Page 50 - Journal of Special Operations Medicine - Summer 2016

Field Sterilization in the Austere and Operational Environment
A Literature Review of Recommendations

Joshua S. Will, DO; Shawn Alderman, MD; Robert C. Sawyer, MD

ABSTRACT
Special Operations Forces medical providers are often Definitions
deployed far beyond traditional military supply chains, The process of preparing medical instruments for use
forcing them to rely on alternative methods for field can be broken down into four categories: cleaning, de-
sterilization of medical equipment. This literature re- contamination, disinfection, and sterilization.
view proposes several alternative methods for both ster-
ilization and disinfection of medical instruments after Cleaning involves any process that removes the visible
use and cleaning of skin and wounds before procedures. soil or contamination from an object that could interfere
This article reviews recommendations from sources like with the sterilization process, thus reducing its “biobur-
the United Nations, the World Health Organization, the den.” This is typically accomplished using water with
1
Special Operations Forces Medical Handbook, and the detergents.
Centers for Disease Control and Prevention.
Decontamination is the use of physical or chemical means
Keywords: prolonged field care; field sanitation; instrument to remove, inactivate, or destroy blood borne pathogens
sterilization; expeditionary medicine
on an item to make them incapable of transmitting infec-
tious particles. Cleaning and decontamination are con-
sidered the first two steps in instrument processing, and a
Introduction
thorough cleaning can lead to decontamination. 1,2
As military medical providers, it is our responsibility to
deliver cutting edge medical care in support of the op- Disinfection leads to the destruction of active microbes,
erational mission in remote and austere locations. Medi- but their inactive spores may still be present. This is usu-
1,2
cal operations are resource intensive, and can lead to ally carried out by liquid chemicals or wet pasteurization.
rapid consumption of Class VIII material. Special Op-
erations physicians, physician assistants, and medics are Sterilization refers to the destruction of all active and
frequently deployed far beyond standard supply chains, inactive microbes, including bacterial spores. Sterilization
and a new emphasis is being placed on prolonged field can be accomplished by physical or chemical methods.
care as a once-mature theater of operations is being de- Steam under pressure, dry heat, ethylene oxide gas, hy-
scoped. Disposable medical instruments can eliminate drogen peroxide gas plasma, and liquid chemicals are the
the need for resterilization; however, they do not allevi- principal methods of sterilization available to healthcare
ate the demands on the supply chain. It stands to rea- facilities. Effective sterilization depends on its ability to
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son that Special Operations Forces medical providers deliver heat, regardless of the form, to the object being
would benefit from an alternate, unconventional, and sterilized.
field expedient method to clean and sterilize the surgical
instruments typically carried in the medical aid bag or Chemical sterilants versus high-level disinfection: A
medical equipment sets. The Special Operations Forces few chemical disinfectants will kill spores if given lon-
Medical Handbook (ST 31-91B) recommends the use of ger exposure times (3 to 12 hours of a chemical soak).
autoclave, dry heat, boiling, and chemicals like chloride Chemicals with these properties are known as chemical
and alcohol. However, this literature review also cov- sterilants. At equal concentrations, but shorter exposure
ers recommendations from other organizations, such as times (typically a 20- to 30-minute soak on average),
the World Health Organization (WHO), the Centers for these chemicals will kill all microorganisms except large
Disease Control and Prevention (CDC), the United Na- numbers of spores. In this capacity, they are known as
tions (UN), and Doctors Without Borders, that pro vide high-level disinfectants. Low-level disinfection can kill
guidance to medical providers operating in austere most vegetative bacteria, some fungi, and some viruses in
environments. 1–7 a practical period of time (typically 10 minutes or less). 8

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