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Understanding the Basics of Sterilization and Liquid Chemical Sterilization

When it comes to sterilization, you can never be too careful. The main objective of proper sterilization of medical devices, supplies and surgical instruments is to remove and destroy all forms of micro life to achieve an acceptable level of sterility.

Medical devices that are not properly sterilized can be life threatening and pose a serious threat to proper patient medical care.

It is imperative then that medical technicians and health workers realize the complex process of sterilization and acquire knowledge about the proper methods and scientific principles of sterilization.

Therefore, it is essential that the standards and principals of sterilization be met in every health care facility, whether it is a dental or a physician’s office, a hospital, a surgical centre, or an outpatient facility.

The Three Key Essentials of the Sterilization Process are:

The conditions should be ideally matched to ensure that the equipment is properly sterilized in a way that would kill any bacterial organism effectively.

The equipment that is sterilized should undergo thorough cleaning to ensure the effectiveness of the sterilization. If the cleaning process is not undergone with strict sterilization parameters, it could damage the whole sterilization process as ineffective.

The sterilized equipment should be thoroughly sterilized with the sterilant so that all surfaces and cracks in the instrument are sterilized.

Achieving proper sterilization is not just based on these three essentials, and proper care should be given to medical device cleaning so that no risk or harm comes to the people that are involved in the sterilization process.

Sterilization involves the use of a chemical or physical procedure to destroy micro bacterial life and organisms. The major agents used to sterilize equipment and instruments are:

  • Saturated Steam
  • Ethylene Oxide gas
  • Hydrogen Peroxide Gas Plasma
  • Liquid Chemicals

Dry heat is used as well but has not been commonly used in recent times. Recently, a new sterilizing agent has emerged, known as Ozone, and it is being used in the US.

Liquid Chemical Sterilization:

Liquid Chemical Sterilization is used to sterilize heat sensitive devices which can be immersed. The method requires the item to be completely immersed in a germicidal solution for a prescribed period of time to kill all the bacterial micro-organisms.

There are two types of liquid chemical sterilization involved in sterilizing equipment:

  • Peracetic Acid
  • Glutaraldehyde

Although it thoroughly accomplishes the task of sterilizing medical devices and equipment, chemical sterility poses a huge risk to the lives of patients and health care workers. Chemicals that come in contact with skin, mucous membrane, tissue, and eyes can have hazardous results. Therefore, it is advised to use protective equipment like goggles, masks, aprons and gloves when performing the process.

Gibraltar Laboratories enjoys an impeccable reputation as a health care service provider. The company boasts a long list of satisfied clients.

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The Different Methods of Sterilizing Medical Equipment

The process of sterilization is an extremely important part of medical care and the health industry. There are many different methods to sterilize medical equipment, devices, implantable devices and consumables.

Sterilization is generally attained when heat, irradiation, high pressure, filtration or chemicals are applied on the medical or surgical equipment.

One of the oldest forms of sterilization is dry heat sterilization. It is also one of the least used methods when it comes to sterilizing medical equipment.

Heat sterilization can be divided into two separate categories:

Dry Heat Sterilization:

Dry heat sterilization is one of the earliest forms of sterilization ever practiced, and it utilizes hot air that is free from any water vapor. There are various methods of dry heat sterilization as well. Some of the most common of these methods are:

  • Hot Air Oven
  • Burning or Incineration
  • Radiation
  • Flaming
  • Microwave

The most commonly used of all dry heat sterilization methods is the hot air oven method of sterilization.

Moist Heat Sterilization:

Moist heat sterilization is the complete opposite of dry heat sterilization in the sense that it uses hot air that is filled with water vapor, and the moisture plays a crucial role in the sterilization process.

There are several different methods used in moist heat sterilization. Some of them are:

  • Water bath
  • Boiling
  • Steam Sterilizer
  • Pasteurization (Milk)
  • Auto Clave

The most frequently used and most preferred form of moist heat sterilization is the auto clave method of sterilization.

Let’s look at the advantages and disadvantages to get a better understanding about these two different styles of sterilization and their methods:

Hot Air Oven Advantages and Disadvantages:

A hot air oven is considerably safer to work with when compared with the auto clave due to the fact that they do not need any water and hence pressure is not built up within the oven which allows them to be used safely in the environment of a laboratory.

They are small in nature but are faster and reach higher temperatures compared to the auto clave.

The only negative would be that since they use dry heat, some organisms like prions might not be killed completely.

Auto Clave Advantages and Disadvantages:

Due to the moist heat and high penetrating property of the water vapor, it kills the proteins in any organic life form instantly. It finishes off organisms like prions with relative ease with its oxidative thorough damage.

Auto clave is used to sterilize equipment that does not get burnt and can withstand high temperatures, like powder or glass ware.

The only negative about Auto clave would be that it burns linen and sterilized surgical equipments lose their sharpness over time.

Gibraltar Laboratories enjoys an impeccable reputation as a health care service provider. The company boasts a long list of satisfied clients.

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Why Medical Instruments need Sterilization

Surely each one of us, at some point in our lives, must have seen several medical instruments. These simple looking tools play a very significant role in diagnosing and treating different kinds of medical problems. You must have also noticed that medical practitioners use the same set of medical instruments again and again on different people during the course of a day. Have you ever wondered about the safety of these instruments because they are being used on different people with infections or diseases?

There is always a chance of a perfectly healthy person catching the same infections through one of these medical equipments. The danger is increased exponentially since the parts of the body that come into contact with these equipments are most vulnerable to infection and contamination. There is no doubt about the significance and importance of these medical tools, the absence of which can cause the whole health care service to cripple. It is, however, also imperative that these tools are properly taken care of in such a manner that they do not transmit infections to healthy patients. This is where medical instrument sterilization comes in.

There are several kinds of medical equipment in use in hospitals and laboratories. Regardless of type, make or size, sterilizing medical equipment is crucial to the proper usage and maintenance of all the instruments. Instrument sterilization not only extends the life of expensive equipment so that they remain useable for a longer period of time, but also ensures safety against transmissible diseases. There are, of course, a few tools that do not require instrument sterilization since they are meant to be used just once. These are discarded immediately after usage.

Sterilizing medical equipment can be carried out in a simple manner with the help of alcohol and cotton. The equipment is rubbed with cotton that has been immersed in alcohol. Ultrasonic bath is another popular method of sterilizing medical equipment. This process involves placing the equipment in a disinfectant liquid for more than 15 minutes. The ultrasonic waves are able to remove even the tiniest of particles from the said equipment. After the ultrasound bath, the equipment is rinsed in running water and dried with paper towels.

An autoclave is also very useful equipment for sterilizing. Instrument sterilization is carried out with the help of high-pressured steam. The equipment, after being subjected to steaming, is kept in a clean and dry place.

There are several other procedures for sterilizing instruments all of which are designed to carry out the same purpose.

Gibraltar Laboratories enjoys an impeccable reputation as a health care service provider. The company boasts a long list of satisfied clients.

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The Necessity of Conducting Proper Sterilization

I have seen medical practitioners fret over the cleanliness of their facility all the time. Sometimes, it becomes so irritating that one starts wondering why it is so necessary to clean each and every thing several times during the course of a day.

It was recently that I came upon an article on the internet that shed light on the requirement of cleanliness and proper medical sterilization in laboratories, hospitals and other medical and medicinal facilities. First of all, medical facilities are places that are constantly being visited by different patients. Some of them are suffering from transmissible diseases. In order to make sure that the staff and the patients at the facility do not catch these diseases from one another, it is necessary that the doctors, nurses and technicians adopt the rules and procedures that have been devised and put in place for medical and surgical sterilization.

There are several prescribed methods for effective surgical sterilization which range from simple soap and water rinsing to high-tech cleaning with the help of ultrasonic sterilization. Ultrasonic surgical sterilization is the most preferred method for cleaning medical tools since it is simple and does not take a lot of time. The process can be carried out with minimum effort while producing astonishing results. Very delicate tools, however, need extra time and effort from the staff because they need to be cleaned manually with special care and precision. The next step of surgical sterilization involves submerging them in an ultrasonic cleaning solution inside the machine. Specially designed thongs are used for this purpose.

The machine takes about five to ten minutes for cleaning the equipment. Once the cleaning is done, the instruments are allowed to dry by themselves. These are, then, placed in perfectly clean and sterilized trays.

Manual cleaning requires a brush and a good scrub. The brush is needed in order to clean the rounds and small points and edges on the instruments that cannot be reached by human fingers. This process involves immersing the instrument in a cleaning solution preferably a detergent and scrubbing as well as brushing it with your hands also immersed in the solution.

Medical sterilization is regarded as a major aspect of diagnosis and treatment of ailments. Surgical sterilization ensures that the instruments being used on different patients do not subject them to further infections from each other. It is also imperative for the well being of the staff at the medical facility. If medical sterilization is not properly carried out, it may be harmful for everyone including the doctors.

Gibraltar Laboratories enjoys an impeccable reputation as a health care service provider. The company boasts a long list of satisfied clients.

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Equipment Sterilization – A Necessity for Medical Services

Equipment sterilization plays a major role in laboratory testing and medical services. Instrument sterilization is carried out with the help of devices that are specifically produced for the same purpose and cater to the strict standards that are required for the safety and well being of the patients as well as the doctors, nurses and other staffs. Inappropriate equipment sterilization can pose a great threat on the proper functioning of medical facilities which, in turn, has a profound adverse effect on the health and well being of millions of people all around the world. It is widely accepted that in the absence of proper medical equipment sterilization, medical institution would not be able to function as reliable health care facilities.

There are several kinds of equipment that are used for medical purposes: diagnosis equipment, life support, therapeutic instruments, laboratory equipment and monitors. Diagnostic equipment can determine a disorder or a disease in a patient. Examples of diagnosis equipment are CT scanners, MRI, X-ray machines, PET, etc. Therapeutic equipment is used for assisting those patients who have undergone surgical procedures. Life support equipment maintains the normal bodily functions of a patient whereas, monitoring devices measure the medical state of a patient like vital signs, blood pressure, etc. The equipment in the laboratories is used for the analysis of urine, blood samples, etc.

It is of little consequence which device is being used; since instrument sterilization is a necessity for the proper care and maintenance of each and every medical instrument. It is also important for the purpose of safeguarding against transmissible infections and other diseases. Apart from the disposable equipment that is thrown after a single use, every instrument needs equipment sterilization before and after every use. The monetary aspect of disposing of expensive instruments is also not a viable option.

Instrument sterilization is a process that should be carried out with proper care and precision so that all the instruments can be used time and again for a longer period of time with maximum effectiveness.

Equipment sterilization can be done simply by washing the equipment with detergent and running water. Alcohol can also be used for this purpose. This is a simple sterilization method. However, it may not be suitable for cleaning each and every item in this manner. There are other equipments that need complex and sophisticated sterilization methods like ultrasound cleaning and pressured steam. It is better that the sterilization process is done by a person who is trained in this field and can carry out the process in detail.

Gibraltar Laboratories enjoys an impeccable reputation as a health care service provider. The company boasts a long list of satisfied clients.

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Gibraltar Labs’ Efforts Instrumental In Helping Compounding Pharmacy Secure Approval To Resume Operations

CompoundingRXUPDATED FOR IMMEDIATE RELEASE

Gibraltar Labs’ Efforts Instrumental In Helping MedPrep Secure Approval To Resume Operations

(Fairfield, NJ – May 13, 2013) NJ-based Gibraltar Laboratories, a leading provider of contract testing consulting services and moist heat steam sterilization services for the pharmaceutical and related industries was contracted by compounding pharmacy MedPrep Consulting in late February 2013. The reason: to help MedPrep improve its quality standards, testing and compounding practices in anticipation of new and stricter regulations governing compounding pharmacies, forthcoming at both the Federal and State levels. On March 13, 2013, an incident occurred involving MedPrep that would test the resources, expertise and responsiveness of Gibraltar Labs.

A Yale-New Haven Hospital nurse noticed that one bag of magnesium sulfate received from MedPrep Consulting contained floating particles, possibly mold. The Hospital reported the incident to the Connecticut Department of Health, who immediately shared it with the FDA, and subsequently the NJ Board of Pharmacies.

Gibraltar Labs CEO, Dr. Daniel Prince, stated, “MedPrep was attempting to be proactive in preparing its facility, personnel and processes to meet the new regulations. Unfortunately, in this particular instance, these enhancements to Med Prep’s QA process that may have prevented this from occurring had yet to be initiated.”

Upon learning that the contaminated bags were sourced from its facility, MedPrep Consulting immediately issued a recall of its 83 compounded preparations and called in Gibraltar Labs for support in managing the crisis. Gibraltar Labs was as a key part of the (medication safety pharmacists and consultants) team tasked to evaluate the situation.

Upon being apprised of the situation by MedPrep, Gibraltar Labs quickly mobilized a response team to begin environmental monitoring to determine if any mold could be detected in the facility, and if the root cause of the problem could be identified. Gibraltar received and tested the contaminated IV bags, and verified that the particles found were mold. They identified the type of mold and then shared their findings with the Centers for Disease Control (CDC) for independent confirmation.

After determining that no mold was present in the cleanroom complex, but finding mold in the warehouse area, Gibraltar was able to arrive at a conclusion as to the likely source of the mold, and issued a report on the possible factors contributing to the contaminated IV bags. Following a critical evaluation of its facility and quality procedures, which included guidelines for improvements and best practices, MedPrep adopted Gibraltar Labs’ recommendations and was also able to address the conditions that may have compromised its ability to safely compound the contaminated doses in question.

MedPrep came to Gibraltar because it is an established laboratory that operates under current good manufacturing practices. It has many years of experience in helping its customers meet FDA requirements.  “This has been the most high profile project that we have been a part of with respect to the involvement of multiple government agencies, at both the federal and state levels,” commented Dr. Prince.  

As part of the process, Gibraltar Labs wrote a position paper on MedPrep’s behalf for submission to the NJ Board of Pharmacy, documenting the steps taken to ensure that MedPrep will continue to operate in a safe, compliant manner, and why MedPrep should be allowed to resume operations. Thanks in part to the comprehensive services provided by Gibraltar Labs, MedPrep was officially notified by the New Jersey State Board of Pharmacy: “The committee has approved MedPrep’s resumption of operation with the conditions and limitations in the Order filed on May 2, 2013.” To date, MedPrep customers have been supportive, recognizing and respecting its responsiveness to the incident as well as the steps taken to prevent future occurrences.

In the span of roughly four weeks, MedPrep recalled all of its compounded preparations, ceased its compounding operations, examined all of its practices and preparations, and was placed under the close scrutiny of the FDA and NJ Board of Pharmacy as a condition to being permitted to resume operations on a limited basis. During its April 24, 2013 meeting  the Board  agreed that MedPrep could be allowed to resume operations on a limited basis and under strict supervision, and after documented proof that the pharmacy had extensively retrained its staff and undertaken significant changes required by the Board to protect the public’s health and safety. The Board last week determined that MedPrep met those requirements.

Although pharmacy compounders are not subject to the same quality standards and oversight as their larger drug manufacturer counterparts, they are beginning to operate in a similar manner, as they produce higher volumes of preparations, and distribute across state lines. With increased scrutiny from the FDA, State Pharmacy Boards, and new regulatory guidelines to better regulate the growing compounding pharmacy practice, this situation is rapidly changing.

This sense of urgency comes in the wake of a fungal meningitis outbreak in 2012 that resulted in 53 deaths and more than 733 illnesses[1] – the result of contaminated steroids distributed by the New England Compounding Center. Following this tragedy, the FDA launched an investigation of 31 compounding pharmacies that produce sterile preparations. To date, FDA inspectors have identified numerous safety violations at all but one of the compounding pharmacies that were part of this investigation. Gibraltar Laboratories stands ready to be part of the solution to help protect and assure patient safety.

As these new operational procedures are put in place, MedPrep looks to become a model that other pharmacy compounders will look to in achieving operational standards for regulatory compliance. “Not only was MedPrep very cooperative with Gibraltar Labs, but also very grateful and thankful for our responsiveness, expertise and thoroughness of support.” stated Dr. Prince. “Med Prep is extremely satisfied with the service and responsiveness of Gibraltar Laboratories and looks forward to continuing the relationship into the foreseeable future.[2]” stated Gerry Tighe, President of Med Prep.

#  #  #  #

About Gibraltar Laboratories, Inc.

With over 43 years of service, Gibraltar Laboratories is a leading provider of microbiology and analytical chemistry services in stability and quality control to the pharmaceutical, medical device, biotech industries. It provides media fill validation support, supplies sterile TSB and Moist heat steam sterilization services of prefilled syringes, ampules, vials etc. Areas of expertise include analytical chemistry, microbiology, virology, validations and calibrations, biopharmaceuticals, environmental monitoring and steam sterilization services. Gibraltar Laboratories headquarters and facilities are located in Fairfield, NJ.

For more information about Gibraltar Labs’ research, testing, and scientific consulting services, please visit: www.gibraltarlabs.com or contact:

Name:  Kristah Kohan, Sales Manager

Gibraltar Labs

T: 973-227-6882 x534

E: kkohan@gibraltarlabsinc.com

For more press information, please contact:

Ed Delia

Delia Associates

T: 908-534-9044

E: edelia@delianet.com

[1] As of 4.8.13 per CDC data (www.cdc.gov)

[2] Gerry Tighe, president of Med Prep.

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USP <71> Statistical Analysis

Non-sterile (P)
Rate

Non-sterile (P)
Rate

Units
Tested (N)

Percent chance to fail sterility test (F)

1:10,000

0.0001

1

0.01

1:1000

0.001

1

0.1

1:100

0.01

1

1.0

1:10

0.1

1

11.1

1:10,000

0.0001

5

0.05

1:1000

0.001

5

0.5

1:100

0.01

5

5.3

1:10

0.1

5

82.4

1:10,000

0.0001

10

0.10

1:1000

0.001

10

1.0

1:100

0.01

10

11.1

1:10

0.1

10

271.8

The above probability of a false negative sterility test F is calculated without respect to the sample volume tested. It is based on the number of units tested and the contamination rate P. Obviously, if a preparation has a contamination rate of P and N units are tested for sterility then the percent chance of correctly identifying a true sterility failure F is directly proportional to the volume of medium tested.

In this example I have highlighted the case where 1 in 1000 units are expected to be non-sterile. Ideally, a sterility test will correctly identify this level of contamination. However, the USP <71> test does not accomplish this. The chance of correctly identifying this level of contamination is 1, 0.5 and 0.1% when 10, 5 or 1 units are tested. Thus, even when 10 units are tested the USP sterility test will miss the contamination event 99% of the time.

Non-sterile (P)
Rate

Non-sterile (P)
Rate

Units
Tested (N)

Percent chance to fail sterility test (F)

1:1000

0.001

1

0.1

1:1000

0.001

2

0.2

1:1000

0.001

3

0.3

1:1000

0.001

4

0.4

1:1000

0.001

5

0.5

1:1000

0.001

6

0.6

1:1000

0.001

7

0.7

1:1000

0.001

8

0.8

1:1000

0.001

9

0.9

1:1000

0.001

10

1.0

1:1000

0.001

20

2.0

1:1000

0.001

40

4.2

In this table it is shown that the chances of correctly identifying a contaminated lot when the contamination rate is 1 in 1000 as a function of sample size. When only a single unit is tested then the there is a 0.1% chance of an accurate result or a 99.9% chance of a False negative result. By expanding the test to include 40 units as the sample size the chance of correctly identifying the non-sterile lot slightly increases to about 4.2%.

Accordingly, any rational to justify a reduced number of units tested should take into account the limits of the statistical meaning of the USP sterility test.

Respectfully Submitted,

By: Daniel Prince

 

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USP <71> Sterility test: The probability of a false negative result is high

Non-sterile (P)
Rate

Non-sterile (P)
Rate

Units
Tested (N)

Percent chance to fail sterility test (F)

Percent False NegativeResult

1:10,000

0.0001

1

0.0

99.99

1:1000

0.001

1

0.1

99.90

1:100

0.01

1

1.0

99.01

1:10

0.1

1

9.5

90.48

1:10,000

0.0001

5

0.0

99.95

1:1000

0.001

5

0.5

99.50

1:100

0.01

5

4.9

95.12

1:10

0.1

5

39.3

60.66

1:10,000

0.0001

20

0.2

99.80

1:1000

0.001

20

2.0

98.02

1:100

0.01

20

18.1

81.87

1:10

0.1

20

86.5

13.54

The above probability of a false negative sterility test F is calculated without respect to the sample volume tested. It is based on the number of units tested and the contamination rate P. Obviously, if a preparation has a contamination rate of P and N units are tested for sterility then the percent chance of correctly identifying a true sterility failure F is directly proportional to the volume of medium tested.

In this example refer to the case where 1 in 1000 units are expected to be non-sterile. Ideally, a sterility test will correctly identify this level of contamination. However, the USP <71> test does not accomplish this. The chance of correctly identifying this level of contamination is 2, 0.5 and 0.1% when 20, 5 or 1 units are tested. Thus, even when 20 units are tested the USP sterility test will miss the contamination event 98% of the time

Non-sterile (P)
Rate

Non-sterile (P)
Rate

Units
Tested (N)

Percent chance to fail sterility test (F)

Percent False NegativeResult

1:1000

0.001

1

0.1

99.9

1:1000

0.001

2

0.2

99.8

1:1000

0.001

3

0.3

99.7

1:1000

0.001

4

0.4

99.6

1:1000

0.001

5

0.5

99.5

1:1000

0.001

6

0.6

99.4

1:1000

0.001

7

0.7

99.3

1:1000

0.001

8

0.8

99.2

1:1000

0.001

9

0.9

99.1

1:1000

0.001

10

1.0

99.0

1:1000

0.001

20

2.0

98.0

1:1000

0.001

40

3.9

96.1

In this table it is shown that the chances of correctly identifying a contaminated lot when the contamination rate is 1 in 1000 as a function of sample size. When only a single unit is tested then there is a 0.1% chance of an accurate result or a 99.9% chance of a False negative result. By expanding the test to include 40 units as the sample size the chance of correctly identifying the non-sterile lot slightly increases to about 3.9%.

Accordingly, any rational to justify a reduced number of units tested should take into account the limits of the statistical meaning of the USP sterility test.

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Women and Their Beauty: How people see you as more beautiful than you see yourself

womanI know that we are often very critical of how we look and how we sound to others. In general we want to “look good” in the eyes of others. Perhaps our reality of ourselves is vastly different than the the reality of others that know us. This video explores the attitudes of women and compares their description of themselves to that of others as illustrated by a forensic artist. Women are more beautiful in the eyes of others than they are to themselves. Watch this interesting thought exercise.
http://www.facebook.com/photo.php?v=120357218161699Women and Their Beauty: How people see you as more beautiful than you see yourself

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Helping Compounding Pharmacies

I have just returned from an all-day consultation audit of a compounding pharmacy. Our role is to perform a critical audit to help the firm identify the source of a fungal contaminate that was found in its sterile preparations. It is necessary to find the root cause and then the firm must institute both preventive and corrective actions.

We know that current good manufacturing practice regulations and FDA oversight are relatively new to the compounding pharmacy industry. We also all see firsthand how FDA and state Boards of Pharmacy are working closely together because of the tragedies that arose from the poor practices recently in Massachusetts [NECC].

The point of this blog is to let you know that we care about the survival of your industry. We want to work with pharmacies which have integrity about offering only safe scripts for their customers/patients. We can provide over 43 years of knowledge to help you adjust and forward your path to the new current expectations as relates to microbiological monitoring, facility design and training.

 

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