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Clean and sterilize tools

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HealthWiki > A Book for Midwives > Chapter 5: Preventing Infection > Clean and sterilize tools


All the tools used at a birth, exam, or procedure must be cleaned and sterilized. Cleaning and sterilizing the tools gets rid of germs. This protects women from getting sick.

Contents

1. Soak your tools

Tools that have been used must be soaked for at least 20 minutes in bleach solution.

2. Clean your tools

Carefully wash all the dirt off your tools.

All tools and equipment you use at a birth or a procedure must be clean. Wash them well after each birth, using a brush to remove any blood or dirt in the hinges or rough edges of your tools. Clean off any rust, and get rid of tools that are dull or damaged. To protect yourself, wear heavy gloves when you clean your tools.

After everything is washed, any tools that you use inside a woman’s body must also be sterilized to kill germs.

3. Sterilize your tools

To sterilize means to kill all the germs on something. If your tools are sterilized, they will not spread germs to women when you use them. This will protect women from getting infections.

Sterilize everything that will go inside a woman's body, will cut her skin, or will be used to cut the cord at birth.

Sterilize these items:

  • syringes and needles
  • scissors or razor blade for cutting the cord
  • materials for sewing tears
  • clamps or hemostats
  • gloves
  • gauze
  • compress cloths
  • bulb syringe or mucus trap
  • MVA cannula
  • speculums, in some cases


Note: You do not need to sterilize tools that are used only on the outside of the body. Stethoscopes, measuring tape, and blood pressure cuffs must be clean but do not
need to be sterile.


When you sterilize a tool, the germs on it are killed and it is safe to use. But if that tool touches anything (including the bed, a table, or you!) it is no longer sterile. Germs from whatever it touched are on it, and those germs can cause an infection when the tool is used.

The next few sections explain 5 different ways to sterilize your tools: baking, pressure steaming, boiling, steaming, and soaking in chemicals. Baking and pressure steaming are best — they kill the most germs. If you cannot use either of those methods, boiling, steaming, or using disinfectant chemicals is fine. Use the ways that work best for you.


WARNING!   If you cannot sterilize your tools, then do not use them. Unsterilized tools will do more harm than good.

Baking

Use baking to sterilize metal tools, and string for tying the cord. Do not bake rubber or plastic. It will melt.

Let the packet cool, then store it in a clean, dry place.

Pressure steaming

Use pressure steaming to sterilize metal tools or rubber or plastic equipment.

Some clinics and hospitals have a machine for sterilizing called an autoclave. Autoclaves sterilize instruments using pressure and steam. If you have a pressure cooking pot, you can sterilize your tools in the same way that an autoclave does.

After sterilizing tools, let them dry. Do not touch them, or they will not be sterile anymore!

Use sterilized tongs, chopsticks, or spoons to pick the tools out of the pot. Move them directly to a sterilized container. Remember, if the tool touches anything, including your hands, it is no longer sterile.

Let the tools dry in the sterilized container. Cover the container with a sterilized cloth or paper to keep dust out.

When the tools are all dry, put the lid on the container and seal it with tape or some other material to keep the germs out.

Boiling

Use boiling to sterilize metal tools, rubber or plastic equipment (like mucus bulbs), and cloth.

Use sterilized tongs, chopsticks, or spoons to pick the tools out of the pot. Move them directly to a sterilized container. Remember, anything you touch is no longer sterile.

Steaming

Use steaming to sterilize metal tools, gloves, plastic equipment, and other tools.

A steaming pot has 3 parts that fit together tightly: one pot on the bottom to boil water in, one pot in the middle that has holes in its bottom, and a lid.


Wait for the tools to dry, and then use sterilized tongs to move the tools from the steamer into a sterilized container, and seal the container.

Steaming uses less water than boiling, and tools that are steamed do not get dull or broken as quickly as tools that are boiled.

A method from the Philippines

The Medical Mission Sisters in the Philippines have developed a method to sterilize tools with steam:

  1. Put your clean tools into a metal tray.

  2. Place the tray in a cooking pan.
  3. water level


  4. Fill the pan with water until it reaches halfway up the tray.

  5. Cover the pan with 8 layers of clean green banana leaves. Bind the leaves tightly in place with strips of banana leaf or bark. Be careful not to spill water into the tray when you do this.

  6. Put the pan on a low fire and boil for about 1 hour.

  7. Throw away the top layer of the leaves. You can use one of the inner layers to put your instruments on.

Using chemicals

Some people use chemicals to sterilize metal, rubber, or plastic tools and equipment. We do not recommend using chemicals to sterilize.

Most chemicals used to sterilize are poisonous. They poison the ground and the water when they are thrown away. They are poisonous to the people who work in factories making them, and they are poisonous to the people who use them to clean tools.

But some tools can only be sterilized with chemicals. Thermometers and some kinds of gloves cannot be baked, boiled, or steamed

If you do need to use chemicals:

or  If you do not have bleach, use one of the following chemicals:

  • ethanol (medical alcohol) 70%
  • isopropyl alcohol 70%
  • hydrogen peroxide 6%


or  If you cannot get any of these chemicals, you can use:

  • strong drinking alcohol like gin, or a strong local brew.


Be sure that all of your tools are very clean before sterilizing them with chemicals. Even a little blood or body fluid left on the tool can stop the chemicals from working. Do not use chemicals to sterilize tools that will go inside the womb.


WARNING!   Glutaraldehydes and formaldehyde are chemicals that we think are too dangerous to ever use. Many clinics and hospitals use these to sterilize, but they are very toxic. Formaldehyde, for example, causes cancer. Try to find a different way to sterilize.

If you use chemicals, keep them off your skin, and wear gloves when you use them. Get rid of chemicals carefully. You may have to dump bleach or other chemicals into a latrine to be sure animals and children do not drink it.

Storing tools and supplies

At some births there will be plenty of time to sterilize your tools and equipment at the mother’s house. But at other births, you may not have time. For this reason, try to sterilize your tools and equipment at home and keep them in a sterilized container in your kit. A metal box or pot with a tight-fitting lid is best. Use any of the above methods to sterilize a container and tools to move equipment. Do not touch the inside of the container.

If you cannot get such a container, wrap the tools and equipment in 4 layers of cloth or heavy paper before sterilizing them. Then keep the sterilized tools wrapped up until you are ready to use them. (You can only use cloth or heavy paper to wrap your tools if you are sterilizing by baking.)

Remember that germs grow in moisture, and they will come back if the instruments are put away while they are wet. But if you are going to use the tools right away, it is OK to use them when they are wet. Germs need time to grow.

Some equipment needs special care

Sterile packets
a glove in a well-sealed packet.
a glove in a torn packet.
hole
tear in package
This glove is sterile. This glove is
not sterile.

Gauze, compresses, gloves, and other equipment sometimes come in sterile packets. Because the inside of the packet is sterile too, you can use this equipment directly out of the packet. But remember: once you take something out of its sterile packet and use it, or if the packet gets wet or gets holes in it, the equipment is not sterile anymore.

Things in sterile packets are often meant to be used only once and then thrown away (disposable). But some of these things can be used again if they are carefully cleaned and sterilized before each use. Gloves can be boiled or steamed. Gauze and compresses can be washed and then boiled or baked.

Thermometers

Wash the thermometer in soap and rinse with cool, clean water before and after you use it. Do not use hot water because the thermometer may break.

After washing, it is best to soak the thermometer in alcohol for 20 minutes. You can use ethyl, isopropyl, or medical alcohol (ethanol). Do not reuse the alcohol. Rinse the thermometer in clean water before you use it again.

Razor blades

Razor blades for cutting cords often come inside of a sterile packet. To keep the packet sterile, wrap it in clean paper or cloth, or keep it in a clean dry box. If the packet gets wet or dirty, it is not safe to use the razor blade unless you sterilize it again.

Try not to reuse razor blades — but if you do, they must be sterilized first. Razor blades can be sterilized by any method.

Gloves

Most plastic gloves can be boiled or steamed, but some will fall apart in the water. Get strong gloves that can be boiled and reused a few times.

Only touch the
inside of the glove.

Before boiling or steaming gloves, turn the cuff inside out. After sterilizing a glove, touch only the inside part of it. If you touch the outside, it will not be sterile anymore.

If the gloves you have cannot be boiled, wash them carefully and soak them in bleach or medical alcohol. Then rinse them in clean water before using them again.

Mucus bulb (bulb syringe)

When you wash out a mucus bulb, make sure to fill it with soapy water and then squeeze the water out. Do this several times. Then rinse it out well.

If you sterilize the mucus bulb by boiling, make sure to let water into the inside of the bulb before boiling and then squeeze out all the water afterward.

Needles

Many people get sick with serious illnesses like hepatitis or HIV/AIDS from using unsterilized needles.

Reusable syringes and disposable syringes
Reusable syringes can be used again and again. Reusable syringes make less waste and can save money, but they must be washed very carefully and sterilized after every use.

How to wash and sterilize a syringe and needle for reuse:

  1. Put on a pair of heavy gloves to protect your hands from germs.
  2. Draw 5% bleach solution up through the needle into the syringe barrel.
  3. Squirt out the bleach solution.
  4. Repeat several times. Rinse everything several times with clean water.
  5. Take the syringe and needle apart and boil or steam them.

Disposable syringes are made to be thrown out after one use. Some disposable syringes can be taken apart, boiled or steamed, and reused several times. But we do not recommend this, because needles that are not completely sterilized can spread disease.

Never reuse a needle or syringe without cleaning and sterilizing it first!

Remember:

If you take a sterile syringe
out of boiling water . . .
and put it in
your pocket . . .
it is not sterile anymore.
Instead, it is dangerous!


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