MIDWIVES AND THE CARE OF THEIR INSTRUMENTS
Disinfection and sterilization of instruments is a crucial point in any midwifery practice. It is the procedure by which health care professionals ensure that all reusable medical devices do not harbor any biological matter before the next use. Sterilization causes biological entities to be killed, removed or deactivated either by physical or chemical means, where as disinfection causes most but not bacterial spors.
CATEGORIES OF PATIENT CARE ITEMS AND INSTRUMENTS
Critial items deal with a high risk of infections if contaminated with any biological agents. These items may come in contact with internal tissues and the vascular system, so the sterility of these items is prioritized above all. Because any microbial induction could lead to the transmission of disease, surgical instruments, implants, catheters and probes are examples of this category.
2. SEMICRITICAL ITEMS:
These items have contact with mucous membrane and nonintact skin. Items should be free from all microorganisms, but as they are less critical than the above category, a small number of bacterial spores are permissible. A laryngoscope blade is an example in this category.
3. NONCRITICAL ITEMS:
Like semicritical items, these items are in contact with intact skin but not with mucous membrane. As the skin is the most substantial effective barrier to most of the microorganism, so here sterility is not a big issue. Blood pressure cuffs, bedpans, and stethoscopes are some examples of this category.
STEAM STERILIZATION VIA AUTOCLAVE:
For steam sterilization an autoclave is used. An autoclave is an instrument in which saturated steam is applied under pressure. Destruction of microorganisims occurs by the irreversible denaturation of enzymes and structural proteins. Like dry heat sterilization, it can also penetrate through all the surfaces of the instrument but is not time-consuming. This technique provides complete sterilization in a shorter time period.
Ethylene oxide or any other highly volatile substances are the active agents to this technique. Must be mixed with any other inert gas, to reduce highly toxic properties. This technique can only be used when no other method works. The efficiency of this gas depends on the concentration of gas, humidity and time exposure. Because 100% EO is required and it is extremely volatile, this procedure must take place in a vacumn. This is not a viable technique for community-based midwives
A NOTE ON BOILING INSTRUMENTS:
Boiling instruments in 100°C water for at least one minute kills 99% microorganisms, except for a few bacterial spores. Boiling does NOT sterilize equipment. This is a disinfection method and may be deemed to be acceptable for cord clamping and cutting implements, but is not recommended for episiotomy scissors or suturing instruments. Pathogenic organisms begin to die off between 60° C and 70°C. Water must be at a full rolling boil for at least 2 minutes at sea level, 3 min at 6000 ft or above to achieve full disinfection, with instruments submerged the entire time.