THERAPEUTIC PROCEDURES - Medicine for Mountaineering and Other Wilderness Activities - page 538

struments) or in autoclaved sterile packages that can be kept dry in plastic bags. Dressings
and instruments that have been wrapped in paper and autoclaved remain sterile for several
months if they are undisturbed and stay dry. If the items become wet, sterility is lost.
However, sterilization of instruments before they can be used is sometimes necessary.
At sea level, boiling in water for fifteen minutes provides adequate sterilization, but equip-
mentmustbeavailableforremovingtheitemsfromthewaterwithoutcontaminatingthem.
At higher elevations the boiling temperature of water is lower and the time required for
sterilization is prolonged, but the additional time required is not easily determined. Boiling
in a pressure cooker for fifteen minutes under fifteen pounds pressure should be adequate
at almost any altitude.
Scalpels, forceps, scissors, and other metal instruments can be sterilized by washing
them thoroughly, dipping them in alcohol, and lighting the alcohol. The instruments must
be permitted to cool before they are used. (Blowing on the items to cool them produces
contamination with bacteria from the nose and mouth.)
Since sterilization of needles and syringes is unreliable, syringes and needles used for
one individual must never be used to administer injections to another. The methods of ster-
ilization in the field are too uncertain and the risk of transmitting hepatitis or human im-
munodeficiency virus are too great to chance in this manner.
Most needles and syringes currently available are disposable—designed to be used only
once and then discarded. Items such as forceps and scalpels are also available in sterile,
disposable kits that are convenient and relatively inexpensive. Supplies of this type should
be secured for wilderness outings and, once used, should never be used again. They must
be carried out.