Sterilization of OT Linen, Drapes and Gowns - Autoclave Method, Packing & Storage

By Annu Maurya | B.Tech Biotechnology, DMLT, D.Pharma, M.Sc Plant PathologyThis PPT explains the complete process of Sterilization of OT Linen including Surgical Drapes, Gowns, and Wrappers.Topics Covered:What is OT Linen? - Drapes, Gowns, Sheets, WrappersDecontamination - Soaking in cold water to remove blood & tissueWashing & Inspection - Machine wash with detergent, checking for torn/soiled linenFolding & Packing - Proper folding, double wrapping for sterile handlingAutoclave Sterilization - 121°C at 15 psi for 30 min OR 134°C at 30 psi for 4 min in prevacuum sterilizer. Steam must penetrate fabric, packs should not be wrapped too tightlyChemical Indicator Tape Test - Brown stripes confirm sterility

Transcript

1. By Annu Maurya B. Tech in biotech, M.Sc. (plant pathology)
2.  Proper linen handling in the operating theater (OT) requires strict segregation, minimal agitation, and complete sterilization before reuse to prevent surgical site infections
3.  Inspection and Packaging: Inspect clean drapes, gowns, and towels for tears or defects. Pack them into standard porous wrapping paper or containers designated for autoclaving.  Sterilization (Autoclaving): Autoclave the packaged linen packs using validated steam sterilization cycles (typically 121°C to 134°C depending on fabric density and guidelines) to ensure the destruction of all microbial spores.
4.  Storage and Transport: Store sterilized linen packs in a clean, dry, dust-free, and temperature-controlled environment separate from dirty utility areas. Transport them into the OT using covered, clean carts.  Aseptic Opening: Open sterile linen packs on a sterile back table using strict aseptic technique just before the surgical procedure begins.
5.  Immediate Containment: Place used or bloodstained OT linen directly into leak-proof, colorcoded bags or containers (e.g., yellow or red impermeable bags) at the point of generation inside the OT.  No Shaking or Sorting: Never shake, sort, or rinse soiled linen in the operating room. Handle it with minimal agitation to prevent the aerosolization of pathogenic microorganisms
6.  Personal Protective Equipment (PPE): Staff handling used OT linen must wear heavy-duty rubber gloves, waterproof aprons, and masks or face protection if splashing or saturation with body fluids is anticipated.  Transport and Decontamination: Transport the sealed containers securely along a unidirectional dirty-to-clean flow path to the laundry or Central Sterile Services Department (CSSD). Soak or wash the linen using hot water (70°C to 80°C) or chemical disinfectants like a 0.5% sodium hypochlorite solution as per institutional protocols before standard laundering and re-autoclaving for future use
7.  A sterilization cycle is the complete sequence of automated or manual steps used in an Autoclave Cycle or other sterilizer to eliminate all living microorganisms, including bacterial spores, fungi, viruses, and bacteria
8.  Purge (Air Removal): Steam enters the chamber and forces ambient air out through a drain using gravity or a vacuum system, as trapped air blocks proper steam contact.  Sterilization (Exposure/Dwell): The sealed chamber maintains a precise high temperature (typically 121°C or 132–134°C) and pressure for a set duration to destroy microbes.  Exhaust (Pressure Release): Steam is safely vented from the chamber to lower pressure back to ambient levels  Drying (Cool Down): Moisture and condensate are evacuated (sometimes via a post-cycle vacuum) so wrapped items return dry and sterile.
9.  Gravity Cycle: Uses natural steam displacement; takes 60 to 90 minutes total (including a 15–30 minute exposure at 121°C). Best for unwrapped, non-porous solids.  Vacuum (Pre-Vac) Cycle: Uses a pump to pull air out via pressure pulses; completes exposure in about 3 to 10 minutes at 132–134°C. Ideal for wrapped, hollow, or porous goods  Liquid Cycle: Features a slow, gradual exhaust to prevent hot liquids from boiling over or spilling out of their containers
10.  Proper storage protects sterilized packages environmental contamination. from
11.  Environmental Controls: Store items in a clean, dry, well-ventilated area protected against extreme temperatures, dust, and moisture. Never store supplies under sinks.  Shelving Clearances---Floor: At least 8 to 10 inches off the floor. Ceiling: At least 5 inches from the ceiling (18 inches if near a standard fire sprinkler head). Walls: At least 2 inches away from outside walls to permit air circulation
12.  Shelf Life & Handling: Sterility is generally event-related rather than time-related—meaning items remain sterile unless the packaging is wet, torn, punctured, or broken.  Dropped Packages: If a wrapped package falls on the floor, inspect it for damage. Heat-sealed impervious plastic packages that remain undamaged and sealed are still considered sterile.  Stock Rotation: Use a first-in, first-out (FIFO) system to ensure older sterile supplies are used first
13.  In an Operating Theatre (OT) context, the workflow for pre-washing, drying, folding, and packing primarily applies to surgical linens (such as surgical gowns, drapes, towels, and shrouds) and surgical instruments before they undergo final autoclaving/sterilization
14.  The goal of the pre-wash phase is to remove gross soil, bioburden, and blood stains immediately to prevent organic material from drying and hardening on items
15.  For Linens: Linens are checked for foreign items (like sharps, tape, or bone fragments). Heavily soiled or blood-stained sheets are often pre-treated or sluiced. If infected, they are handled with strict PPE, bagged at the point of use, and soaked in a disinfectant solution (e.g., 1% sodium hypochlorite) before full machine washing
16.  For Instruments: Instruments are wiped down at the sterile field, then fully immersed in an enzymatic pre-wash solution or instrument soap. Manual scrubbing or ultrasonic cleaning follows to clear all micro-debris before they move forward
17.  Moisture is the enemy of sterilization. Any residual water can shield bacteria from sterilization or create "wet packs," rendering the final sterilized package unsterile
18.  For Linens: Linens are processed in commercial- grade mechanical dryers. They must be completely bone-dry to prevent moisture-trapping during autoclaving.  For Instruments: After a clean-water rinse, instruments are thoroughly dried using a lint-free medical towel or an automated drying cabinet. Special attention is given to hinges, box locks, and crevices
19.  Surgical textiles must be folded using specific techniques to ensure that they can be unwrapped and donned aseptically in the sterile field without contamination.
20.  Accordion (Zig-Zag) Folding: Gowns, drapes, and shrouds are folded using an "accordion" style. This allows the scrub nurse or surgeon to grab the item by its designated edges and have it drop open naturally using gravity without touching the outside  Inspection: Staff inspect linens over a lighted workstation table to check for tears, pinholes, or remaining lint. A single hole invalidates the microbial barrier
21.  Packing prepares the items for the autoclave, ensuring the external wrap acts as a sterile barrier after processing
22.  Sequential Wrapping: Items are placed diagonally on a sterilization wrap (diamond style). They are tightly wrapped using a standardized envelope or square fold technique, creating a neat pull-tab so the package can be opened aseptically later.  Chemical Indicators: A chemical sterilization indicator tape or strip is placed inside the pack and used to seal the outside of the pack. This strip changes color once the package successfully undergoes sterilization.  Labeling: Every pack is labeled with critical tracking details: the contents (e.g., "Major Surgery Pack" or "Gown Pack"), the date of processing, batch/expiry code, and the initials of the operator.