Saturday, June 23, 2012

Off-Grid Autoclave

One of the greatest advancements of modern medicine came with the invention of the autoclave.  Historically, more people died of infection than died from medical intervention itself.  Knowing that the sterilization of surgical instruments, suture needles and cord cutters is of paramount importance, we decided practice this skill now, before we are confronted with the need in less than desirable circumstances.

The first thing that we required were sterilization pouches.  Not only are the pouches necessary for sterilizing, they provide a sterile field once the instruments are opened.  We bought our pouches through a medical supply house, however, they are available on-line.  They come in different sizes, depending on your needs.

After gathering our equipment (shears, rubbing alcohol, sterilization pouches and pressure canner) we did an initial sterilization by submerging the shears in rubbing alcohol.  (Alcohol will sterilize an article for up to 24 hours, but requires additional sterilization after that time has elapsed).  Once the shears had been dipped in alcohol, they were slid into the sterilization pouches and the pouches were sealed.  The next step is the actual autoclaving process.

Dipping the shears in rubbing alcohol
Slid into the sterilization pouch and sealed
A non-electric autoclave is little more than a pressure canner with a basket in it to keep the instruments from being submerged in water.  In fact, the best non-electric autoclave on the market is manufactured by All-American Canner Company!  Because we don't have an actual autoclave (darn!) we used our All-American canner (that we sterilized per the instructions in "A Book for Midwifes".   We put the canning rack on the bottom of the canner, with a pie pan on top of that (to raise the instruments up and out of the water) and topped that off with a second canning rack.  Once the second rack was placed in the canner, we set the pouches of shears on the rack, screwed down the lid and started heating the canner.  First, we evacuated the steam for about a minute, flipped the steam relief valve down and began building pressure.  An autoclave works at higher temperatures than required for typical pressure canning, so we allowed the pounds of pressure to settle in at 20 pounds (the book says that it can be anywhere from 15 to 20 pounds of pressure).  We autoclaved the shears for 20 minutes at 20 pounds of pressure.

Pouring water into the autoclave....errr, pressure canner
Inside the autoclave
Process for 20 minutes at 20 pounds of pressure
The guys were a little concerned with the pressure, hence the helmets
Removing the pouches from the canner

We allowed the canner to cool down and removed the lid.  Although somewhat moist (we will use even less water next time), the process worked perfectly.  We are certain that if we ever have to live a worst-case-scenario lifestyle, we will most certainly need to know how to sterilize surgical instruments.  Practicing now will enable us to perform our duties quickly and efficiently when the need arises.

With a few basic items, autoclaving in an off-grid setting is easily accomplished.  Although none of want to think of having to perform medical techniques outside of a hospital setting, it is comforting to know that in a pinch, we can. Sterilizing your equipment increases your success rate exponentially - now is the time to learn.  With a little knowledge and a pressure canner, you too can make your own off-grid autoclave.


  1. Enola,

    You and your family are so wonderful. You impress me very much and are an inspiration. We love you!! Many, many Blessings to you :) Hope to see you soon!

  2. Suggestions not mentioned in your article:

    Only sterilize CLEAN instruments, removing any oil, or blood or serous fluids with a scrubbing of the instruments with a firm brush (a new tooth brush used for this purpose only, works really well)
    using clean water and glycerin soap, rinse well.
    then use 70% rubbing alcohol and submerge them for 15 minutes.
    If you have no rubbing alcohol, you can use pure ethanol, (everclear).

    Boil a pair of long tweezers or metal tongs to use to put the cleaned, and then alcohol dipped instruments into the pouches. Do not use your fingers.

    Some pouches require heat sealing. You can use a hot iron for this.

    When you are finished with the sterilization process, mark the ends of the pouches with the date, and time with a wax pen marker, and not a liquid marker pen, unless you are also using non-porous labels, which can also be purchased from surgical suppliers on line.

    Keep and store all sterilized instruments in a clean, dry, rubber gasketed sealed container.

    God Bless you and yours Enola!

  3. Alcohol is a poor choice for sterilization. "These alcohols are rapidly bactericidal rather than bacteriostatic against vegetative forms of bacteria; they also are tuberculocidal, fungicidal, and virucidal but do not destroy bacterial spores." from CDC

    I've used the same pouches and the same "All American" 'autoclave' as you do -- a technique I learned in Medical Corps excellent "Austere Medicine' course. Note that the pouches have a color-coded indicator which changes color once they have been autoclaved.

    I like soap and water prep before sterilization.

    I've found using this technique implies a need for care in handling of the pouches post sterilization. There is no 'indicator' if the seal on the pouch has been breached -- so take care in storing/packing.

    Disposable sterile drapes are quite expensive. One may wish to have a few on hand for acute situations, but if you have more time you may want to consider cotton dish towels. One could put aside clean towels and fenstrated towels (pair of scissors and a sewing machine for various sized openings), which can then be sterilized in your autoclave (keep them up out of the water) just prior to use.


  4. Use some cream of tartar to clean the pressure canner interior ;) use dry steam
    less water

  5. Wondering about sterilizing homemade bandages.
    Thanks for your informative blog!!

  6. With an electric autoclave, the final step of processing dries the chamber and packaged instruments. The intent is to prevent bacteria from "hitching a ride" when a moist peel-pack (instrument envelope) is in contact with a non-sterile surface. With a pressure cooker, this can be achieved by lifting the entire wire basket out of the cooker, and placing it on a dry, clean surface, and allowing the packets to dry completely before handling.

    Additionally, before processing the instruments, all instruments should be open so steam may infiltrate areas that would be pressed together when locked. Once sealed in the packs, the packs should be set on their edges to ensure steam penetration of all packs, which is less likely to happen with packs overlapping or stacked on top of each other.

    This based on my many months of being the instrument sterilization tech on a military deployment, and my wife's 20+ years as a surgical technologist.

    Finally, packs need to be stored in a dry environment. As packs are steam permeable, the are definitely not water resistant; a pack this is damp, or appears water-stained, should be considered no longer sterile and taken out of service until re-sterilization

  7. I don't want to detract from the sterilisation process but be aware that sterilisation of medical tools does not necessarily destroy all nasty things that can be transferred between patients. The protein from CJD being one that springs to mind.
    Now in a SHTF scenario I'd prefer one of your home sterilised tools vs. an un-sterilised one but there are still contamination risks for the patient.
    This is why today so many medical tools are disposable one-use.

  8. At my last job, part of it was maintaining, but not actually using , a steam, as well as gas(ethylene dioxide/freon mix-according to the warning label on the cylinder, it's nasty stuff!)sterilizer. Sterilized instruments were randomly tested for sterility. It might be interesting to have a lab test a few random samples of your end result, to see how well it works.

  9. Enola:

    I'm not sure if you are a "For The Record" fan, but I hope this encourages you and Maid Elizabeth:

    Have a blessed day.