Regulatory and Environmental Consulting

Nathan Schiff, Ph.D.    Tel(519) 645-8575    Fax (519) 645-1003

By Nathan Schiff, PhD

 In 1995, Booth Avenue Laundry, serving the downtown Toronto hospitals, amalgamated with Centennial Hospital Linen Services, which resulted in the creation of Booth Centennial Linen Hospital Services (BCLHS).  Two years later, the downtown Booth Laundry plant closed and it's volume was transferred  to the newly created BCLHS, on Norfinch Avenue in the north end of the city. Situated in a modern 210,000 sq. ft. facility, and using 6 tunnel washers, the plant processes 55,000,000 lbs of laundry annually which supplies most of the hospitals in the GTA.  Then in 2001, Steripac, a separate operating division of BCLHS was created to meet the demand of supplying sterile Operating Room (OR) packs to hospitals. This article deals with the sterilization aspects of preparing laundry packs in the super modern 32,000 sq ft Steripac facility operation.  

What are OR, or Sterile Packs
During an invasive medical procedure care must be exercised to prevent patients from coming into contact with infectious germs. For this reason, linen, such as towels or gowns which may contact blood or  exposed internal organs, must be sterile or totally free of all life forms, including spores. When conditions are unfavorable for their existence, some bacteria convert into spores which are extremely adept at surviving harsh conditions and can easily be transferred to open wounds. Once the bacteria's environmental conditions improve, the spores can revert back to their vegetative or normal state, where they once again are capable of carrying on with their normal metabolic processes including the production of toxins and the spreading of an infection by multiplication. Therefore, garments destined for OR use, require special, high tech processing and QA tests in addition to the normal laundering procedures, to insure germ free and sterile products.

How the System Operates  
The linen needed to supply each of the 4,200 daily OR packs are initially inspected for holes or tears.  If found, the garments are repaired by using micro fiber thermal patches. At this step each fabric is also marked, prior to further processing, in order to keep track of the number of laundry cycles that it has gone through.  Eventually all laundry products will be replaced with those composed of micro fibers, since they exhibit a longer useful hospital life, capable of withstanding 75 laundering cycles compared to current 65 cycles from cotton products. The contents of each OR pack is filled according to specific hospital orders, wrapped in micro fiber wrappers and placed on 3-tier shelving units, destined for further processing.  

The Sterilizing Process  
Several shelving units holding the packs are wheeled into one of the 4 medium sized sterilizers (36" w x 60" h x 60" d) for further processing of the OR packs. During the 45 minute cycle the sterilizing chamber is steam heated at a pressure of 29 psi (pounds per sq. in.) and to a temperature of  132^oC-134^oC ( 270 - 273^oF), and held at that temperature for 3 minutes to insure that sterilization has occurred. The sterile packs are then transferred to an adjacent cooling down room via a second door opening of the sterilizer.  This room is virtually bacteria free, and the sealed floors are disinfected daily. The room is under a positive air pressure and the air volume is exchanged 20 - 25 times each hour. In addition the air is filtered through a 0.1 micron filter (1/10,000^th of a mm), which is capable of trapping most bacteria and other airborne life forms. Access to the room is available only to a few individuals with authorized access. The wearing of protective clothing, gloves, shoe covers, gowns and appropriate masks are a requirement before entering the room.   

The Secret of Quality Packs Lies in the QA
Once the OR packs have cooled down random samples from each pack are examined for product sterility. To that effect Biological and color test indicators measuring sterilizer integrity, are enclosed in each laundry packet
Using 3M's Attest Rapid Readout kit, vials of Bacillus stearothermophilus, disease-causing, heat-resistant spores are placed in the packs prior to sterilization and are removed and examined for biological activity after sterilization. The lack of spore viability and the absence of microbial growth indicates that the sterilization cycle has been successful. Additional tests including the Bowi Dick Test are done to verify the integrity of the steam cycle, proper air removal and sterilizer steam injection via color changes to the test material. The pack contents are also examined for wetness, since its presence could indicate a lack of splash proof integrity of the micro fibers which is needed to prevent penetration of body fluids during medical procedures. Finally, the contents of the packs are checked against the sticker label to insure the accuracy of the package contents. Once opened and checked, OR test packs are sent back for reprocessing and the others are transferred to a cabinet, locked and transported to the hospitals

Benefits of Outsourcing
In order for a business to flourish it has to economically fill a need, which is what Steripac does.

Among some of the benefits include:
Savings are realized on a cost per use basis when hospital laundry is outsourced.
Chemical and water usage are carefully monitored and environmental conditions are met
Outsourcing, eliminates the need for hospitals to invest in capital expenses and equipment such as sterilizers, laundry washers and dryers
With reuse of fabrics 75 times less land fill waste is generated, compared to the use of disposables