Sterilizing

A Message from the IPAC Work Group

Dear midwives and practice groups,

We are writing to you as the AOM’s Infection Prevention and Control (IPAC) Work Group, which was formed after a bacterial outbreak at an Ontario midwifery practice group. Our first piece of work was to develop a set of values to guide us in supporting midwives in the continuous improvement of infection prevention and control practices.  

As midwives, first and foremost, we all share the goal of providing high-quality care and of not harming our clients through our care. Lack of appropriate attention to strengthening infection prevention and control practices can also lead to other consequences, such as public health inspections of the practice and media attention (click for an example).

The IPAC Work Group has identified instrument sterilization as a high-impact area of improvement and is developing resources to support you to ensure excellent infection prevention and control practices (see the resources listed below).

We recognize that effective infection prevention and control requires considerable resources (both time and funding) from you and your practice group. Your negotiations team will be prioritizing requests for additional targeted funding and systemic solutions from the Ontario Midwifery Program to support this improvement initiative; meetings with the ministry are expected to begin within the next three weeks.  Alternatively, some midwives have explored using disposable sterile instruments or paying a local organization (e.g., hospital) to sterilize their instruments for them.   We recognize the importance of bringing you recommendations that not only improve infection and prevention and control practices, but also reflect the midwifery model of care and do not place unnecessary burdens on midwives and clients.

Given how important it is to ensure instruments are sterile – for the protection of our clients, for ourselves, and for the reputation of midwifery – we encourage you to review your current practices and the new resources available.   

I want to thank the IPAC Work Group members and AOM Quality and Risk Management staff who have worked very hard on your behalf to get high-quality resources to you quickly while keeping clients central to our work. Keep your eye out for more resources over the next many months!

Thank you very much for taking the time to review and implement these resources.  For additional information, contact the Quality and Risk Management team at the AOM at 1-866-418-3773 ext 2244.  We are committed to supporting midwives as you undergo changes to your IPAC processes.

Sincerely,

Sara Chambers, Chair on behalf of IPAC WG members: Zuzana Betkova RM, Jacqueline Curran RM, Suzanne Desaulniers RM, Sarah Hook RM, Josée Nolet RM, Ava Vosu RM, Karline Wilson-Mitchell RM, Rachel Rapaport-Beck (College of Midwives of Ontario), Catha McMaster (Midwifery Education Program student)

Because instrument sterilization is complex, the AOM IPAC Work Group strongly encourages practices to have anyone involved in instrument sterilization complete this free online course from Public Health Ontario and that at least one person per practice complete a recognized training course, for example, from the Medical Device Reprocessing Association of Ontario (MDRAO).

Each practice group site that autoclaves its own instruments now qualifies for an additional $750 (over and above max funding for individual midwives) to send an administrator or midwife to instrument sterilization training. Apply here.


     PRESENTATION - Packaging Your Instruments for Sterilization

Recorded webinar
Originally presented June 9, 2016:
Proper packaging of instruments is important to ensure that they can be sterilized and that they remain sterile. This webinar reviews the options: pouches, wraps, and cassettes.

    PRESENTATION - Are Your Instruments Really Sterile?


Slides
Recorded webinar
Originally presented May 2, 2016.
Even though the tape changed colour, your instruments may not actually be sterile. Join AOM infection prevention and control work group members Sara Chambers, RM and Anne Augustin (Public Health Ontario) to learn about provincial best practices; the steps involved in cleaning and sterilizing instruments; and the proper use of biological, physical and chemical indicators when using your autoclave.

 
    SAMPLE PROTOCOLS

 
    Instrument Cleaning and Reprocessing
    Reprocessing


    TEMPLATE - Instrument Cleaning and Sterilizing Checklist Updated June 2016


1 page version

2 page version

These instructions can be hung on the wall above your autoclave and used each time you clean and sterilize instruments. The concise list is intended to guide you through the necessary steps of instrument cleaning and sterilizing, without explaining them in depth.  The checklist is provided in a Word template format, which allows you to adjust and change steps to make the checklist most relevant to your own practice.

    EQUIPMENT LIST - Instrument cleaning and sterilization

    This chart lists and explains the purpose of each piece of equipment needed for reprocessing. It is intended to explain the details of any
    unfamiliar items and to assist decision-making when making new purchases.
    TEMPLATE - Autoclave log with examples Updated July 2016
    Record-keeping: Used together, the log, pouch label and charting allow you to retrospectively see instruments used with a client passed
    their biological indicator, chemical indicator and physical indicator. you to track the instruments used with a client to the autoclave cycle.
    On the first page you will find sample autoclave log entries, package label samples, and charting samples. Blank pages of the autoclave
    follow for your use.

    TEMPLATE - Autoclave maintenance log


    The autoclave maintenance log will provide you with a place to document all autoclave maintenance and cleaning that you perform.

    VIDEOS - Autoclave YouTube playlist


    Playlist that focuses on autoclave maintenance and sterilization practices.

    REFERENCES

    Link to additional sterilizing resources and list of references used for this section.



IPAC Work Group Objective and Values Statement

Objective: To support the continuous improvement of infection prevention and control practices in midwifery by making recommendations about priorities and strategies to the midwifery community.  

The IPAC Work Group believes that this objective will be best met by:

  1. Respecting the values and model of midwifery care.
  2. Recognizing the importance of both the needs of each individual client and the needs of the community of clients.
  3. Acknowledging that midwifery clients and their babies are generally healthy, yet everyone is susceptible to or may carry infection.
  4. Respecting midwives’ ethical responsibility to provide care that protects their clients and themselves from infection.  
  5. Remaining aware of the potential impact on the environment.
  6. Empowering midwives and practice groups to reflect on their own practice and make adjustments in a way that considers the context in which they are providing care.