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Stainless steel instruments should not be placed next to instruments made of other metals, such as brass or copper because an electrolytic conduction reaction can occur The instrument and brush must be kept submerged in the solution during cleaning to prevent contaminated water droplets from aerosolizing ultrasonic cleaner removes small organic particles and soil from areas of instrumentation that manual or mechanical cleaning cannot reach; utilizes cavitation Packaging material performance standards must maintain sterility of the items until use; should permit the package to be opened in a manner that allows for easy removal of items without contamination; should allow the sterilizing agent to penetrate and reach all surface areas of items to be sterilized Packaging material performance characteristics efficiency, ease of opening, sterilization suitability, strength, barrier efficiency and support impermeability, seal integrity, safety, sterility maintenance Woven textiles made of cotton or blends of cotton with synthetic material such as polyester Muslin made of cotton, single or double ply Nonwoven materials disposable wrappers that are designed for single use If using marker to label peel pack only label on the plastic side and do this before sterilization process maximum size of linen pack (muslin) 12 inches high by 12 inches wide by 20 inches long; must not weigh more than 12 pounds Three steps for preparation of sterilization inspection; reassembly; and preparation Inspection when instrument function is assessed for repair or replacement Reassembly reassembly of items that need to be together before sterilization Preparation proper arrangement and positioning of items before sterilization Basin sets should be wrapped with an absorbent towel between them to allow adequate air space Five factors critical to sterilization process time, contact, temperature, moisture, pressure Wrapped instrument set 30 minutes gravity at 250 degrees Wrapped instrument set 4 minutes pre-vacuum at 270 degrees unwrapped instrument set with no lumens 15 minutes gravity at 250 degrees unwrapped instrument set with no lumens 3 minutes gravity at 270 degrees unwrapped instrument set with no lumens 3 minutes prevacuum at 270 degrees unwrapped instrument set with lumens 20 minutes gravity at 250 degrees unwrapped instrument set with lumens 10 minutes in gravity at 270 degrees unwrapped instrument set with lumens 4 minutes prevacuum 270 degrees wrapped basin set 20 minutes gravity 250 degrees wrapped basin set 4 minutes prevacuum 270 degrees Most frequent reason for failures during steam sterilization cycle lack of contact between steam and surfaces of items to be sterilized autoclave device to accomplish steam or gas sterilization envelope fold useful for smaller instrument trays and individual items square fold useful for large packs and instrument trays Written label information package contents, shelf-life indication, date of sterilization, identification of the sterilizer, cycle number, initials of who prepared package, department to which the package will be sent Steam sterilization utilizes moist heat in the form of saturated steam under pressure within an enclosed environment; the most dependable method of sterilization in which all microbes including spores are destroyed The thermal destruction of microbes the result of the denaturation and coagulation of protein within the cells Moisture allows the use of a lower temperature than that normally required to denature proteins within the microbes Direct steam contact of all surface areas must occur for an item to be rendered sterile Air must be completely removed from the chamber if efficient sterilization of materials within is to occur chemical indicators used externally and internally to verify that items have been exposed to sterilizing conditions mechanical monitoring monitor the progress of the machine during the sterilization process biological indicator a device that contains a specific type of microorganism when exposed to sterilizing conditions Gas/Eto sterilization used to process materials that cannot be processed using steam sterilization Ethylene oxide predominant chemical used in gas sterilization process; must be aerated before use; works at lower temperatures Eto exposure toxic and flammable; causes skin irritation, respiratory difficulty, headaches, nausea, and possibly cancer, reproductive difficulties and chromosomal alteration Eto sterilization time up to 16 hours Peracetic acid Steris; heated to 50 degrees Celsius and can be used to sterilize endoscopes; for immediate use only Plasma sterilization Sterrad; uses gas at low temperature to sterilize heat-sensitive materials