Ancient Times

 In ancient times, demons and evil spirits were

thought to be the cause of pestilence and infection. Methods involving witchcraft
and magic were used to drive them away.

 Mummy preserved with ancient knowledge of germicides

3,000 BC – The use of antiseptics such as pitch or tar, resins and aromatics was
widely employed by the Egyptians in embalming bodies even before they had
written language. They were also acquainted with the antiseptic value of dryness
resulting from the use of certain chemicals such as niter and common salt. They
became so skillful in the art of embalming that mummies of thousands of years old
are still in good condition.

 Moses (circa 1450 BC) was the first to prescribe a system of purification by fire,
and we learn from the books of Leviticus, Numbers and Deuteronomy that he also
developed the first system for the purification of infected premises. The stern
mandates given by the Mosaic law formed the basis of the first sanitary code and
the various systems of purification of the succeeding ages.
 Ancient Greek Hoplite warriors naked in battle to avoid
infection from dirty clothing in wounds
550 BC, Greek Infantry men known as hoplite sometimes fought naked, especially
against fast-moving cavalry, since they knew, without knowing exactly why, that
pieces of clothing carried into a wound by a penetrating sword or spear point were
more likely to cause infection.

 The fumes of burning chemicals were also used by the ancients for deodorizing
and disinfecting purposes. Of early importance was sulfur, apparently the first of
the useful chemicals to be mentioned. In the Odyssey, the following passage may
be found:

To the nurse Eurycleia then said he:

“Bring cleansing sulfur, aged dame, to me
And fire, that I may purify the hall.”

 Hippocrates
Hippocrates of Cos (460-377 BC), was the first to separate medicine from
philosophy and disproved the idea that disease was punishment for sin. He also
advocated irrigation of wounds with wine or boiled water, foreshadowing asepsis.
  Galen Roman
Centurions treated with knowledge of boiling as a germicidal means
Galen (130-200 AD), a Greek who practiced medicine in Rome and was the most
distinguished physician after Hippocrates, boiled instruments used in caring for
wounded Roman gladiators. His writings and those of Hippocrates were the
established authority for medicine for many centuries.

The Middle Ages

Purification by fire during the plague

In the period from 900 to 1500 AD, progress from the standpoint of noteworthy contributions
having a direct bearing on the development of the art of sterilization was virtually in a
standstill. Filth, pestilence, and the plague ravaged all Europe in the Middle Ages. Attempts
were made to combat the pestilence in hospitals and infected houses by means of
cleansing solutions, aeration, the smoke of burning straw, fumes of vinegar, and, not the
least, the fumes of sulfur, antimony, and arsenic.

The Renaissance
 Papin’s digester: the first steam pressure cooker
Denis Papin, a French physicist, invents the “Digester” (pressure cooker) in 1680.
Pressure cookers work by creating a tight seal between pot and lid. This seal traps the
air inside the pot as it gets heated. As the air gets heated, it expands but because it is
trapped, pressure increases. As pressure increases, so does the boiling point of the
water inside: An increase of about 15 pounds per square inch (psi) above standard
atmospheric pressure (a typical pressure-cooker setting) boosts the water boiling point
from its normal 212°F (100°C) to about 250°F (121°C). The superheated steam trapped
in the cooker circulates around the items inside quickly penetrating them, or in the case
of food, quickly cooking it.

 In 1683, Antonj van Leeuwenhoek, a Dutch linen draper

develops the microscope and proves the existence of microorganisms.
 1758 – the earliest recorded instance of the use of surgical glove -Dr. Johann Julius
Walbaum formed a glove from the intestines of a sheep and used it to deliver babies.
 1795 – Nicholas Appert, a chef, invents canning by preserving meats and vegetables in
jars sealed with pitch then boiling them. He wins the prize of 12,000 francs offered by
Napoleon for a way to prevent military food supplies from spoiling.
The Modern Era
 Ignaz S: Hand washing and sanitary measures
Ignaz Semmelweis, an Hungarian obstetrician, advocated in 1847 the value of
handwashing and fingernail scrubbing.

 Louis P: Germ theory of disease transmission

In 1862, French chemist and microbiologist Louis Pasteur publishes his findings on
how germs cause disease, which he later uses to develop the pasteurization process.

 Lister’s antiseptic sprayer

Joseph Lister, an English physician, reduced the mortality rate of his patients in 1867
by using a carbolic solution spray as he operated, he then used it in the wound, on the
articles in contact with the wound and on the hands of the operating team.
 The first steam autoclave
Charles Chamberland, Louis Pasteur’s pupil and collaborator, developed the first
pressure steam sterilizer, or autoclave in 1876.
 In 1876, John Tyndall, an English physicist, discovered heat-resistant bacteria. Based
on this discovery, he later originated the method of fractional sterilization by
discontinuous (intermittent) heating.

 Robert K: disinfecting properties of steam and hot air

The research of Robert Koch and his associates in 1881 on the disinfecting properties
of steam and hot air mark the beginning of the science of disinfection and sterilization.
They devised the first nonpressure flowing steam sterilizer.
 1881 – Sterilization by boiling was introduced. Everything used during an operation,
including linens, dressings, and gowns was boiled, although some surgeons still
believed Lister’s method to be adequate.

 In 1885, Ernst von Bergmann, a German physician, first used the

steam sterilizer for the sterilization of surgical dressings.
 The end of the operating theater
Gustav Neuber introduced mercury chloride in 1886 to clean his apron. He advocated
scrubbing the furniture with disinfectant and sterilizing everything in contact with the
wounds.

 Around 1889, Dr. William Stuart Halstead, to remedy a nurse’s

complaints of dermatitis caused by the strong chemical disinfectants used to perform
hand scrubs, asked the Goodyear Rubber Company if they could create a thin rubber
glove with gauntlets to protect their hands. The gloves were successful and other
operating room personnel soon requested gloves for themselves.

 steam sterilizer tray

Aesculap created the first rigid instrument container, originally made of stainless steel,
in Germany. In the early 1900’s, responding to the needs of the military hospitals and
aid stations, Aesculap manufactured chrome-plated containers for safe transport of
sterile instruments. Reusable textile filters were introduced in the 1930’s, replacing
valves and sliding vents. Rubber gaskets were added shortly thereafter to ensure a
 proper seal between the lid and the bottom. In the 1960’s anodized aluminum replaces
stainless steel, providing optimal heat retention and distribution. The lightweight
construction also allows for easy handling and stacking.

rigid sterilizer container

rigid sterilizer container

 During the period of 1885 to 1900 the Germans made many notable contributions to
the principles governing steam sterilization and chemical disinfection. Widespread
application of these principles, including their adaptation to sterilizing equipment, did
not, however, take place until some thirty years later with the introduction of the modern
temperature-controlled sterilizer — a product of American manufacturers.

 outmoded surgical equipment

During the late 1800’s, surgical instrument design was radically changed when
antiseptic and aseptic surgical techniques became the norm. Newly instituted
sterilization procedures called for smooth instruments that could withstand high heat
and that could be disassembled quickly to expose germ-harboring joints and recesses.
Gone was the sword-like amputation knife, as were the carved ivory and wood handles
that decorated earlier instruments. Also banished were leather cases, lined with silk or
velvet, replaced by canvas bags that could be sterilized along everything else.
 dry heat sterilizer “Poupinel”
Early type of hot air sterilizer used in bacteriological laboratories at the turn of the
century. Of German design, it had a double wall, and it attempted to circulate gas-
heated hot air by gravity convection (photo Getinge-Castle).

 laboratory autoclave sterilization of TB

1906 – Steam sterilizers in use in a laboratory preparing tuberculosis serum in
Marburg, Germany.

 Early 1900’s, Europe starts using Ozone for potable water treatment. Presently, about
90% of all European municipal water systems use Ozone treatment.
 Used as a fumigant for insects in the early twentieth century, ethylene oxide was
recognized as an antibacterial agent around 1929, when it was used to sterilize
imported spices and furs. It has been employed as a sterilizing agent in industry and
hospitals since the 1940’s.
 Sterilization by irradiation developed thereafter. It is used for commercial sterilization of
surgical supplies.
 early steam autoclave with controls
This sterilizer, based on the Kny-Sprague design, was introduced in 1933. It was
equipped with a dial top operating valve and the entire control of the performance was
centered in measurement of temperature by a thermometer located in the discharge
outlet at the bottom of the chamber (photo Getinge-Castle).

 1940’s steam sterilizer

A “steam sterilizer” unit from the 1940’s.

 early microwave from the 1940’s

In 1947, Percy Spencer, a Raytheon engineer, discovers that microwave energy could
be used to cook food, leading to Raytheon’s development of the microwave oven. The
first microwave oven weighed 330kgs. and was 1.67m tall.
 In 1956, Principles and Methods of Sterilization in Health Care Sciences by J.J. Perkins
was published. This textbook set the standard and methodology for processing and
sterilization of reusable medical devices.
 1963 – Glutaraldehyde was introduced, the first chemical solution approved by
the Environmental Protection Agency (EPA) as a sterilant for heat-sensitive
instruments.
 Earle H Spaulding (1968) American Physician
  Proposed that how an object will be disinfected or sterilized depended on the
object’s intended use.
 Spaulding’s classification system:
o CRITICAL – objects which enter normally sterile tissue or the vascular system
or through which blood flows should be sterile.
o SEMICRITICAL – objects that touch mucous membranes or skin that is not
intact require a disinfection process (high-level disinfection[HLD]) that kills all
microorganisms but high numbers of bacterial spores.
o NONCRITICAL -objects that touch only intact skin require low-level
disinfection.
 In 1989, an Ozone sterilizer for health care applications, developed by Life
Support,Inc., Erie, Pennsylvania, was cleared for marketing by the FDA.
 Also in 1989, Steris System 1, a low temperature system for endoscopic devices enters
the U.S. marketplace. In May 2008, the FDA rejected the Steris System 1, and Steris had to
withdraw it from the market.

 Also in 1989, the STATIM high speed steam autoclave was also
introduced into the U.S. by SciCan, Inc., Toronto, Ontario.

 plasma sterilizer
In 1993, the FDA aproves the Sterrad Sterilizer, a plasma sterilizing system, for use in
the U.S.
 William Rutala (1994) American Physician working with the CDC
 Characteristics of an Ideal Sterilization Method
 o High efficacy -the agent should be virucidal, bactericidal tuberculocidal,
fungicidal. and sporicidal.
o Rapid activity -ability to achieve sterilization quickly.
o Strong penetrability -ability to penetrate common medical device packaging
materials and penetrate into the interior of device lumens.
o Material compatibility -produce negligible changes in either the appearance or
function of processed items and packaging materials, even after repeated
cycling.
o Nontoxic -present no health risk to the operator or to the patient and pose no
hazard to the environment.
o Organic material resistance -withstand reasonable organic material challenge
without loss of efficacy.
o Adaptability -suitable for large or small (point of use) installations.
o Monitoring capability -monitored easily and accurately with physical. chemical.
and biological process monitors.
o Cost-effectiveness -reasonable cost for installation and for routine operation.
 http://disinfectionandsterilization.org/
 In 2010 in April FDA approved the Steris System 1E – however since the rinse water is tap
water that has been filtered and exposed to UV, it is not sterile. Therefore, the final
processed devices are not considered sterile (or cannot be assured to be sterile).
https://brnskll.com/shares/a-brief-history-of-sterilization/