Hesperian Health Guides
Clean and disinfect or sterilize tools
HealthWiki > A Book for Midwives > Chapter 5: Preventing Infection > Clean and disinfect or sterilize tools
Contents
1. Take apart your tools
Tools that have been used should be taken apart, if possible, so that all surfaces can be cleaned and then disinfected or sterilized.
2. Clean your tools
Cleaning removes visible dirt and substances from your tools. This is an important step before you remove germs. Use clean water, cleaners appropriate for your tools (like detergents) and 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 your tools are clean, they must also be disinfected or sterilized to kill germs.
3. Remove germs from your tools
Once the tools are clean, it is important to remove germs from them. This will protect against them spreading infection. Germs are removed from your tools by disinfecting or sterilizing. Which you do depends on the tool and how it is used.
Disinfecting kills most of the germs that cause infections. Disinfect tools that touch mucous membranes (such as inside the mouth and inside the vagina) or broken skin, and that are not resistant to heat.
Disinfect these items:
- bulb syringes and mucus traps
- MVA cannula
- speculums
Sterilizing kills all the germs that cause infections. Sterilize tools that are used to cut into the body, or that come in contact with wounds. For example, any tools that will be used to cut the cord at birth must be sterilized.
Sterilize these items:
- syringes and needles
- scissors or razor blade for cutting the cord
- materials for sewing tears
- clamps and hemostats
- gauze
- compress cloths
Using tools that have been disinfected (but not sterilized) to cut into the body puts the person at risk of infection, and should be done only when their life is in danger. The next few pages explain different ways to sterilize or disinfect your tools.
Storing tools and supplies
At some births there will be plenty of time to disinfect or sterilize your tools and equipment at the mother’s house. But at other births, you may not have time. For this reason, try to prepare your tools and equipment at home and keep them in a sealed container in your kit.
For tools you sterilize by baking or pressure steaming, keep them sealed in the packet or container you sterilize them in until you are ready to use them (see below). For tools you disinfect, use any of the methods to disinfect or sterilize a storage container. A metal box or pot with a tight-fitting lid is best for storage. Do not touch the inside of the container. Keep the container closed until you are ready to use the tools inside.
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.
How to sterilize by baking
Baking uses dry heat to sterilize tools. This can be used for metal tools and string for tying the cord. Do not bake tools made of rubber or plastic – they will melt!
Take your tools apart and clean them (see above). Then wrap them in 4 layers of clean cloth or heavy paper and tie it shut.
Put the packet of tools into a container or on a pan.
Bake at 170ºC (340ºF) for 1 hour or 150ºC (305ºF) for 2½ hours.
Then let the packet cool and store it in a clean, dry place. Do not remove tools from the packet until you are ready to use them, and then touch them only when wearing sterile gloves. Once a tool is exposed to the air or touches anything (like a table or your skin), it is no longer sterile and the germs on it can cause an infection when it is used.
How to sterilize by pressure steaming
Pressure steaming uses heat and steam under pressure to sterilize tools. This can be used for metal or rubber tools and some 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.
How to disinfect by boiling
Use boiling to disinfect metal tools, rubber or plastic equipment (like mucus bulbs), and cloth.
Take your tools apart and clean them (see above). Then place in a pot, cover with water, and boil for 20 minutes.
Start counting the 20 minutes when the water starts to boil.
Then let the tools cool and dry. Use disinfected tongs, chopsticks, or spoons to remove the tools from the pot. Move them directly to a disinfected container with a lid. Remember, anything you touch with your hands is no longer disinfected.
How to disinfect by steaming
Use steaming (without pressure) to disinfect metal tools, gloves, plastic equipment, and other tools. Steaming uses less water than boiling, and tools that are steamed do not get dull or break as quickly as tools that are boiled.
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.
Take your tools apart and clean them (see above). Boil a little water in the bottom pot. Put the clean tools into the steamer pot with the holes. Cover with the lid.
Steam over boiling water for at least 20 minutes.
Start counting the 20 minutes when the water starts to boil.
Wait for the tools to cool and dry, and then use disinfected tongs to move the tools from the steamer into a disinfected container, and seal the container.
A method from the Philippines
The Medical Mission Sisters in the Philippines have developed a method to disinfect tools with steam:
- Take your tools apart and clean them (see above). Then put them into a metal tray.
- Place the tray in a cooking pan.
- Fill the pan with water until it reaches halfway up the tray.
- 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.
- Put the pan on a low fire and boil for about 1 hour.
- Throw away the top layer of the leaves. You can use one of the inner layers to put your instruments on.
If possible, avoid using chemicals
Some people use chemicals to disinfect metal, rubber, or plastic tools and equipment. We do not recommend this.
Most chemicals used to disinfect 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 disinfected with chemicals. Thermometers and some kinds of gloves cannot be baked, boiled, or steamed.
If you do need to use chemicals:
- mix up a bleach solution.
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.
Take your tools apart and clean them (see above). Be sure that all of your tools are very clean before disinfecting them with chemicals. Even a little blood or body fluid left on the tool can stop the chemicals from working. Do not use tools that have been disinfected with chemicals inside the womb.
Soak in 6% hydrogen peroxide for 30 minutes.
Soak in alcohol for a whole day.
After soaking, pour the chemicals off and let the tools dry. Move them directly to a disinfected container with a lid using disinfected tongs. Remember, anything you touch with your hands is no longer disinfected.
WARNING! Glutaraldehydes and formaldehyde are chemicals that we think are too dangerous to ever use. Many clinics and hospitals use these to disinfect, but they are very toxic. Formaldehyde, for example, causes cancer. Try to find a different way to disinfect.
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. For more information on safe disposal of chemical waste, see Chapter 19 of A Community Guide to Environmental Health.
Some equipment needs special care
Sterile packets
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 hole
tear in package |
| This glove is sterile. | This glove is not sterile anymore. |
Sterile gauze, compresses, gloves, and other equipment sometimes come in sterile packets. 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 things inside are 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 reused if they are carefully cleaned and sterilized before each use. Gauze and compresses can be washed and then baked.
Thermometers
Wash a thermometer in soap and rinse with cool, clean water before and after you use it. Do not use very hot water with a glass thermometer because it may break.
After washing, it is best to soak the thermometer in alcohol for 20 minutes. You can use 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 small sterile packets. To keep a 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 (see above). Try not to reuse razor blades — but if you do, sterilize them first.
Gloves
Most plastic gloves can be boiled or steamed, but some will fall apart. Try to get strong gloves that can be boiled and reused a few times.
Before boiling or steaming gloves, turn the cuff inside out. After disinfecting a glove, touch it only on the inside. If you touch the outside, it will not be disinfected anymore.
If your gloves cannot be boiled, wash them carefully and soak them in bleach or medical alcohol. Then rinse them in clean water before using them.
Mucus bulb (bulb syringe)
To wash out a mucus bulb, fill it with soapy water and squeeze the water in and out several times. Then rinse it well with clean water. If you disinfect it by boiling, let water inside the bulb before boiling. Squeeze the water out afterward while wearing a disinfected glove.
Reusable syringes and disposable syringes
Reusable syringes can be used again and again because they can be taken apart for cleaning and are strong enough to be sterilized. Reusable syringes make less waste and can save money, but they must be cleaned and sterilized after every use.
Disposable syringes are made to be thrown out after one use. They cannot be sterilized again. Disposable syringes can be disinfected and reused, but we do not recommend doing this because a syringe that has only been disinfected can still spread infections, including hepatitis and HIV. This should be done only when someone’s life is in danger.
How to wash and disinfect a disposable syringe and needle:
To most safely reuse a disposable syringe, wash and disinfect it right after using it, and again right before you reuse it. This makes it less likely to spread infection, but does not prevent it completely.
- Wear gloves to protect your hands from cuts and germs.
- Pour clean water into 2 cups, and full-strength bleach into a third cup.
- Draw clean water from one cup through the needle into the syringe. Shake or tap the syringe at least 30 seconds to loosen anything stuck inside (take care not to stick yourself with the needle). Squirt the water into a sink or bowl, not back into the water cup.
- Repeat step 3 until water in the syringe is clear (no blood).
- Draw full-strength bleach from its cup through the needle into the syringe. Shake or tap the syringe at least 30 seconds to loosen anything stuck inside. Squirt out the bleach into a bowl or sink.
- Repeat step 3, but with water from the second clean water cup.
Remember:
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| If you sterilize a reusable syringe . . . | and then put it in your pocket . . . |
it is not sterile anymore. Instead, it is dangerous! |