Technical Note: New Sterilization
Procedures for Post Operative Socks
Martha Field, M.S.
Prosthetists and hospital rehabilitation
teams often assist surgeons in selecting the
optimal post operative dressing for a particular amputation. In some rigid dressing applications, acrylic/Lycra spandex socks are
used (1,2,3). Since both acrylic and Lycra
spandex are manufactured fibers with moderately low melting points, these socks must
be sterilized in a gas autoclave rather than a
steam autoclave.
Recent federal and accrediting organization regulations require hospitals to have
sterilization procedures on file for every
product they sterilize. This has caused a redefining of the standard sterilization procedures by the Association for the Advancement of Medical Instrumentation (4). The
new standard hospital procedures for gas
autoclaving shorten aeration time considerably-from 24 hours to 12 hours at 120 degrees F (49 degrees C) in an aeration
cabinet or eight hours at 140 degrees F
(60 degrees C) in an aeration cabinet. Since
sterilization is 105 minutes at 130 degrees F
(54.4 degrees C), the prosthetist may now
have socks properly sterilized within the 24hour scheduling period that is often required
by hospitals, or even in a 12-hour period if
requested. Sterilant mixture is 12 percent
Ethylene oxide, 88 percent Dichlorodiflouromethane (Freon 12); sterilant concentration is 650 mg/l of chamber space; relative
humidity, 60-100 percent; maximum pressure, 21 psi.
As well as adopting the new sterilization
procedures, one manufacturer of post operative socks (9) has had the socks tested by an
independent testing company (10) to determine whether or not the sterilization procedure really is effective on rolled socks and
whether or not safe residual levels of the
Ethylene oxide are achieved after the recommended aeration procedures. Both criteria
tested positive. Resterilization is not recommended.
Just because written procedures are on file
in the hospital's records does not always
mean they are readily available to the hospital's staff on every workshift. This can force
the prosthetist to handle a frustrated call
from the staff. To alleviate this situation an
insert card explaining the sterilization procedures will be placed in each sock bag, or the
procedures will be printed on the bag itself.
Currently, socks are packaged in polyethylene bags. The sterilization procedure
recommends paper-to-film or tyvex-to-film
pouches for sterilization. Hospital personnel
and prosthetists were consulted on whether
to change the polyethylene bag packaging.
Both groups felt hospitals were more comfortable using their own supplies and that the
polyethylene bags were sufficient to protect
the socks until use.
Prosthetists need the assurance that their
choice of post operative dressing is supported with products that meet patient needs and
comply with current hospital sterilization
practice. Many studies have been done evaluating the benefits of post operative fittings
and recording new applications. A few of
these have been cited (5,6,7,8). The new
sterilization procedures for the socks used in
these dressings have been defined by the Association for the Advancement of Medical
Instrumentation, are standard hospital practice, are effective in sterilizing the rolled post
operative acrylic/Lycra socks and will accompany the socks.
Martha Field, M.S. is the manager of research
and development for Knit-Rite, Inc., Kansas
City, Mo.
References:
- Burgess EM. Immediate post-surgical prosthetic fitting: a system of amputee management.
Physical Therapy, February 1971; (51)2:139-43.
- Zettl JH. Immediate postsurgical prosthetic
fitting: the role of the prosthetist, Physical Therapy, February 1971; (51)2:144-51.
- Sarmiento A, et al. Lower-extremity amputation. The impact of immediate postsurgical prosthetic fitting, Clinical Orthopaedics and Related
Research, January-February 1970; 68:22-31.
- Standard for automatic general purpose
ethylene oxide sterilizers and ethylene oxide sterilant sources intended for use in healthcare facilities, draft version, Association for Advancement
of Medical Instrumentation, Arlington, Va.,
EOST-D-8/85.
- Mooney V, Harvey JP, McBride E, Snelson
R. Comparison of postoperative stump management: plaster vs. soft dressings, Journal of Bone
and Joint Surgery, March 1971; 53:241-9.
- Nicholas GG, DeMuth, WE Jr. Evaluation
of use of the rigid dressing in amputation of the
lower extremity. Surgery, Gynecology & Obstetrics, September 1976; 143.3:398-400.
- Harrington J, et al. Use of a pylon for early
ambulation after below-knee amputation; a preliminary report. Canadian Journal of Surgery,
September 27, 1984; 5:500-2.
- Penzur MS, et al. Early post-surgical prosthetic limb fitting in dysvascular below-knee amputees with a pre-fabricated temporary limb. Orthopedics July 1, 1988;7:1051-3.
- Knit-Rite, Inc., Kansas City, Mo.
- Ethox Corp., Buffalo, N.Y.
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