Reference Manual - IARC Screening Group

Infection Prevention ProcessesMoist heat at 80°C kills essentially all bacteria, viruses, parasitesand fungi in 20 minutes. Unless the altitude of the health facility isover 5,500 meters (18,000 feet) it is not necessary to increase thesteaming or boiling time (Favero 1985).High-LevelDisinfection byBoilingOpen or take apart all instruments and other items. Submerge them inwater and cover pan. Boil for 20 minutes. Timing should begin when thewater is at a rolling (bubbling) boil and all items should be totally underthe water. Nothing should be added to the container after the waterbegins to boil. After boiling for 20 minutes, remove boiled items usinghigh-level disinfected forceps, place in a high-level disinfected containerand allow to cool and air dry.Use instruments and other items immediately or leave in a covered, dry,high-level disinfected container. (The container used for drying theinstruments can be used for storage only if there is no water in the bottomof the container.) Store for up to 1 week.Boiling Tips• Always steam or boil for 20 minutes using a pot with a lid.• Start timing when the water begins to boil.• Items should be covered completely a with water.• Do not add anything to the pot after the water begins to boil.a An IPAS report documented that the interior temperature of a plastic cannula floatingon the surface of boiling water reaches a temperature of 96–98 °C in less than a minute(IPAS 1993). For items that float (e.g., plastic syringes, surgical gloves or rubber items),it is not absolutely necessary that they be fully covered by the water to achieve HLD.High-LevelDisinfection bySteamingSteaming surgical gloves has been used as the final step in processinggloves for many years in Indonesia and other parts of South East Asia. In1994 a study by McIntosh et al confirmed the effectiveness of this process.In this study, the steamer used (Figure C-3) consisted of:• a bottom pan (approximately 31 cm in diameter) for boiling water;• one, two or three circular pans with multiple, 0.5 cm (diameter) holesin their bottoms to permit the passage of steam up through them andwater back down to the bottom pan; and• a lid that fits on the top pan.C-6 Cervical Cancer Prevention Guidelines for Low-Resource Settings