reach a sterilization temperature of e. Depending on the resistance of the micro-organisms to be deactivated, they are only deactivated in part or not at all. By measuring the temperature inside a reference vessel by means of a temperature sensor, the exact temperature of the liquid to be sterilized can be determined and then used to regulate the sterilization process.
Sterilization time starts only, after the required sterilization temperature inside the liquid has been reached.
The reference vessel is to be filled with water. It is crucial, that size and filling level of the reference vessel correspond to the largest vessel filled with the liquid to be sterilized. The temperature sensor for measuring inside the reference vessel is required to ensure that the sterilization temperature inside the liquid is reached. It is also required to ensure a safe removal temperature after the sterilization has been carried out.
The thermal heat transferred into the liquid in connection with the associated excess pressure may cause considerable hazards for the operator of an autoclave. For example, a delayed boiling may occur which means that the liquid will spontaneously start to boil when the autoclave is opened. This instantaneous boiling will generate a pressure wave consisting of steam and hot liquid, erupting — similar to a geyser — from the vessels.
Based on this considerable hazard potential, autoclaves used for sterilizing liquids are subject to corresponding regulations. DIN EN stipulates that autoclaves used for sterilizing liquids must be equipped with safety devices preventing an opening of the autoclave before the liquids have not been cooled down to a removal temperature safe for the operator.
A safe removal temperature is defined in the standard to be 20K below the boiling point of water at atmospheric ambient pressure. State-of-the-art autoclaves are equipped with a temperature and pressure dependent door lock. Cooling liquids down to a safe removal temperature may take a rather long time. A size frequently used for autoclaves in labs is an autoclave with a pressure vessel capacity of approx. Is such an autoclave filled with bottles containing the liquid to be sterilized, the total sterilization cycle may take up to 10 hours.
It is thus recommended to equip the autoclave with a recooling system considerably reducing the overall time required to sterilize the batch and preventing further hazards and disadvantages when sterilizing liquids. Quick recooling — maximizing productivity and safety Recooling systems available for autoclaves basically distinguish between two types of cooling systems:.
Cooling by evaporation — boiling the liquid during the cooling phase 2. Cooling by radiation — heat radiating from the liquid, no boiling of the liquid with this cooling system. Cooling by evaporation is the most frequently used type of cooling inside an autoclave.
That may be: — Self-cooling via slowly releasing steam — Ventilation cooling — cold ambient air is ventilated onto the pressure vessel from the outside — Water cooling without support pressure. All cooling types stated above have serious disadvantages when sterilizing liquids and may contain considerable hazard potential, if the sterilization process is not carried out properly, as this type of cooling requires the liquid to be cooled down to boil.
When the liquid boils during the cooling phase, part of the liquid is lost. Especially, if the protein content of the liquid is high, it tends to boil even more, increasing again the loss of liquid.
As the liquids must boil to cool down, the probability for them to boil over is high. Therefore, the bottles are only being filled half or even only one third to prevent over boiling. On the other hand, boiling over cannot be prevented reliably. If liquids boil over, the autoclave must be cleaned and, for example, agar-based liquids may flow into the pipe system drain of the autoclave and block it, when the agar cools down and solidifies there.
Cleaning the pipe system is frequently highly cost-intensive and only possible for the manufacturer of the autoclave. Liquids can only boil from open bottles. Therefore, the bottles must be open or at least vented the lid must be slightly open. If venting the bottles is forgotten or done improperly, the liquid inside cannot boil during the recooling phase and thus will not cool down.
This poses a considerable hazard, as these bottles may explode during removal from the autoclave and the liquid contained therein may evaporate spontaneously — similar to a delayed boiling.
Cooling by radiation has considerable advantages as compared to cooling by evaporation.
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