How to load a steam autoclave so steam reaches everything

Steam has to touch every surface to sterilize it. Most failures that are not mechanical come from dirty items, poor packaging or crowded loads.

Clean before you sterilize

Blood, tissue and other soil act as a barrier to steam. The CDC guideline stresses cleaning items as soon as possible after use, before they dry. Rinse or presoak instruments that cannot be cleaned right away.

Package for steam

• Use wraps, pouches or containers made for steam sterilization.
• Open hinged instruments so surfaces are exposed.
• Place an internal chemical indicator where steam is hardest to reach.

Place items so steam can circulate

• Put peel pouches on their edge in perforated or mesh racks or baskets.
• Place basins and other containers without holes on their edge, so air and water can drain.
• Place small items loosely in wire baskets.
• Do not pack the chamber tight. Leave space between packs.

Heavy and dense loads

The guideline notes that heavy metal mass in surgical sets is a cause of wet packs, and that wrap density and set design also affect drying. Spread heavy items across trays and follow the manufacturer's limits.

Choose the right cycle

Use the cycle the manufacturer validates for that kind of load. Cycle times differ between gravity and prevacuum sterilizers and between wrapped and unwrapped items. The CDC's Table 7 lists minimum times for common cases.

After the cycle

Let packs cool and dry before handling. Check indicators and the cycle record before items go to storage.