TITLE: NARMS-KS-1-Autoclave Use
AUTHORS: tdoerks

[DESCRIPTION]
Instructions on how to use autoclave in Mosier P209.

[STEPS]
SECTION: Waste
1. Make sure waste to be autoclaved is in a biohazard bag (no more than 3/4 full) and place in autoclavable container.
SECTION: Waste
2. Wrap 2 Steam Migrating Integrator Strips together with autoclave tape and a piece of string and place in the middle of the bag of waste to be autoclaved with the piece of string hanging out of the bag so that the strips are easily retrieved after autoclave cycle is finished
SECTION: Waste
3. Tape string with autoclave tape to an AccuFast Biological Indicator (BI) and place in the middle of the bag of waste to be autoclaved with the piece of string hanging out of the bag so that the BI is easily retrieved after autoclave cycle is finished.
SECTION: Waste
5. Close the door with foot peddle and select Cycle 4 from the cycle menu and select 'Start Cycle.'
SECTION: Waste
4. Add 1 liter of water to the bag and loosely close with autoclave tape leaving about a 2-finger space opening and load from door in room P209.
SECTION: Waste
6. When load is finished, open door with caution as steam can be released from the doorway and using appropriate PPE (temperature resistant gloves, lab coat, and goggles) unload the tray containing the bag.
SECTION: Waste
7. Observe autoclave tape color and record results (color change - yes or no). 
SECTION: Waste
8. Remove and read the steam strips and record results.
SECTION: Waste
9. Remove BI and crack open glass ampule using the indicated slot in the incubator (L202) and incubate at 60°C for 10 hours. 
SECTION: Waste
12. If load has passed sterilization then it can be placed in a black trash bag and taken out to the trash. If load has not passed then it needs to be reautoclaved until it passes sterilization. Please see section on trouble shooting should this occur.
SECTION: Waste
10. In the case where BI and the steam strip results conflict, defer to the BI results as they are considered more accurate and consistent. 
SECTION: Media
13. Place all media in autoclavable trays and make sure to not overload autoclave with media like stacking trays on top of each other (only one layer thick) or putting media bottles too close to each other (make sure they are not touching with at least a finger width or two apart)
SECTION: Waste
9.1. Blue color indicates 'Pass' while yellow color indicates 'Fail.'
SECTION: Waste
8.1. Blue in the 'Pass' window indicates 'Pass' otherwise it is considering 'Fail.'
SECTION: Waste
8.2. If one steam strip fails and one strip passes, record as 'Pass.'
SECTION: Waste
10.1. Example: 
BI=Pass, Steam Strip=Fail, then consider the load as 'Pass'
BI=Fail, Steam Strip=Pass, then consider the load as 'Fail'

SECTION: Media
14. Place autoclave tape on each bottle or rack of media to be autoclaved along with 2 Steam Migrating Integrator Strips wrapped together with autoclave tape and a piece of string and place in the middle of one of the trays to be autoclaved with the piece of string hanging out of the tray so that the strips are easily retrieved after autoclave cycle is finished. 
SECTION: Waste
5.1. Cycle Parameters:
Cycle Type - Gravity
Purge - 1:00
Sterilization Time - 60:00
Sterilization Temp - 121.0°C
Overdrive - 1.5°C
Overtemp - 6.0°C
Undertemp - 1.0°C
Undertemp - Restart
Print Interval - 2 minutes
Vacuum Dry - 10.0 inHG
Dry Time - 05:00
SECTION: Waste
11. Record all results on NARMS-KS-F-1A Autoclave Log
SECTION: Media
15. Tape string with autoclave tape to an AccuFast Biological Indicator (BI) and place in the middle of one of the trays containing media with the piece of string hanging out of the tray so that the BI is easily retrieved after autoclave cycle is finished.
SECTION: Media
16. Close the door with foot peddle and select Cycle 5 from the cycle menu and select 'Start Cycle.'
SECTION: Media
17. When load is finished, open door with caution as steam can be released from the doorway and using appropriate PPE (temperature resistant gloves, lab coat, and goggles) unload the trays containing the media and let cool before handling. 
SECTION: Media
18. Observe autoclave tape color and record results (color change - yes or no). 
SECTION: Media
19. Remove and read the steam strips and record results.
SECTION: Media
19.1. Blue in the 'Pass' window indicates 'Pass' otherwise it is considering 'Fail.'
SECTION: Media
19.2. If one steam strip fails and one strip passes, record as 'Pass.'
SECTION: Media
20. Remove BI and crack open glass ampule using the indicated slot in the incubator (L202) and incubate at 60°C for 10 hours. 
SECTION: Media
20.1. Blue color indicates 'Pass' while yellow color indicates 'Fail.'
SECTION: Media
21. In the case where BI and the steam strip results conflict, defer to the BI results as they are considered more accurate and consistent. 
SECTION: Media
21.1. Example: 
BI=Pass, Steam Strip=Fail, then consider the load as 'Pass'
BI=Fail, Steam Strip=Pass, then consider the load as 'Fail'
SECTION: Media
23. If load has passed sterilization then media is acceptable for use. If load has not passed then the media needs to be reautoclaved until it passes sterilization. Please see section on trouble shooting should this occur.
36. Screen says 'CLOSE THE DOOR BEFORE STARTING CYCLE'
36.1. If door in P209 is closed, then push up slightly on the door in P209A (other side of autoclave) and attempt to start the cycle
37. If load stops in the middle of cycle with alarm sounding and says 'TOO LONG TO SEAL DOOR' 
SECTION: Troubleshooting
35.3. Add more or less water into the bag and between all 'steam barriers (smaller bags inside larger bags etc) in order that steam reaches all waste in the bag

SECTION: Troubleshooting
35.2. Reduce the amount of waste in the bag (separate into two bags?)

SECTION: Troubleshooting
35.1. Confirm correct load was selected and ran with no errors

SECTION: Troubleshooting
35. Load does not pass sterilization
SECTION: Glassware and Instruments
24. Place all glassware and/or instruments in autoclavable trays and make sure to not overload autoclave with items like stacking trays on top of each other (only one layer thick) or putting items too close to each other.
SECTION: Glassware and Instruments
25. Place autoclave tape on each item or autoclave tray to be autoclaved along with 2 Steam Migrating Integrator Strips wrapped together with autoclave tape and a piece of string and place in the middle of one of the trays to be autoclaved with the piece of string hanging out of the tray so that the strips are easily retrieved after autoclave cycle is finished. 
SECTION: Glassware and Instruments
26. Tape string with autoclave tape to an AccuFast Biological Indicator (BI) and place in the middle of one of the trays containing glassware and/or instruments with the piece of string hanging out of the tray so that the BI is easily retrieved after autoclave cycle is finished.
SECTION: Glassware and Instruments
27. Close the door with foot peddle and select Cycle 3 (use Cycle 4 for large loads) from the cycle menu and select 'Start Cycle.'
SECTION: Glassware and Instruments
27.1. Cycle Parameters:
Cycle Type - Gravity
Purge - 1:00
Sterilization Time - 30:00
Sterilization Temp - 121.3°C
Overdrive - 1.5°C
Overtemp - 6.0°C
Undertemp - 1.0°C
Undertemp - Restart
Print Interval - 2 minutes
Vacuum Dry - 10.0 inHG
Dry Time - 18:00
SECTION: Glassware and Instruments
28. When load is finished, open door with caution as steam can be released from the doorway and using appropriate PPE (temperature resistant gloves, lab coat, and goggles) unload the trays and let cool before handling. 
SECTION: Glassware and Instruments
29. Observe autoclave tape color and record results (color change - yes or no). 
SECTION: Glassware and Instruments
30. Remove and read the steam strips and record results.
SECTION: Glassware and Instruments
30.1. Blue in the 'Pass' window indicates 'Pass' otherwise it is considering 'Fail.'
SECTION: Glassware and Instruments
31. Remove BI and crack open glass ampule using the indicated slot in the incubator (L202) and incubate at 60°C for 10 hours. 
SECTION: Glassware and Instruments
30.2. If one steam strip fails and one strip passes, record as 'Pass.'
SECTION: Glassware and Instruments
32. In the case where BI and the steam strip results conflict, defer to the BI results as they are considered more accurate and consistent. 
SECTION: Glassware and Instruments
31.1. Blue color indicates 'Pass' while yellow color indicates 'Fail.'
SECTION: Glassware and Instruments
34. If load has passed sterilization then media is acceptable for use. If load has not passed then the media needs to be reautoclaved until it passes sterilization. Please see section on trouble shooting should this occur.
SECTION: Glassware and Instruments
32.1. Example: 
BI=Pass, Steam Strip=Fail, then consider the load as 'Pass'
BI=Fail, Steam Strip=Pass, then consider the load as 'Fail'
SECTION: Media
16.1. Cycle Parameters:
Cycle Type - Liquid
Purge - 1:00
Sterilization Time - 15:00
Sterilization Temp - 121.0°C
Overdrive - 1.5°C
Overtemp - 6.0°C
Undertemp - 1.0°C
Undertemp - Restart
Print Interval - 2 minutes
SECTION: Media
22. Record all results on NARMS-KS-F-1A Autoclave Log
SECTION: Glassware and Instruments
33. Record all results on NARMS-KS-F-1A Autoclave Log
37.1. Press 'Service Help', then 'Clear Alarm', followed by 'Abort', then 'Abort' again and 'Status Print' and wait for instruemtn to return to original screen.
37.2. Check door in P209A fully closed by pushing up slightly and that the seal around the door in P209 is pushed in and has not obstructed the door and restart the load.