The overkill method is perhaps the most common method used in the development and validation of
sterilization processes. Overkill sterilization primarily is applied to the moist-heat processing of
materials, supplies, and other heat-stable goods. It generally is considered to be the simplest and most
straightforward method for the design and validation of moist-heat sterilization processes. Although
this is true, there is substantial confusion about how to use the overkill method and, in fact, regarding
what actually constitutes an overkill process. Confusion associated with the overkill approach exists
in all of the widely used sterilization technologies; that is, moist heat, dry heat, gas, and radiation.
This article focuses on steam sterilization, of which there is both a greater amount of published
definitions and a more precise and generally accepted understanding of the underlying science.
A contemporary definition of overkill moist-heat sterilization follows: "This is usually achieved by
providing a minimum 12-log reduction of microorganisms having a D-value of at least one minute at
121 C" (1). This is a simple-enough definition. Unfortunately, it cannot be demonstrated in a
straightforward manner with presently available technology. What this definition suggests is that
overkill requires a 12-D process, which equates to lethality sufficient to deliver a 12 D121 lethality
level. This is not a lethality standard at all, however, because it inappropriately links the process
lethality requirement to the characteristics of a specific biological indicator (BI). This article reviews
present sterilization practices and explores the difficulties inherent in this definition.
Sterilization basics
Sterilization as a process can be rather simply defined as:
a validated process used to render a product free of viable organisms. In a sterilization process, the
nature of microbiological death or reduction is described by an exponential function. Therefore, the
number of microorganisms which survive a sterilization process can be expressed in terms of
probability. While the probability may be reduced to a very low number, it can never be reduced to
zero (2).
The difficulty lies in demonstrating the effectiveness of that process. The death of microorganisms by
any sterilization method has been shown to generally follow a straight line termed the "death curve"
(see Figure 1).
Figure-1
This phenomenon occurs with all microorganisms and is not restricted to any particular species. The
slope of this line represents the resistance of the microorganism to the sterilization process. The death
curve for organisms exhibiting substantial resistance will have a shallow slope, and those with low
resistance to the sterilization process will have a much steeper slope (see Figure 2).
Figure-2
The difference in microbial resistance is critical to sterilization validation. The microbial genera
Geobacillus, Bacilli, and Clostridia, having substantial resistance to the sterilization process, are
commonly chosen as BIs to provide an appropriate evaluation of the process. These BI organisms are
stipulated to be spore populations that have much higher resistance to sterilization processes than the
vegetative cells that predominate in the normal microflora found in pharmaceutical production
environments. Using these spores as indicator organisms creates a process challenge that is inherently
worst-case. In the case of moist heat in which sterilization conditions are very well defined and
understood, BIs are best used to establish that there is sufficient correlation between physically
measured lethality, generally in the form of thermometric data, and biological lethality measured
using calibrated BIs.
Sterilization processes are designed using one of three basic approaches (including the overkill
method), each of which requires some degree of knowledge of the resistance and population of the
bio indicator and bioburden (1). The bioburden method requires detailed knowledge and control over
the bioburden resistance and population. The bioburden/biological indicator (BB/BI) method relies
on the difference in resistance of the bioburden and BI (see Figure 2). With information about and
control over the bioburden population and resistance, sterilization cycles requiring less time and
temperature (relative to the overkill method) can be used successfully. Both of these methods allow
for lower heat input to the materials being processed (an important consideration for terminal
sterilization of filled product containers or the sterilization of in-process fluids and laboratory media),
provided that increased attention is paid to pre sterilization bioburden.
The overkill method relies upon the selection of a lethality level known to be adequate to ensure
sterilization without routine control over bioburden. A delivered F0 of 12 min is an example of an
overkill level of lethality. The basis for this level is that if the bioburden on an article were one
million and all of that bioburden consisted of resistant spores with a D121 value of 1 min, then a 106
probability of a non sterile unit (PNSU) would be consistently attained. Obviously, this reflects
worst-case assumptions regarding both the bioburden level and resistance, which would in every
instance be lower in the real-world condition. The role of the BI would be to prove that there is a
strong correlation between a physically determined F0 of 12 min and biological lethality at the
location of the indicator. A good correlation between biological and physical lethality ensures that an
efficient and well-designed cycle with suitable steam penetration and air removal (where necessary)
exists.
If understanding of overkill sterilization were all that is needed, this effort would be complete. The
difficulty lies in validating overkill sterilization in a manner that is easily defendable to those
unfamiliar with sterilization science and realistic in its execution. The first and simplest step is to
define the minimum process objective for the sterilization process. The objective is the universal
maximum probability of a single non sterile unit (PNSU) in 106 units (a PNSU of 1 106 for any
individual item). This is nothing more than an acceptable risk of contamination, whose origin (in the
food industry) goes back many years. This criterion is the same for all sterilization processes,
regardless of the sterilization method or the cycle approach used. The expectation is that the routine
process will achieve the desired PNSU and that the routine process requirement does not apply to the
validation effort. If that were not the case, then there would be no difference in the cycle approaches.
The intent is always to establish the process such that it provides the same minimum confidence in
the sterilized materials regardless of the varying controls defined.
Table I: Definitions of overkill sterilization and assessments of the validation difficulties for each
Figure-3
The confirmation of a 1 106 PNSU using any microbial challenge available can only be assumed,
but it can be assumed with a high degree of confidence based upon biological lethality data. This
salient point must be accepted without question. Irving Pflug has explained, "Accept that while the
objective of a sterilization process may be a PNSU of 106, we cannot directly measure microbial
levels of less than one surviving microorganism in 10 to 100 units (from 101 to 102). Therefore
when designing or validating sterilization processes, we use indirect methods, so we have real
measurements that are equivalent to our nonmeasurable PNSU of 106" (9).
In a sterilization validation study using an initial BI population of 106 spores per indicator, 20 strips
per study, and three replicate runs in which no survivors are observed, the log reduction demonstrated
requires approximately 9 logs (106 20 3 = 6 107 reduced to zero survivors) (see Figure 4).
Figure-4
If this process is considered the half cycle, then the full cycle (with twice the exposure time) is
depicted in Figure 5.
Figure-5
Because the lethality of the full cycle cannot be demonstrated using a bio challenge and recalling that
a 106 BI challenge is destroyed in the half cycle, the log reduction delivered to the BI must be
assumed. Using the assumed log reduction for the half cycle and doubling the dwell time, the log
reduction for the BI in the full cycle can be estimated at 18 logs and easily meets the overkill
definition of a minimum 12-log reduction of a BI with a D-value of 1 min (assuming the BI had a
D121 > 1 min) as is typical in nearly all overkill validation studies.
Figure-6
There are several inherent assumptions with the half-cycle method. The first assumption is that the
bioburden would be as numerous and resistant as the BI. Second, it is assumed that the complete
destruction of the multiple BIs in triplicate studies demonstrated a 9-log reduction of that BI. Finally,
the death curve of the BI is assumed to be linear in a region where it cannot be experimentally
determined.
Sterilization process objective
The routine sterilization of items in any sterilization process is intended to destroy the bioburden
microorganisms that might be present on or in the materials being processed, regardless of their
initial population and resistance. The goal is constant: to attain a minimum PNSU of 106. Consider
the following definition of overkill sterilization as being consistent with what process expectations
should be:
Overkill sterilization is a process where the destruction of a high concentration of a resistant
microorganism supports the elimination of bioburden that might be present in routine processing.
That objective can be demonstrated by attaining any of the following: a defined minimum F0, a
defined time-temperature condition, or a defined log reduction of a biological indicator.
This definition reflects the process requirement directly, with full recognition that bioburden
organisms typically have minimal heat resistance. Destruction of the BI in high concentration
requires time and temperature conditions far in excess of what is required to destroy the bioburden,
and thus overkill is demonstrated.
Demonstrating a minimum PNSU of 1 106 for a sterilization process can be ensured only where
the number and resistance of the microorganisms present on or in the items being sterilized is known.
This can be accomplished definitively using any of the sterilization-cycle approaches described
previously, and delivering that lethality is not restricted to the overkill method. It is supported by
information about the relative resistance of the bioburden to the biological indicator in the BB/BI
method in which partial kill of the indicator is sufficient to support the required minimum PNSU for
the bioburden. With the overkill method, complete destruction of the resistant BI in high numbers is
more than sufficient to ensure the minimum PNSU for any conceivable bioburden.
In everyday usage of sterilizing equipment, the BI is not present. The process is expected to
confidently destroy the bioburden. In today's industry, we have numerous controls on the presterilization bioburden, and in many instances, especially terminal sterilization, it is monitored for
each sterilizer load.
Although the half-cycle method might seem acceptable to some, it strikes this author as an overly
conservative approach that belies the customary industry controls on bioburden. There is little, if any,
scientific rationale for its continued use in steam sterilization. Requirements for environmental
monitoring, cleaning validation, bioburden monitoring, and component preparation all serve to ensure
that pre sterilization bioburden will approach neither the population nor the resistance of the
biological indicator. If resistance and count are within reasonable controlthat is, being non
thermophilic and meeting the local environmental limitsthen any of the alternative approaches can
be used.
Conclusion
Process expectations for demonstration of a minimum PNSU of 106 are essentially universal.
Overkill sterilization in its many variants is only one means of demonstrating that minimum
expectation. Its demonstration for routine processing relies on either knowledge or assumptions
regarding the bioburden number and resistance and little else. As the challenge microorganism is not
present in routine sterilization, only information about the bioburden is relevant to establishment of
the desired PNSU.
James Agalloco is president of Agalloco & Associates, PO Box 899, Belle Mead, NJ 08502, tel.
908.874.7558
908.874.7558, jagalloco@aol.com