okay you know every time this starts I must look like a complete and total idiot out there it starts off with my face inside the camera and then I walk away and start doing my thing because I haven't really mastered how to uh adjust the video all right now let me get a marker hopefully it'll work all right so steam sterilization let's first discuss what these words mean a we have steam I mean how difficult could that be but what exactly is steam well steam is the gaseous state of water okay water exists in three states liquid gas and solid right steam is the gas so steam is the gashes state of water now we'll come back to that in a second and again uh I apologize for the handwriting so steam is a gaseous state of water what is sterilization let's discuss that quickly and we're going to come back to that also sterilization is the destruction of all microorganisms okay remember we had the several um things that we need to remember we have cleaning disinfection or decontamination and sterilization cleaning was the yeah who who can tell me what cleaning is well let's be a little bit more specific you're right it is the removal of of gross visible and invisible soil we have to now express ourselves in the way of the exam okay so it's the removal cleaning is the removal of gross visible and invisible soil and again I remind you that the word gross g r o SS means big chunks of soil dirt biological bioburden as they refer to it okay then we have the disinfection decontamination which would be the destruction of most microorganisms okay and sterilization is the destruction of all microorganisms right so these are the three different stages of sterilization cleaning decontamination and sterilization and sterilization be being the destruction of all microorganisms all right so steam gaseous state of water as I told you water has three states solid liquid gas solid being ice liquid being plain old liquid water gas being steam okay very nice let's remind ourselves that from freezing to Boiling we go from 0 de Celsius to 100° CS that's boil and these two temperatures equal 22 oh my God degrees fah and 0° C equals 32° F so this is a scale for boiling okay this is freezing and this is boiling may I remind you that only pure water boils and freezes at these temperatures only pure water H2O other water that contains contaminants freezes at a different temperature and Bo boils at a different temperature okay but this number boiling is important because at that point in time the water turns into steam if you will actually it turns at different temperatures at different times okay if you reduce the pressure for example your boiling point lowers decreases okay so and if you increase the temperature the boiling temperature increases as well as well so it's an interesting thing all right so only pure water boils at this temperature and only freezes at this temperature now I would like to tell you that gas or steam is bigger than water I'm going to put that over here steam is bigger than water what does that mean it's it's a very pedestrian statement that I'm making okay but I want you to remember it by pedestrian I mean it's not scientific so if I were to take a pot of water close all the doors and windows in this room start boiling it the steam from this pot as it evaporates will cover the entire room so how is it possible that a pot of water this big filled with water and when it boils out this entire room is going to be covered in Steam right it's going to be so foggy you won't be able to see anything so steam will occupy this entire room amazing so from this pot we go to this room that's pretty big right so steam is bigger than water in other words the same amount of water when boiling when turning into steam will occupy a much larger volume does that make sense okay now I I'd like to sort of demonstrate something to you now here in my hands I have a glove might as well be a balloon but let's say it's a glove all right I'm going to inflate it just a little bit so let's say I just filled up this glove with air now watch what's going to happen that looks pretty okay I can squeeze it pretty well right it looks I could inflate it a bit more couldn't I now watch this I'm going to give this a squeeze what's happening what am I doing did I change the amount of air that I have in there and what's happening to my glove it's stretching now look at this it's now hard so what happened to the pressure inside the air pressure inside incre I increased the pressure so it's a little bit distorted now sorry Glo kind of looks like a statue all right so but in any case um the pressure went down I decrease my space without increasing the amount of air and I increase the pressure so far so good are we together so if I were to now that we had this visual I want you to think about this if I if I were to take my room full of steam if I were to take all its walls and start moving it in what's going to happen in this room that's filled with steam as I start moving the walls in and there's no place for the steam to go pressure is going to increase pressure is going to increase I want you to hold that thought as we sort of learning this stuff so far so good are we together okay let's move on so uh let me introduce another word into this mix over here can I erase this okay here's an interesting word and the word is sterilant sterilant uh is it related to any of the words we have up on top sterilization sterilization so can anyone based on the language that you see over here can anyone Define for me the word sterilant Achi sterilization that's good so good so the word sterin but so let me write down what you just said is a med that facilitates sterilization so go ahead and write that down so the word sterilant means it's a medium that facilitates sterilization so what can I compare it to steam well no I don't want to compare it to steam yet steam is a stero in this particular case steam equals steriline and in this particular case it is a medium that facilitates sterilization the question is how so but before I go there I just want to make sure that you understand the statement it is a medium that facilitates sterilization it is something that causes something else to become sterile sterile means does not have any microorganisms on it does that make sense so do you understand the word sterilant you understand the definition it is a medium that facilitates sterilization okay good it's a very key Concepts you must understand these Concepts before you move on so can I move on so given the fact that steam is our sterilant how does steam sterilize anything it's just water that turned into gas how does steam facilitate sterilization how does that happen well I can cook many different things that doesn't make it sterile why couldn't I just throw it into my instrument into a pot of boiling water then and keep it there for an hour or two I ain't going to do it so I'm going to tell you a little story are you ready for a little story back about 30 years ago I found myself in this place called Ford Benning Georgia it's an army base and over there I went through this thing called the basic training so one day they took us into this what they call the down south theater also known as theater it was a movie theater we never went there but it was a movie theater on base and over there they used it to give us lectures and we must have been sitting in these incessant lectures in very beginning for hours and hours and hours and what you couldn't do is fall asleep and the only thing you wanted to do was fall asleep so I'm sitting there in that theater and somebody is giving a lecture and what they have down south anyone ever been down south they have cockroaches yeah big you say flying ones I've seen those too so I hate cockroaches I'm deeply traumatized from my childhood as seeing cockroaches I lived in a place where there were a lot of Navy people and navy people bring in their boots back cockroach eggs so all these cockroaches mutated you couldn't kill them for nothing I've seen all sorts of all breeds of cockroaches well it doesn't matter so I'm sitting there falling asleep and in front of me crawls a cockroach yay big I'm looking to the left I'm looking to the right and I don't see anybody and I go Splat my question to you is what killed the Cockroach pressure the pressure killed people say my boot it's true but my boot was what you would call a medium that facilitated the Splat of a cockroach so the end of that story is I'm glad you got the concept okay so it was the pressure that killed the Cockroach the end to the story was that indeed someone was watching what I was doing it was the drill sergeant he said boy you picked that up so the boy picked up the roach I said boy let's go outside outside was about 110° said boy you know what you did I said no drill sergeant he said boy you just made his wife and children orphans you're you're a killer son I said no I'm not a killer drill sergeant he said you're not a killer what are you doing in my Army I said I'm a killer drill sergeant oh so you're a killer in any case after about 20 minutes of the circular discussion whether I was a killer not a killer killer not a killer said okay boy you take off your steel pot which is your helmet and you start digging imagine this is Georgia 1986 it's hot I take off my helmet and I start digging I dug and I dug and I dug in sand anyone ever digs sand knows that it's very hard to dig a sand so in any case I dug up a lot of sand he made me bury the Cockroach oh my God in that grave then he made me make a memorial plaque for the Cockroach out of twigs and stones and then I stood there over the cockroach's grave with the helmet in my left hand and my right hand over my heart singing the American Anthem until I went horse that by the way is How I Learned the words through the American Anthem as well so imagine that in any case so that story having been told to you uh I uh telling you that uh it was the pressure that killed him now remember my thing with the glove okay very good so now we're going to put a few things together so it's the pressure that killed the Cockroach right all right so it was my boot that was something that facilitated the pressure killing the Cockroach what was I doing with my glove when I squeezed it I was creating pressure inside the glove and if anything was inside my glove it would feel squeezed as well and I wouldn't imagine yourself on the MBTA bus during rush hour anyone there ever been on a rush hour in an MBTA bus did you feel the pressure especially if the driver is there with a texting and trying to kill you at the same time and in any case the fact of the matter is you feel the pressure now imagine you're just ay weeny little bug sitting on the uh end of your surgical instrument and you are inside this machine right over here that we call the autoclave okay or ster steam sterilizer and we keep building and building and building the pressure inside by boiling the water we keep boiling the water inside there and it keeps turning into more and more Steam and the steam is getting collected inside that box over there inside that steel chamber with a solid door okay nothing is getting out only staying in so there's more and more pressure so how are the microorganisms being destroyed by steam pressure but that's just one of those things so steam destroys by a pressure and B Because steam is hot and you know that when you're boiling yourself a pot of water to make tea or coffee and you're trying to turn off something or move something on the other burner and that steam hits your hand or arm how does that feel H hot by pressure and heat so Steve you were kind of right when you said it Cooks it well it does but first it crushes it it's the pressure and then it Cooks it with fire sounds pretty simple doesn't it well that's basically the essence and the formula by which we destroy microorganisms using pressure and heat there's also one more factor that I'd like to add in there and I'm not going to put it with a letter A or B but I will write it in the big letters time you can't just do it halfway it has to be done over a specific period of time otherwise you didn't do it you have to kill it it completely you have to kill it thoroughly I mean I I don't even know what else to say it but you do it once you do it right and you do it for a prolonged period of time enough to make sure that hey is everything dead yeah it's dead all right we're done when you only do things halfway it only costs you later if you've been watching the news you know I'm right in any case here we are so how do we kill I mean we may as well end the class right now if you understand this you understand everything but we won't we're going to move on and we're going to talk about this in a little bit more detail because I have to teach you a little bit about the mechanics of steam sterilizers all right to make things work completely and totally in your mind can we move on yes okay let's go and for the time will let you know you don't have to do anything you never have to have a timer the machine is preset to specific conditions so you um fortunately and unfortunately at the same time you don't have any latitude to to select the amount of time you can select a cycle like for example on your machine at home that does the laundry you can set you don't have the ability to set the the time where well you can set the timer a little bit uh but you can't select a cycle you have different selections of Cycles they're preset you can't modify them at all okay a cycle is a cycle delicate nits or whatever the heck they have over there I don't know on my machine there's an automatic cycle I like that one okay and so steam sterilizer a steam sterilizer is a pressure cooker pressure cooker looks like this okay it is a cross-section of a pressure cooker it is a pot with nice uh kind of like lips around the edge and into here fits the lid and it fits into these grooves now I'm going to draw a shaded area right over here and a shaded area right over here we're going to come back to this so this is our lid this is our pot right over here I'm going to draw a valve okay over here I'm going to put a little bit of water underneath I'm going to put in heat and you know what I'm going to do I'm going to put a little tray over here a little tray all right and on this round tray and this round tray is not going to be solid it's going to have holes in it kind of like a mes right can you see the little table over here and on this little table I'm going to put my little pair of scissors that I'm going to sterilize and just for your visual pleasure I'm going to put my little cockro on the end of the scissors can you see how beautiful this is amazing right totally totally fantastic warms my heart it's about the size of the guy I stumped God it was so nasty picking him up off the floor I mean I really did a nice job splattering him okay so very important to understand the areas that I shaded over here I'm going to call this the gasket so let's sterilize shall we heat is applied to my pot water begins to boil and it turns into steam so water turns into steam as I apply the heat to water the water will turn into steam what did I tell you about steam steam is bigger than so therefore steam is going to expand inside this closed chamber so my pressure cooker and I'll tell you a story about a pressure cooker unless I already told you a pressure cooker story did I tell you my pressure cooker story no I haven't oh I will oh I will so and it has nothing to do with B Marathon so has to do with my wife so in any case water turns into steam and it expands water turns into steam steam expands inside the closed slash sealed chamber now before I boiled the water and turned it into steam before steam started expanding what did I have left inside the chamber when I closed the chamber I had water in the bottom I had my scissors my little table my little cockroach sitting on the end of it what was in here huh no no steam yet you're right steam came later you had air left over as the steam is expanding what's happening to the air it's going away from where the Val thank you you guys are brilliant brilliant I tell you did everybody catch this discussion so remaining air and you know what I'm going to put it right over here I'm going to put a couple of words right here residual air residual means left over stuff that was left behind resid residual air what happens to residual air as the steam expands it gets pushed out so residual residual air we'll keep it simple escapes so I'm going to put number three over here very important residual air is displaced bless you by expanding steam I want you to really really write that down and understand what we're doing as we're boiling the water as the water turns more and more into steam residual air gets pushed out from that valve over there on top residual air is displaced displaced which is another word for pushed out from the enclosed chamber by the expanding steam so far so good so in the essence there is no air during sterilization it's very important because air is uh is a great insulator for heat and for cold so we want to get rid of the air and how we get rid of the air by expanding the steam inside the chamber the question becomes then how does this valve differentiate between Steam and air it's very simple it's a very simplistic little mechanism when it heats up to a certain point the spring inside there compresses because the the pressure when it gets to be really high will actually compress the spring inside the valve and it's going to stop and steam is going to stay in and the air already escaped simple no moving Parts really no electronics nothing that says I'm going to count the pressure when it gets to uh 35 PSI I'm going to electronically close the valve simple 1 2 three it's like your uh teapot begins to whistle as the steam begins to expand as the steam begins to escape with a certain speed and that's when the water is boiling when the whistle blows right in this particular case this valve automatically closes when the pressure becomes too great inside the chamber so a little bit of steam escapes but so what after a while when the pressure is high it's just going to keep building and when you turn off the heat that valve is going to open and the remaining steam is is going to blow off wouldn't it sure just turn off the heat and everything is going to be all right so as the residual air is displaced by expanding steam this has a term that you must know number three is also known as gravity air displacement this is super important you must know the definition of the words gravity air displacement and now you do know what it means and it means that residual air is displaced by expanding steam this equals gravity air displacement does everybody understand the meaning of the word gravity air displacement awesome and now I am here to tell you that all of this is happening at a imately 250° F which equals to 121° Celsius roughly or Centigrade whatever the heck they call it makes no difference Celsius Centigrade all the sake so the gravity air displacement and all of this is happening at roughly 250 to uh 250° Fahrenheit which translates to 121° C all right in the meantime the gasket right over here is preventing the air from and steam from escaping if it wasn't there nothing would work am I correct in my assumption yeah sure I am of course I'm correct I couldn't be wrong somebody called my wife and tell her that okay so at this moment in time the little karacha sitting on the the end of my scissors over there is now squashed and burned cooked as you soly put it Steve right done karacha is no more a little Spanish for you free of charge okay so very important for you to remember now my little uh pressure cooker Story one day I come home and I find my wife in extremely good mood now I know something's wrong so she says honey she says oh now she calls me honey I would definitely I'm in trouble because usually she uses an exploitive to greet me well in any case the fact of the matter is she says I got us the most amazing thing and I'm thinking oh Lord please anything my first question is Steve much thank you how much he says you don't even know what I got I said oh please just tell me how much I just need to make sure to you know so the things don't bounce he says but I bought an amazing dish to cook dinners in no time like ah what's wrong with the damn frying pan what's wrong with a pot that we already have says honey it's German stainless Surgical steel oh I know that hurt not only is a German stainless surgical steel but it's Carl zepter German state of the steel I'm thinking oh I'm I'm already counting decimal points and and everything else I said how much but it's going to I'm going to be able to cook chicken soup in eight and a half minutes ah how much but I can cook rice in 2 minutes oh in any case uh it turned out to be $250 beautiful we cooked it once I don't think it was washed it went straight to the attic but it's this is this is this is not my point this is not my point yeah we cook chicken soup in in 7 and a half minutes just like the advertisement said but we never used it again so God knows it's still up there somewhere but a month later I found myself walking in a dental uh instrument show here in Boston uh and I'm walking going la la la la la la la and all of a sudden with my peripheral vision I spotted my wife's pressure cooker I walk myself over to the table and I look I don't see it doesn't say Carl zpp there anywhere I look around but it is my wife's pressure cooker except it had over here it had a gauge right over here that measured pressure it had another gauge that measured guess what temperature temperature and the guy put on a $20 Walmart heating coil you know the one they sell for 20 bucks it's electric coil you plug it in you can cook on it he he welded it on the bottom and it had a cord and over here it had a little thing called a timer so Carl zepter $20 uh heating coil couple of $5 gauges and a $5 timer and he was selling a dental tabletop sterilizer for $1,500 which is a bargain for a tabletop sterilizer it's a bargain he also had a little table that go that went in there all right so he probably profited about 800 bucks per unit after all that was said and done I come up to the guy that's sing and said that's a Carl's after pressure cooker ain't it that's my little pressure cooker story so in other words my dear friends even in your book if you look inside the picture the talks about steam sterilization we're talking about the first unit was a pressure cooker as a matter of fact you got a pressure cooker you want to sterilize some home more part twoo stick it in there just like this put on a little table with a mesh in it and sterilize it it'll work perfectly okay and so I'd like to give us uh one more little definition over here before I show you how a real sterilizer is put together okay instead of this valve thing over here I'm going to call it something else I'm going to call my valve a thermostatic trap thermostatic trap so just commit that to paper and uh let me know when I can erase it for you but do you see how simple sterilization with steam is no matter how many computer boards how many touch screens they can put together it makes no difference from this unit here except this one you're the touchcreen you're the computer board you just need to know when to turn these dials okay so don't put too much stock in in some of these computer driven systems at the end of the day they may fail and that's why they all have a manual cycle okay does this make sense do you understand the meaning of gravity air displacement do I need to go over anything cool all right may I erase awesome no all right let's go then and so we're going to take our pressure cooker and turn it on its side and this is going to be our chamber over here please use your imagination will be the chamber door I'm making it round because the chamber is around and this would be our chamber door around the door will be our gasket sometimes the gasket is actually around over here door gasket chamber chamber is made out of stainless steel over here we have in the bottom front we have the drain the drain drains out and it has a little bit of an elbow right over here but I'm going to highlight this area right over here and you know what I'm going to call it right over here I'm going to call it thermostatic trap do you remember where where we had the thermostatic Trap before that little valve on top right over here I'm going to draw a little nozzle and in front of a nozzle I'm going to put a little plate like this okay we're going to call this our steam Inlet and I'm going we going to call this a baffle plate and I'll explain what that is in the moment now I'm going to do something now that kind of doesn't make any sense but it will what is Steve drawing thank you excellent that was an excellent pickup Steve so I am drawing insulation except you know we don't really call it insulation even though a lot of times it is just plain old insulation this right over here is the jacket we're going to go over all of these things in a moment and let's stop right over here so just like our pot that we had before except in our pot we poured the water here we pour in the steam through the steam Inlet so the steam shoots out right in there but right before the steam I put this thing called a baffle plate you see that you guys know the meaning of the word baffle yeah it's not bad I'm going to demonstrate for you what baffled means look look I'm baffled so steam comes out at a high rate of speed there's a baffle plate in front of it goes slam baffle whoa so baffle plate prevents the steam from shooting out directly into the chamber but it hits it and it spreads out evenly throughout the entire chamber you see that so the steam shooting out this way really hard what it does it makes a sudden turn and it spreads out in different places evenly rather than just shooting out this way we're going to put a little x on it here the baffle plate prevents it from shooting out directly into the center otherwise instruments directly in the center would be the only ones affected really hard does that make sense we don't want that to happen we want the steam to be baffled and to spread out evenly going around does that make sense the drain the drain is customarily is in the Front Bottom of the sterilizer the drain is where the residual air and ultimately water when steam condenses back to water will drain into okay so whatever has to come out will come out over here so let me ask you a question where would be the residual air that didn't come out where would it be stuck by the drain so whatever a little bit of air that may be left over will be left over over here just like a little bit of water always collects before your drain inside your uh drain inside your tub right just like here a little bit of air always pulls over there why am I spending the time to tell you this because this is the coldest place in the entire sterilizer coldest and with the least amount of pressure because that remaining air pocket is sitting there and it's not going anywhere do you kind of get the feeling what I'm talking about anybody leaves lives in a house or ever live in in an apartment where there was Steam Heat ever hear the pipes banging in an old apartment building bang bang bang you know what that is that is the heating system trying to dislodge an air pocket stuck somewhere and that is it's simply hitting the pipe so it goes so it rattles it so that gas bubble dislodges and the system pardon me passes gas and the steam hot steam is able to go through your radiators and heat them up imagine that so the same thing here so why am I telling you this by the drain by the drain the drain is the coolest and by coolest I don't mean hip or pop po it is the coolest meaning coldest place inside the chamber why is that important and I will explain let me ask you a question if you were a microorganism that was trying to escape sterilization meaning being killed where would you find yourself fleeing to the coolest spot right over there so if I wanted to test my sterilization process and I wanted to place a what they call a biological indicator a little package like this and we'll talk about this a little bit later where would I want to put it to test how effective my machine is in the coolest spot next to the drain why because if I kill what's inside of this package over here in the most difficult most coolest spot where there's a little where there's less pressure than any place else if I kill it right over here that means I killed it here here here here or here because the rest of the spots are hot and have the greatest pressure this is the coolest place and has the lowest pressure capish we all understand hey we're in good shape we're in good shape so far so good now the question then becomes hey why the heck do I need a jacket around the chamber well because unlike our pressure cooker where temperature fluctuations on the outside don't really matter much for sterilization if the air is really cool inside the room where the sterilizer is cold air is going to touch my chamber and what's going to happen to the steam around the edges it's going to turn into liquid into droplets the jacket keeps the outside of the chamber just as hot as the inside of the chamber that is why many many times in the new sterilization machines it's not just some kind of a insulation wrap they also let steam inside the jacket so the temperature inside the chamber and inside the jacket is the same and the pressure is always the it's also the same so it's kind of like a it's kind of like a two layer it's like a two layer of uh of protection so the jacket makes sure that there's no condensation inside the chamber and I'm going to put that in here jacket keeps the uh chamber temperature stable to prevent condensation inside because condensation equals wet peack wet peack equals unsterile truer words could never be spoken so if the jacket doesn't keep the temperature we have a problem if there's one other problem that we have to sort of address potential problem and that would be the gasket if the gasket does not hold and remember I believe I showed you the gasket last time let me dig it out so I open the door and I pull out the gasket if this guy right over here if this gasket on this chamber door does not hold its own just like in your refrigerator at home if the door gasket doesn't work if the door gasket does not uh you know prevent the uh uh the cool the warm air with moisture to enter your refrigerator all the contents of your fridge are going to be wet right sweaty that's the last thing you need and when you find the contents of your fridge sweaty that means your door gasket stinks or somebody didn't close the door properly right well everybody has to close the door properly or the machine properly is not going to turn on and in this particular case we're going going to have a wet pack wet pack equals L sterile because bacteria and all microorganisms like wet warm and Dark Places and if we if our packages are wet we have a problem it's just not cool I mean it is cool does this make sense yes and please remember that the door gaskets have to be checked in the beginning of every shift and they have to be cleaned with lintree cloth to make sure that the door seals properly and if you see Cuts cracks or the deformities to the to the gasket you might as well not run the sterilization cycle it's just not going to be good you don't want to take a chance remember every time you sterilize you put your name on every package that's inside the load that information is kept for seven years someone comes down with infection they can sue your name is on there so this right here was a further U how should I say display of what we called gravity air displacement sterilizers but we also have another form of steam sterilizers known as Dynamic air removal sterilizers okay so I'm going to introduce this Dynamic air removal Dynamic air removal this process is called no what this process was called was just regular steam sterilization also known as gravity air displacement I'm moving on right now to a different product called Dynamic air removal also steam but I'm going to explain what dynamic means dynamic means action or action of air removal see gravity air removal or gravity air displacement is uh expanding steam pushing out the residual air right dynamic means that we exercise some degree of force or some action okay to remove the air so Dynamic air removal uses pumps to pump out the air before we inject steam so Dynamic air removal uses vacuum pumps to remove residual air from the chamber go ahead write that down go ahead write that down and I want you to understand this vacuum yeah so we create a vacuum ins inside the chamber and we pump out the air from the chamber before we put the steam inside does that negative pressure lower the boiling point brilliant of course it does excellent pickup when we create a vacuum inside the chamber the steam because vacuum creates uh decreases pressure and as the pressure is decreased boiling point decreases so the water turns into steam at a much lower temperature depending on how deep the vacuum is we're probably lowering it by about 10° it's a lot and if the vacuum is deep we can boil the water at barely over room temperature imagine that imagine that we won't have too much pressure for that we still need the heat so what is the difference between Dynamic air displacement machines and gravity air displacement machines well well gravity air displacement machines use just expanding steam so it's a fully manual cycle we heat up the water it turns into steam Dynamic air displacement we introduce a new vacuum pump into the mix so into this picture we can add one more nozzle let's say we put it over here and we call it vacuum pump and the vacuum pump will suck out the air from the chamber before we with the steam in now I want to tell you the dynamic air displacement machines that first we have gravity air displacement machines machines like this one and then we have the machines with a vacuum pump which is basically all of the machines in the hospitals are Dynamic air displacement machines and we remove the air from the chamber before thereby reducing the boiling point of water but what we also do at the same time is we increase the temperature we heat up the temperature higher why are we doing this quicker brilliant did everybody hear that no quicker it will be quicker and that leads me to a point the higher the temperature the less time you need it the lower the temperature the more time you need so time and temperature are what they call inversely related to one another okay the more expensive the pressure cooker the less money you have in the bank all right so the higher the temperature the hotter okay let's say you're in a hurry and you want to heat something up in your oven what do you do turn turn and Crank It Up baby yeah it might get slightly singed on the outer edges but boy will it be done a little bit quicker yeah see time temperature proportions if if you want to do it right lower the temperature let it cook a little bit longer but you know what it's going to be even heat distribution which leads me to the next Point are we clear so far by the way I did mention to you that Dynamic air displacement system runs between 270 and 275° F which is roughly 131° C that's the dynamic air displacement temperature now before I move on to my next topic what did I say my next topic was by the way I kind of lost track for a second I said something what was it Steve you're my like a black box on the plane what did I say I I said something that moves me to the next point the what was I talking about before talking oh oh oh I was uh relationship h a relationship yeah oh God I hate relationships in any case what I want to show you here is one more test okay Dynamic air displacement uh systems use a test all right pass it around you can't see what's inside but I will tell you what this is can I erase this God you know I I I had something in mind and I was going to move to it and that's it the the brain is not what she used to be no what is the name on the package what does it say what's the name on the test Bowie dig test that's right very important oh gosh oh yeah oh I remember Steve remind me as I move on that I was going to talk about uh heat transfer as soon as I'm done with this little topic here I'm going to talk about heat transfer all right so Dynamic air displacement uh sterilizers utilize the test that's now being passed around the room that little blue package which is known as the Bowie slash or Dash dick test it is also known as residual air removal test so what this little packet that's now circulating around does is that you throw it inside the chamber before the work day begins you round a test cycle and you run a cycle with that package in there and that package once you open it up is supposed to give you results did the vacuum system inside the sterilizer effectively remove all of the resist ual air if the package says no it didn't machine is not working machine is not working and there was one more test that we placed over the drain right remember that green package right over here that one says that it's a uh steam Plus Pack called biological indicator H so right here we have a living biological entity which we'll talk about that we're supposed to kill and we're going to open this up we're going to look inside the little ampule that's there and we're going to make sure that what's what was inside was destroyed and we put this with every load that we run in the hospital now I want to caution you right over here the biological indicators and you know what I'll talk about this separately in in a couple of minutes all right we're going to get back to this I was going to talk about the Bowie dick test also known as the residual air test what does it test it tests if the residual uh residual air was removed from the chamber that's what this test does uh test but it also tests one more thing and it's it's important to know it tests specifically the door gasket because if the door gasket is leaking as the vacuum pumps do their thing more air gets sucked in through a partially closed door because the gasket is screwed up so if the gasket doesn't hold we don't create a vacuum if we don't create a vacuum the Bowie dick test or the residual test is going to fail if it fails the sterilizer is taken out of commission you may not use it for sterilization purposes it might work but then again it might not you will never know you will know when somebody gets sick or more times than not will die you don't want that on your conscious now do you does this make sense are we okay may I erase yeah all right and now I was going to talk about the heat transfer and then I was going to talk about the biological indicator right okay good keep me Keep Me steady on this otherwise I will forget I know I'm blitzing you with a lot of information and I'm here to tell you that all of this that we put on the board all of it all of it all of it the test will be on the test all of it as you review the video later if you review your notes it will be on the test there's no baloney here this is just the essentials and the basics all right I know we've blown through a lot of it in just a little bit over an hour but you know what you must know this for btim you must know it you must feel it you must understand it don't mess with it this is important stuff this is meat and potatoes of sterilization 60% of what you do in the hospital will revolve around steam sterilization so now heat transfer right or was I going to talk about heat transfer let's talk about heat transfer it's a quick now we have three different types of heat transfer conduction convection and radiation you must know these three words more specifically you must know the first two conduction conviction conduction heat transfer by direct contact example frying pan as you're making your favorite egg sunny side up you take an egg you put it in a hot frying pan it begins to sizzle direct contact heat transfer egg Cooks right do you understand the concept of conduction yeah if you take a spoon and you put it in a hot tea does the spoon heat up yes conduction by the same token as the spoon conducts heat away from your tea the tea also cools off right convection heat transfer by circulating gas be it air be it steam example baking bread in the oven as you put in your bread dough inside the oven the hot air begins to circulate the dough begins to rise and bake you understand heat transfer by convection radiation we don't care what this is because radiation is not used in the hospital there will not be questions on the test dealing with radiation see how much I love you I won't make you do extra but if you want to know what this is Sun's Rays as they fly through the atmosphere and they strike your skin and you feel hot radiation microwave oven sending radio frequency radio waves through the Chamber of the microwave through your food exciting the cells exciting the uh particles inside your food and as they vibrate they heat up because of friction within there's no actual heat transfer inside the microwave radiation make sense we don't irradiate anything in the Sterile Processing department so forget it steam sterilization is the example of What conduction or or convection yeah thank you circulating gas steam is gas it circulates so let me ask you a question and it is very important why am I talking about conduction and convection a there's going to be one or two questions about conduction and convection so please know the difference as the gas is supposed to circulate throughout the chamber what could you possibly screw up when you load the sterilizer to prevent the gas from circulating overlo overloaded don't put too much stuff inside the chamber thank you thank you so as you put you know your packages inside the sterilizer don't overload it just because you made it fit doesn't mean it's going to work okay it's like overloading your washer it's like overloading your dryer you may have gotten the door closed but it's just not happening you're going to take out dirty clothes the same thing here the air needs to circulate freely around the packages if it doesn't it doesn't penetrate right you may also not put packages in such a way inside the chamber that they touch the outer walls because the outer walls are hot the packages will burn and the gas will not circulate so there must not be any contact so one way to remember where water won't flow flow steam won't go kind of like that right so if you're putting things too tightly in there and the water cannot flow freely around it the steam is not going to go so things need to be laid out neatly with enough space for things to flow around them okay so packages cannot touch one another packages cannot touch the sides of the chamber right make sense and one more thing that people don't really know all the time or don't think about you cannot wrap things too tightly if you wrap things too tightly too tightly you're creating insulation rather than you know um uh packaging so things need to be able to get into the package as well too tightly wrapped packages don't sterilize very well does that make sense all right okay is this clear yes okay may I erase this yes we're almost done folks we're almost done I promise you I promise you I know it's a lot of information and I'm telling you that this time everything is on the test everything this is this is big stuff and next class we're going to be will be low temperature sterilization and all of that is going to be on the test as well after these two after these two classes I assure you you are capable of uh going through a job interview and securing a job after next week's class and if you review your material you will have enough solid information to have an intelligent conversation with a department manager please have enough strength of character to apply for a job but that's with how many classes before this last class this class and this class okay packaging steam sterilization low temperature sterilization you're in good shape you can con your way through an interview no problem I'll tell you a little story when I was young I was in college and I needed summer gig and so I saw a wonderful job which was uh a summer position working in the morg assisting with autopsies now I really wanted to I really wanted to get a job doing that I had no experience why did I want a job working not because I'm some kind of a ghoul but because I wanted to learn human anatomy better than I learned in a college okay I saw this job and I applied there were two of us at the end of the day a medical school student who want needed a gig like this and me I was in the medical school yet in any case orever I ended up not going but the fact of the matter is the other guy didn't have the winning personality that I did remember folks I told you it's all about the personality but the the doctor the pathologist in the hospital wasn't sure so he asked me Steve can you assist with an autopsy a straight question I said yes doctor I can okay your hired come in on Monday 700 a.m. I was thrilled so I come in I gone up I I go in says all right there's our body do the Y incision I said okay how the guy turns to the table and says you told me that you knew how to do an autopsy I said Doctor that's not what you asked me said you asked me can you do an autopsy and I said yes I can you have to show me says you son of a but by then it was too late I was already tired he says okay you take the knife into your right hand cut oh wow said okay and that's how it happened what's the moral of the story I'm not telling you to lie but if they're telling you do you know how to perform high temperature sterilization no it's not it's a direct question don't lie but they said do you understand understand high temperatur of course I do expanding steam you know removes the residual air blah blah blah temperatures 250° or 275 blah blah blah yada y y y can you do it of course I can of course I can just show me show me I know I can I'm the best candidate that you have seen the best I may not know anything but I'm definitely the best you've got there is no one better when you apply for a job they almost don't care what you know they're interested in you will you fit with the group will you give them a hard time will you call them sick the answer is if they look at you and say all right and all I got to do is show this guy a couple of times what to do looks pretty smart okay good let's go that's what they want they don't want a boat rocker they don't want a boob they want someone competent reliable reliable and a positive attitude they don't need your bad luggage from another hospital they want to teach you what they want and they want to keep you for the next five years or more you understand let's move on what was I going to talk about Biologicals or okay so process challenge devices or pcds what is the process sterilization thank you boy Steve you're really process by process huh he's on fire on fire smoking process we're talking about sterilization bang why are we challenging sterilization you all hear that man this guy is good Steve you got to go you you need to apply for a manager position straight away so the fact of the matter is we're challenging the process of sterilization to see if it works to see if it works I mean trer words were never spoken so process challeng devices if they were to say it in France shal anyway did I tell you that I learned all my French from Pep oh my we we Dar in any case so process challenge devices we challenge sterilization to see if it works all right and remember one of the places where we challenge it which is in the most difficult place where sterilization will take place will be by the drain right and I called it a biological indicator first one bi or biological indicator if I were to say it in French it would be indicator biologic I sure I'm probably right by those that speak French in the classroom indicator biologic in our particular case the biological indicator for steam sterilization is called geobacillus stopus oh yeah that yeah that long one Geo basilis stero thus I think I I hope I spelled correctly but it doesn't matter cuz you can look it up in the book geobacillus thermophilus at least I can say it giil thermophilus it's a biological indicator for just about everything except for one and I'll teach you that next time okay so geobacillus theophilos is a biological indicator and what preil is the geobacillus ster thermophilus it is a Spore what is a Spore Spore is a bacteria with a hard shell around it that makes it more difficult to kill okay that's what a Spore is Spore is a bacteria with a hard shell a bacteria with a hard shell think a difference between a turtle with a hard shell and a lizard I mean lizard is pretty much a turtle without the shell make sense if I can kill a turtle I can kill a lizard right so I take this Turtle I put it inside that little pack that I circulated with you earlier right biological indicator doesn't look like a biological indicator it looks like a package with something but allow us to ruin this beautiful package and if you see it's it's kind of wrapped up in some kind of a textile material and once I open it up it has well I don't know it has index cards index cards but behind door number one inside here we have something else all right we have a Ule and I take it out it's wrapped in a uh here for you to see and inside here we also have something else inside this ampule I don't want to open that up is the Spore of geobacillus ster thermophilus and in here just to be safe it's also a chemical indicator we haven't put that on the board yet so we have a chemical indic indicator and a biological indicator so inside this test tube is that bacteria is that Spore that we're supposed to kill it's inside the these uh you know packages here right it's inside here lives right there and it kind of mimics the package so it allows these 3x5 cards allow the steam to kind of penetrate in there this makes it more difficult I could just throw this in the sterilizer and let it St par but no we want to challenge it to make it as real as possible you know for these things to uh tell us the real truth we need to make it as hard as possible we need to make the steam penetrate inside of a pack it needs to be by that uh chamber drain so it's the hardest place if the steam goes in there we have really pushed our process of sterilization to the brink we want to make sure that the darn thing works doesn't it so we want to kill the most difficult diffult thing if we kill the most difficult thing then the easier microorganisms are done as well make sense you know that song New York New York if you can make it there you'll make it anywhere if you can kill the Spore of geobacillus Theophilus right next to the drain that means you pretty much killed just about everything make sense the next one will be the chemical indicator or CI chemical indicator and one of the Chemical indicators is that thing that I showed you just now all right it's a little thing a strip that if it's exposed to steam and heat will turn a different color I'll toss it to you take a look at it doesn't seem like much of anything and another chemical indicator is this tape right over here and if you look closely at this you will see Stripes going all across the tape of kind of almost neutral color it's kind of hard to see pass it around take a look and see if you see strips in there stripes let me tell you what these stripes are are made out of they're made out of lead they're inside this layer of tape and when it's exposed to heat and steam it melts and it changes color you see the stripes in there kind of like yellowish when they change color they change color to brown or black and they're supposed to stay that way I'll tell you my first day on the job many many years ago in the military when somebody taught me how to sterilize I did not know what that tape was so I saw that all these packages were top and masking tape and I thought to myself gee could they come up with something better and this masking tape had black stripes in it so what did I do when I wrapped up my first package I got myself a roll of masking tape you know the stuff that the painters use and then I took a Sharpie and I started drawing stripes on it and I was doing it for a while not a long long while until somebody says hey boy what the bleepity bleep are you doing and I said well ized packages are indicated by Stripes he said son he says are you as dumb as you look of course I didn't think I was dumb but would you say that's pretty dumb I nobody taught me see so I was drawing Stripes I know it's funny if I could tell you the first day I got a job in the hospital and they told me to go measure people's temperature oh my God you measure it yeah I took everybody's temperature and I come back with a clipboard and the nurse said okay son you're the new boy I said yes ma'am I'm the new boy so I went in she says go to the closet get a clipboard get a thermometer and take everybody's temperature so I went into the closet I see there are two two thermometers over there one is red and one is blue I like the red one better I took the red one and I took everybody's temperature I come back says aren't you nice she said you got everybody's rectal temperature I said no she says what temperature did you take I said oral she says oh honey you used rectal thermometer my first day on the job in the hospital folks listen to me if I could do it and still come out and not serve any time uh or actually excel in some of the jobs that I had done you can do it too and I'm here to share with you my pathetic experience in medicine to tell you that you know my first day in the job when I used a rectal thermometer to take everybody's oral temperature and from the time that I used a Shar and and masking tape to Mark sterile packages it's not my fault to the time that I interviewed for the deer's position to assist with the autopsies never having done one or even really not seen a dead body before it's all for your benefit again I could write a book and I'm here to tell you that it's it's all right to screw up except just don't be a horse's ass be good about it and don't lie somebody's life depends on it okay if you screwed up take your lumps like a man or a woman whatever the case may be take it take it like a you know just just take it all right you'll have it done once to you you won't do it again and as long as you didn't kill anybody or MIM or injure you're okay all right so I use rectal thermometer okay so chemical indicator we have the tape and we have the inserts that go inside of a package the outside of the package is wrapped up and closed with this tape so it shows the doctor or the nurse or the scrub technician that this package was definitely sterilized unless it was done by me way back when when I put the little lines on there okay and when they open it up inside there they see that other little thingy that I gave you and they say yeah if that turn the color that the inside of the package was also duly exposed to the sterilant does that make sense so the chemical indicator together with a biological indicator give us some degree of satisfaction that we're providing sterile instruments but there is more there is something called the Mi or mechanical indicator these are your gauges these are these guys right over here temperature pressure time machine gauges you need to also look to see if the temperature is in the proper Zone you need to see if the pressure is right and you need to know that your timer is working properly and it went from start to finish and it went Bing cycle is over all of these three things need to be recorded mechanical biolog iCal chemical now mechanical indicators are monitored with every load monitored with every load meaning every time you load up your sterilizer you better make sure that you watch your mechanical indicators Chemical indicators are every pack contains Chemical indicators now biological indicator requires a little bit of uh of U uh conversation because they have a trick question for biological indicators so I'm going to tell you that the minimum standard or the minimal standard for biological indicator is once a week so we check at the very minimum we check the biological indicator once a week very important minimal what did I say minimal what a week once a week test check no yeah so minimal check my God I again I'm going cile minimal check once per week so if the question is what is the minimum number of times that we check the biological indicator minimal is once a week but is there's the big butt right over here but if you are running mixed loads before every cycle you do it every cycle every load if running mixed loads check every Lo this is extraordinarily important as you must know the difference because that will trick you what is the minimum n what is the minimal value once a week for biological indicator what's a mix Lo thank you what's a mixed load I'll explain if I'm sterilizing nothing but stainless surgical steel it's not a mixed load however if I want to throw in an implantable device and I want to sterilize that what did I just do I mixed the load so in other words if you're doing nothing but whites in your laundry is it safe to put bleach and run it at high temperature yeah yeah but if you throw in a color item in there is it safe to put bleach will you run it on high no because you're going to ruin your your whs if you're doing a mixed load it's time to change your parameters it's warm SL cold right if you're running nothing nothing and I mean all the time if you don't have anything but stainless surgical steel give you an example your dentist checks their sterilizer with a biological indicator once a week because they don't have anything but stainless surgical steel look at their instruments all stainless surgical steel so how often do they have to do it hey a once a week if they're really anal retentive about it they can do it once a day if they're totally stupid it's going to cost them a Fortune they're going to do it with every load but you're in a hospital God only knows what you're putting in in those packages different packages different shelves put them all in hey it's a mixed load it's always a mixed load so in the hospital hospital if you're if you're doing it how often do you check every load but if you are doing no mixed loads the minimum value would be please understand that and you are safe and with that I am done for today believe me it's a lot of information to absorb we broke it up with a little humor a little bit of stories here and there that cockroach thing and so on and so forth hopefully it's going to keep you focused as you're reviewing this this is good stuff all of it will be on your test read the chapter gently don't over stuff your brain just read it and remember specialize in the stuff that I give you oh oh oh I'm so sorry I know I already taught you this but there's also one more p uh process challenge device and we already talked about it and it only works with Dynamic air displacement and that was the Bowie dick test remember that one yeah so that's one more thing that you know it's separate Bowie dick is also a process challenge device also a process challenge device and that's it we're done let me kill this