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include the effect of water quality, the number of instruments 5. DENCOM Pam 40-5-1, Appendix J, Instrument Processing and
that can be processed, and the effect of different heat sources. Sterilization, June 2015.
™
™
6. 3M Health Care. 3M Attest Readout Biological Indicator
™
Despite numerous questions remaining regarding the proper 1292 for Steam Sterilization, 50/BX. https://www.3m.com/3M/en
use of a pressure cooker as an autoclave, the need for inex- _US/company-us/all-3m-products/~/3M-Attest-Rapid-Readout
-Biological-Indicator-1292-for-Steam-Sterilization-50-BX/?
pensive and simple methods of sterilization in austere and N=5002385+3294796462&rt=rud. Accessed 16 December 2020.
prehospital settings exists. The review by Fast et al. of steril- 7. Swenson VA, Stacy AD, Gaylor MO, et al. Assessment and verifi-
ization practices in the Republic of Congo, Madagascar, and cation of commercially available pressure cookers for laboratory
Benin highlights the struggles of resource-limited areas with the sterilization. PLoS One. 2018;13(12):e0208769.
infrastructure required for autoclaves. Similar struggles with 8. Fast O, Fast C, Fast D, et al. Limited sterile processing capabili-
8
infrastructure can be expected among expeditionary healthcare ties for safe surgery in low-income and middle-income countries:
experience in the Republic of Congo, Madagascar and Benin.
providers who will be tasked with providing a reliable, agile, BMJ Glob Health. 2017;2(suppl 4):e000428.
and responsive sustainment capability necessary to support 9. Tosh PK, Disbot M, Duffy JM, et al. Outbreak of Pseudomonas aeru-
rapid power projection, multidomain operations, and indepen- ginosa surgical site infections after arthroscopic procedures: Texas,
dent maneuvers. 11 2009. Infect Control Hosp Epidemiol. 2011;32(12):1179–1186.
10. Knox RW, Demons ST, Cunningham CW. A novel method to
decontaminate surgical instruments for operational and austere
Conclusion environments. Wilderness Environ Med. 2015;26(4):509–513.
11. United States Department of Agriculture, Food Safety and Inspec-
This study provides evidence that sterilization is a device ag- tion Service. High altitude cooking and food safety. https://www
nostic process and a Presto 4-quart stainless steel pressure .fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get
cooker can be used to create the conditions for sterility with -answers/food-safety-fact-sheets/safe-food-handling/high-altitude
a run time of 20 minutes at a pressure of 103.4kPa. All 128 -cooking-and-food-safety/ct_index. Accessed 15 December 2020.
trials in this study, each confirmed by a 3M Comply SteriGage 12. The US Army in Multi-Domain Operations 2028. TRADOC
chemical integrator strip, a Henry Schein Self Seal steriliza- Pamphlet 525-3-1. 6 December 2018. https://adminpubs.tradoc
.army.mil/pamphlets/TP525-3-1.pdf. Accessed 15 December
tion pouch, and a 3M Attest 1292 Rapid Readout biological 2020.
indicator, achieved sterility. Though lacking FDA approval,
the use of this commercially available pressure cooker may
provide a method of sterilization requiring minimal resources
from physicians, dentists, and medics working in expedition-
ary environments.

Disclaimer
The opinions and views contained herein are the private views
of the authors and are not to be construed as official or reflect-
ing the views of the Department of Defense or US Government.

Disclosure
The authors have indicated they have no financial relation-
ships relevant to this article to disclose.

Funding
Funding was provided by the primary author; there was no
outside funding.

Author Contributions
RC conceived the study concept, collected the data, and wrote
the first draft. TB analyzed the data. JM and MP acted as men-
tors for the project. OW acted as the blinded observer. All
authors read and approved the final manuscript.

References
1. Centers for Disease Control and Prevention. Guideline for disin-
fection and sterilization in healthcare facilities. https://www.cdc
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2. World Health Organization. Decontamination and reprocess-
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.pdf;jsessionid=B0B8DAE98E564405760F39AE44D965E0?
sequence=1. Accessed 15 December 2020.
3. World Dental Relief. Portable autoclave and sterilization. https://
www.worlddentalrelief.com/book/Chpt%2014%20Portable
%20Dental%20Equipment.pdf. Accessed 15 December 2020.
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Pressure Cooker for Sterilization | 39