In an effort to keep up with the demand for rapid turnover of surgical instruments and supplies, many facilities have created "substerile" rooms close to their ORs where techs can clean and sterilize small quantities of instruments quickly and have them ready for the next case. Many manufacturers have developed smaller and faster washers and sterilizers, as well as containers especially for these rooms. For an update read on.

Washers
The STERIS Amsco Reliance 333 is designed to provide consistent cleaning and low-level disinfection of reusable surgical instruments, minimally invasive surgical instruments and microsurgical instruments. The unit's compact design (it is 965 mm by 864 mm by 736 mm) is well suited for smaller spaces, according to the company. The control panel has an easy-to-use touch pad with three pre-programmed cycles, three customizable cycles and a decontam cycle to clean out the interior chamber. A three-shelf detergent compartment holds "bag-in-a-box" disposable boxes that contain instrument-safe, neutral detergent and lubrication agents. The amount of detergent for each load is adjustable; the boxes can provide up to 100 cycles. The unit has a stainless steel wash chamber and stainless steel rotary spray arms. These are mounted at the tip of the wash chamber so that the spray completely covers all instrument surfaces. It has an optional drying cycle that can be adjusted from one to 60 minutes.

Additional accessories include:

• a two-level instrument rack, designed to hold up to four 260 mm by 520 mm trays or various micro-instrument trays;
• a rigid rack for minimally invasive surgical instruments, which has a top level for the instruments and a lower level for miscellaneous attachments;
• mesh baskets for small removable components such as screws, end caps, and gaskets;
• a printer, which provides a record of the cycle parameters.

The washer lists for $2,350. Call STERIS at (440) 354-2600 or go to www.steris.com.

According to SciCan, its HYDRIM C51w instrument washer is both small and environmentally safe. The unit measures 23.5" by 17.75" by 18.25" and can fit easily on most countertops. This unit also is organized to make washing instruments simpler, with baskets for loose instruments and racks that can hold most instrument management cassettes of various sizes. Simply load the machine, close the door and select the appropriate cycle-a regular cycle for lightly soiled loose instruments, a heavy cycle for heavily soiled instruments or cassettes, or a rinse-and-hold cycle. Cleaning solution is dispensed automatically during each cycle and is evacuated from the unit when the cycle ends. The unit has three rapid cycles: six minutes, 15 minutes, and 20 minutes.

The list price is $2,995. Call (412) 281-6780 or visit www.scican.com.

HAMO USA's LS-950 compact washer measures 31.49" wide by 33.46" high by 22.83" deep. Available in either undercounter or freestanding designs, the unit fits easily into most smaller rooms. You can choose from a wide variety of insert baskets and accessories. It also is equipped with a high-powered drying unit, which draws in air from the room, filters it, and forces it through a thermostatically controlled heating unit. The filtered air can be adjusted to a drying temperature from 30 ?C to 110 ?C. The heated air passes through non-return valves into the washing system, where it circulates around the wash load. Average cycle time is 20 minutes.

The unit lists for $18,000. Call (888) 702-4266 or visit the website at www.hamo.com.

The Sonic Irrigator Model 1100 from UltraClean is specifically designed for cleaning cannulated surgical instruments. It uses ultrasonic energy to do so. The ultrasonic energy comes from bubbles emitted from the bottom of the unit. Each droplet of water contains an average of about 100,000 of these tiny bubbles. As these bubbles are pressed together, pressure builds, until the bubble implodes releasing energy. The energy then travels through the water and through instruments to loosen any debris lodged within. The system also has an internal irrigation system, which provides a constant flow of water and enzymatic solution through the unit. This process removes the loosened debris and carries it to the system's internal filter. According to the company, ultrasonic cleaning combined with internal irrigation of an enzymatic solution is proven to remove over 99 percent of debris found in laparoscopic instruments, and the Sonic Irrigator can also clean standard non-cannulated instruments as well. The unit will hold up to 12 instruments; cycle time is less than 15 minutes. The unit is 30" wide by 18" long by 12" high and can be plugged into any standard wall electrical outlet.

The list price for the Sonic Irrigator Model 1100 is $8,995. Call (813) 935-6624.

Sterilizers

Steam sterilizers
According to Midmark, its M9 UltraClave was designed to be completely automated and easy to use. All the operator has to do is press the start/standby button, and the M9 automatically fills with the correct amount of water. Flash sterilization cycle time is 12 minutes with an additional 10 minutes to cool down. Once sterilization is complete, the M9 door opens automatically to dissipate steam and dry the instruments. The operator can load the M9 and then go back to the OR without having to check on the load until it is completely finished. Also, the M9's printer accessory provides a permanent record of cycles, times, temperatures and pressures reached during a cycle. This record guarantees the cycle was completed without problems. Four stainless steel trays come with each M9. They include two large trays (12" long by 7.31" wide by 0.88" deep) and two small trays (12" long by 5.62" wide by 0.88" deep). The unit measures 18.81" long, 15" wide, 16.44" high.

The Midmark M9 lists for $3,869. Call (800) MIDMARK or visit www.midmark.com.

The STATIM 2000 cassette autoclave from SciCan gently flash sterilizes instruments in six minutes. The sterilizer has a steam injector system that rapidly heats the instruments, reducing the amount of time they are exposed to the extreme temperatures. This makes it safe forwrapped and unwrapped instruments (wrapped instruments take about 14 minutes). The unit is fully automatic; it will abort the cycle if any fault occurs. The operator simply chooses from one of four programs: Unwrapped, Wrapped, Rubber/Plastic, or Heavy Duty Unwrapped. Measuring 19" by 16.25" by 6", the unit is small enough to fit on a countertop.

The unit lists for $4,640. Contact SciCan at (412) 281-6780 or visit www.scican.com.

Getinge/Castle offers the Series 100HC steam sterilizers, available in a wide variety of sizes and configurations in both gravity displacement and pre-vacuum models. Each model has up to 19 programmable cycles. The selectable temperature range is 110 ?C to 135 ?C and from 104 ?C to 121 ?C for sterilizing liquids. According to the company, you can use this unit to flash sterilize porous or non-porous instruments, gowns, or towel packs, as well as self-venting or unsealed containers. You can also use it for standard sterilization. The system varies in size depending on the facilities needs.

Call (800) 475-9040 for price or visit www.getingecastle.com.

The Vernitron 2000M Autoclave from ALFA is also very simple to use and maintain; you can use it for flash sterilization or standard sterilization. The operator simply fills the chamber with water, inserts the instruments, closes the door, and turns the timer on. The average cycle time lasts about 40 minutes. The unit sterilizes at 190 ?C and will shut off and vent automatically at the end of the cycle; a drying cycle is available for standard sterilization. The 2000M is also equipped with a low water cutoff function, which will automatically stop the cycle to protect the sterilizer from running without water. At 16" deep by 12" high by 7" wide, with an instrument tray of 7.5" wide by 12" deep by 1.5" high, the unit can fit into the smallest spaces.

The sterilizer lists for $2,695. Call ALFA at (800) 762-1586 or visit www.sterilizers.com.

Gas plasma
Advanced Sterilization Products presents the STERRAD 50, a versatile compact sterilizer that is safe to use on delicate instruments. The STERRAD 50 is a compact "plug-in-and-use" sterilizer that uses a combination of hydrogen peroxide vapor and low-temperature gas plasma to sterilize metal and non-metal instruments that are too delicate for steam, EtO, or formaldehyde. The load temperature never exceeds 50 ?C, and the sterilization occurs in a low moisture environment. Total processing time is about 45 minutes. The unit is mounted on a cart for easy mobility; including the cart it measures 644 mm by 1450 mm by 827 mm.

The STERRAD 50 lists for $65,000. Call (800) 595-0200 or visit Advanced Sterilization Products at www.sterrad.com.

Peracetic acid
The STERIS SYSTEM 1 is an automated, tabletop device, measuring 40" wide by 24" deep by 32" high. It provides low temperature sterile processing for immersible surgical and diagnostic devices. According to the company, it can sterilize even the most delicate, heat sensitive scopes, cameras, instruments, and accessories in 30 minutes. The STERIS SYSTEM 1 consists of the STERIS SYSTEM 1 Processor and the STERIS 20 Sterilant. The entire sterilization process takes place within the processor's environmentally sealed chamber. At the completion of each cycle, the processor prints a list of the process and load information. The STERIS 20 Sterilant was developed exclusively for use in the STERIS 1 Processor. Its active ingredient is peracetic acid, a liquid chemical sterilant.

The item lists between $16,200-$18,200. Call (440) 354-2600 or visit www.steris.com.

Ethylene oxide
Anderson Products offers a tabletop ethylene oxide gas sterilization system, the Anprolene. This system consists of a glass ampoule containing liquid ethylene oxide sealed into a plastic gas release membrane, a sterilization bag to hold the items to be sterilized, a secure bag closure, and a stainless steel sterilizer container. The operator places the ethylene oxide ampoule and the items to be sterilized in the sterilization bag and secures it with the bag closure. The operator then breaks the ampoule through the sterilization bag and places it in the stainless steel container. When the ampoule breaks, it releases ethylene oxide into the sterilization bag, sterilizing the items inside. The sterilizer container is ventilated and designed to protect the operator from the ethylene oxide during the sterilization cycle. At the end of the sterilization cycle, the liner bag is purged of ethylene oxide for two hours to further protect the operator. Anderson offers two different sizes of bag and ampoule combinations to match the size of your sterilization load, so you never use more gas than you need. Bag and ampoule sets include 5cc and 20cc ampoule and 7 liter or 35 liter bags. The stainless steel container is 21" by 14" by 20.5".

List price is $1,650. Call (336) 376-3000 or visit www.anpro.com.

Containers
Riley Medical's Flashpak is a laboratory and hospital tested closed container sterilization system. It opens inside the sterilizer to safely sterilize instruments and implants in five and ten minute cycles, and then it automatically closes to protect the sterilized instruments during transport. The Flashpak is a sealed rigid container with pressure actuated valves on the top and bottom. At atmospheric pressure both valves are closed, resulting in a sealed container. When the container is in the flash sterilizer and pressure begins to rise, the valves in the top and bottom open, allowing cold air to flow out of the container through the bottom valve and steam to enter through the top valve. During the sterilization cycle, steam moves freely through and within the container. At the end of the cycle, as pressure decreases in the sterilizer, the valves close, resulting in a sealed container, which prevents recontamination. Flashpaks come in various sizes: 11.5" by 11.2" by 7.3"; 11.2" by 20.7" by 8.4"; 11" by 24.7" by 9"; and 13" by 24.7" by 9.7".

These containers list from $1,000-$1,600. Call (800) 245-3300 or visit www.flashpak.com.

The SurgiNizer, a Jewel Precision product, is a sterilizing container made of PlasTel, a plastic-coated metal. According to the company PlasTel helps to prevent moisture retention and protects the instruments. The SurgiNizer also features a patented Snap ?n Lok accessory system, which are a series of silicone inserts that you can snap into place to create compartments in the containers. The inserts also serve to reinforce the containers and help them maintain their shape. These containers also have transparent lids, which allow you to see what is inside.

A set, including a basin, lid and insert, costs approximately $330. Call (973) 857-5545.

Sparco, Inc. offers the Flash-Guard Sterilization and Transport System. Designed of stainless steel, this rigid container has a bottom exhaust valve, which exhausts steam when the autoclave door is open. The steam will continue to escape as long as the temperature inside the sterilizer and Flash-Guard remains higher than the atmospheric temperature. The unit is available in five different sizes ranging from 6.85" wide by 14.25" long by 6.25" high through 13" wide by 22" long by 8.5" high, and there are also different baskets available to keep delicate instruments or sets separate from heavier ones.

The containers list for $895. Call (760) 734-4299.