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03/24/2005    Joseph Menn, DPM

Cold Sterile Trays

Query: Cold Sterile Trays

Does anyone have any suggestions for what type
of chemicals to use in
treatment room cold sterile trays. We used to
use Benz-all. Then we
found out that it doesn't really kill all the
nasties required by law (i.e., HIV, hepatitis
and TB). Then we switched to Surgicare. This
worked great, but we can't get it from American
Medical Specialties any longer. We now have
switched to Cidex-OPA. This meets all
requirements, but stains everything a blue
color (lab coats with blue drips, pants, shoes,

The main problem we face that I think most
people may overlook is that we need a solution
that is not toxic to tissues without rinsing in
water first, or toxic to breath at full strength
day in and day out. This rules out everything
with gluteraldehyde (i.e., Cidex Plus,
Metricide, Wavecide, Cetycide just to name a
few). The solution is for a chemical that
sterilizes in a short period of time, non-
staining, non-toxic to tissues, non-toxic fumes,
and doesn't cost $500 per month. Does anybody
have any suggestions?

Joseph Menn, DPM
Myrtle Beach, SC

Other messages in this thread:

03/25/2005    Elliot Udell, DPM, Marc Lindy, DPM

Cold Sterile Trays (Joseph Menn, DPM)

RE: Cold Sterile Trays (Joseph Menn, DPM)
From: Elliot Udell, DPM

There are problems with cold sterilization of
routine podiatry instruments. In a busy office
is it not possible to achieve total sterility
when the same set of instruments are used all
day long for many different patients. As you
pointed out some of these chemical agents can
even be toxic. The solution to the problem is
simple. Bite the bullet and autoclave all of
your instruments. This will mean investing
several hundred dollars into the purchase pf
multiple sets of instruments. You will also need
disposable sterilizer bags which cost rough a
dime per bag. Because it takes roughly an hour
to autoclave and cool down instruments, we
sterilize all of them once at the end of the
day. If we find we are running short, we do two
runs in the course of a day. This way we are
secure that we not spreading disease and we are
helping and not harming our patients.

Elliot Udell, DPM
Hicksville, NY

Cold Sterilization is a hot topic that
unfortunately our profession has not faced
squarely. We have used the term "cold
sterilization" for so long that we have come to
believe it actually occurs, when in fact we are
speaking of "chemical disinfectants." Since the
Hep and HIV concerns peaked over the past
decades, dentists have been known to have signs
in their waiting rooms which state "All
instruments in this office are steam
sterilized." Would you be happy going into any
medical facility where the sign states "all of
our instruments are disinfected?" There is a big
difference between disinfecting and sterilizing,
and it’s not a question of what is required by
law, it should be mandated foremost by our own
professional standards and ethics.

Quaternary ammonium compounds are not worth the
words to discuss them so onto glutaraldehyde.
Glutaraldehyde is meant for items that cannot be
steam sterilized. It is a high-level
disinfectant at twenty minutes and only a
sterilant at six to twenty hours (depending on
temperature and concentration). According to
the Handbook of Infection Control in Office -
Based Health Care and Allied Services published
by the Canadian Standards Association, "Most
disinfectants lose their effectiveness rapidly
and severely in the presence of organic matter.
In other words, if an item is not clean, you
will have considerable difficulty disinfecting
it. You can clean without disinfecting, but you
cannot disinfect without cleaning."

I practiced in Australasia when the New Zealand
and Australian podiatry associations mandated
that the standard for all instruments was
sterilization and not disinfection.
Practitioners were given a compliance period and
the educational tools to make the change in
attitude, equipment and practice. I've heard
most of the arguments for the status quo,
including "I've practiced for years without any
problems" and "I'm not working below the skin,
cutting it or touching blood or fluids." These
responses are nothing but wishful thinking and
not modern contentious patient care.
Based on the Podiatric Management annual survey
results just published, I'd say we can all
afford a decent autoclave and a dozen sets of
good stainless instruments. It’s a small price
to pay for public protection.

Marc Lindy, DPM
Vancouver, BC, Canada


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