1 / 62

STERILIZATION AND DISINFECTION

STERILIZATION AND DISINFECTION. Meral Sonmezoglu , MD . Ass oc Professor of Infectious Dıseases. DEFINITIONS. Decontamination : Removal of disease-producing m.o. to leave an item Disinfection : Inactivation of disease-producing m.o. (not destroy)

Download Presentation

STERILIZATION AND DISINFECTION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. STERILIZATION AND DISINFECTION Meral Sonmezoglu, MD. Assoc Professor of Infectious Dıseases

  2. DEFINITIONS • Decontamination: Removal of disease-producing m.o. to leave an item • Disinfection: Inactivation of disease-producing m.o. (not destroy) • Sterilization: Destruction of all forms of microbial life (bacteria, viruses, spores, fungi) • Sanitation: A process that reduces mo on an inanimate object to a level of below infectious hazard

  3. Disinfection—The process of microbial inactivation that eliminates virtually all recognized pathogenic microorganisms, but not necessarily all microbial forms (e.g., spores) • Sterilization—The use of physical or chemical procedures to destroy all microbial life, including large numbers of highly resistant bacterial endospores. Procedures include— • Steam sterilization • Heat sterilization • Chemical sterilization

  4. Efficacy of Disinfection/Sterilization • Cleaning of the object • Organic and inorganic load present • Type and level of microbial contamination • Concentration of and exposure time to disinfectant/sterilant • Nature of the object • Temperature and relative humidity

  5. Decreasing Order of Resistance of Microorganisms to Disinfectants/Sterilants Prions Spores Mycobacteria Non-Enveloped Viruses Fungi Bacteria Enveloped Viruses

  6. Disinfection and Sterilization An object will be disinfected depended on the object’s intended use. CRITICAL - objects which enter normally sterile tissue or the vascular system or through which blood flows should be sterile. 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. NONCRITICAL -objects that touch only intact skin require low-leveldisinfection.

  7. Processing “Critical” Patient Care Objects Classification: Critical objects enter normally sterile tissue or vascular system, or through which blood flows. Object: Sterility. Level germicidal action:Kill all microorganisms, including bacterial spores. Examples: Surgical instruments and devices; cardiac catheters; implants; etc. Method: Steam, gas, hydrogen peroxide plasma or chemical sterilization.

  8. Critical Objects • Surgical instruments • Cardiac catheters • Implants

  9. Chemical Sterilization of “Critical Objects” Glutaraldehyde (> 2.0%) Hydrogen peroxide-HP (7.5%) Peracetic acid-PA (0.2%) HP (1.0%) and PA (0.08%) HP (7.5%) and PA (0.23%) Glut (1.12%) and Phenol/phenate (1.93%) _______________________________________________ Exposure time per manufacturers’ recommendations

  10. Processing “Semicritical” Patient Care Objects Classification: Semicritical objects come in contact with mucous membranes or skin that is not intact. Object: Free of all microorganisms except high numbers of bacterial spores. Level germicidal action:Kills all microorganisms except high numbers of bacterial spores. Examples: Respiratory therapy and anesthesia equipment, GI endoscopes, thermometer, etc. Method: High-level disinfection

  11. Semicritical Items • Endoscopes • Respiratory therapy equipment • Anesthesia equipment • Endocavitary probes • Tonometers • Diaphragm fitting rings

  12. High Level Disinfection of “Semicritical Objects” Exposure Time > 12 m-30m, 20oC Germicide Concentration_____ Glutaraldehyde > 2.0% Ortho-phthalaldehyde (12 m) 0.55% Hydrogen peroxide* 7.5% Hydrogen peroxide and peracetic acid* 1.0%/0.08% Hydrogen peroxide and peracetic acid* 7.5%/0.23% Hypochorite (free chlorine)* 650-675 ppm Glut and phenol/phenate** 1.21%/1.93%___ *May cause cosmetic and functional damage; **efficacy not verified

  13. Processing “Noncritical” Patient Care Objects Classification: Noncritical objects will not come in contact with mucous membranes or skin that is not intact. Object: Can be expected to be contaminated with some microorganisms. Level germicidal action:Kill vegetative bacteria, fungi and lipid viruses. Examples: Bedpans; crutches; bed rails; EKG leads; bedside tables; walls, floors and furniture. Method: Low-level disinfection

  14. Low-Level Disinfection for “Noncritical” Objects Exposure time > 1 min Germicide Use Concentration Ethyl or isopropyl alcohol 70-90% Chlorine 100ppm (1:500 dilution) Phenolic UD Iodophor UD Quaternary ammonium UD _____________________________________ UD=Manufacturer’s recommended use dilution

  15. Disinfectants for Surface Disinfection • Noncritical Surfaces • Medical equipment surfaces (BP cuff, stethoscopes) • May frequently become contaminated with patient material • Repeatedly touched by health care personnel • Disinfectant/detergent should be used • Housekeeping surfaces (bed rails, bedside tables) • May play a theoretical but less significant role in diseases transmission • Disinfectants/detergents may be used (II) and detergents (non-patient care areas)

  16. Sterilization and Disinfection of Patient Care Items

  17. Critical Instruments • Penetrate mucous membranes or contact bone, the bloodstream, or other normally sterile tissues (of the mouth) • Heat sterilize between uses or use sterile single-use, disposable devices • Examples include surgical instruments, scalpel blades, periodontal scalers, and surgical dental burs

  18. Semi-critical Instruments • Contact mucous membranes but do not penetrate soft tissue • Heat sterilize or high-level disinfect • Examples: Dental mouth mirrors, amalgam condensers, and dental handpieces

  19. Noncritical Instruments and Devices • Contact intact skin • Clean and disinfect using a low to intermediate level disinfectant • Examples: X-ray heads, facebows, pulse oximeter, blood pressure cuff

  20. Instrument Processing Area • Use a designated processing area to control quality and ensure safety • Divide processing area into work areas • Receiving, cleaning, and decontamination • Preparation and packaging • Sterilization • Storage

  21. Automated Cleaning • Ultrasonic cleaner • Instrument washer • Washer-disinfector

  22. Manual Cleaning • Soak until ready to clean • Wear heavy-duty utility gloves, mask, eyewear, and protective clothing

  23. Preparation and Packaging • Critical and semi-critical items that will be stored should be wrapped or placed in containers before heat sterilization • Hinged instruments opened and unlocked • Place a chemical indicator inside the pack • Wear heavy-duty, puncture-resistant utility gloves

  24. Heat-Based Sterilization • Steam under pressure (autoclaving) • Gravity displacement • Pre-vacuum • Dry heat • Unsaturated chemical vapor

  25. Liquid Chemical Sterilant/Disinfectants • Only for heat-sensitive critical and semi-critical devices • Powerful, toxic chemicals raise safety concerns • Heat tolerant or disposable alternatives are available

  26. Sterilization Monitoring Types of Indicators • Mechanical • Measure time, temperature, pressure • Chemical • Change in color when physical parameter is reached • Biological (spore tests) • Use biological spores to assess the sterilization process directly

  27. Storage of Sterile and Clean Items and Supplies • Use date- or event-related shelf-life practices • Examine wrapped items carefully prior to use • When packaging of sterile items is damaged, re-clean, re-wrap, and re-sterilize • Store clean items in dry, closed, or covered containment

  28. Environmental Infection Control

  29. Environmental Surfaces • May become contaminated • Not directly involved in infectious disease transmission • Do not require as stringent decontamination procedures

  30. Categories of Environmental Surfaces • Clinical contact surfaces • High potential for direct contamination from spray or spatter or by contact with DHCP’s gloved hand • Housekeeping surfaces • Do not come into contact with patients or devices • Limited risk of disease transmission

  31. Clinical Contact Surfaces

  32. Housekeeping Surfaces

  33. General Cleaning Recommendations • Use barrier precautions (e.g., heavy-duty utility gloves, masks, protective eyewear) when cleaning and disinfecting environmental surfaces • Physical removal of microorganisms by cleaning is as important as the disinfection process • Follow manufacturer’s instructions for proper use of EPA-registered hospital disinfectants • Do not use sterilant/high-level disinfectants on environmental surfaces

  34. Cleaning Clinical Contact Surfaces • Risk of transmitting infections greater than for housekeeping surfaces • Surface barriers can be used and changed between patients OR • Clean then disinfect using an EPA-registered low- (HIV/HBV claim) to intermediate-level (tuberculocidal claim) hospital disinfectant

  35. Cleaning Housekeeping Surfaces • Routinely clean with soap and water or an EPA-registered detergent/hospital disinfectant routinely • Clean mops and cloths and allow to dry thoroughly before re-using • Prepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations

  36. Medical Waste: Not considered infectious, thus can be discarded in regular trash Regulated Medical Waste: Poses a potential risk of infection during handling and disposal Medical Waste

  37. Regulated Medical Waste Management • Properly labeled containment to prevent injuries and leakage • Medical wastes are “treated” in accordance with state and local EPA regulations • Processes for regulated waste include autoclaving and incineration

  38. Monitoring Options • Water testing laboratory • In-office testing with self-contained kits • Follow recommendations provided by the manufacturer of the dental unit or waterline treatment product for monitoring water quality

  39. Definition: Medications that are injected into the body Cases of disease transmission have been reported Handle safely to prevent transmission of infections ParenteralMedications

  40. LOW LEVEL DISINFECTANTS • PHENOLIC DISINFECTANTS: • Effective against bacteria (gram+) and enveloped viruses • Not effective against nonenveloped viruses and spores • Active in the presence of organic material • Used for decontamination of hospital environment • Not recommended for semicritical items

  41. LOW LEVEL DISINFECTANTS • QUARTERNARY AMMONIUM COMPOUNDS: • Widely used as disinfectants • Contraindicated as antiseptics • Not effective against nonenveloped viruses, fungi and bacterial spores • Commonly used in ordinary environment sanitation of noncritical surfaces

  42. INTERMEDIATE LEVEL DISINFECTANTS • ALCOHOLS • Ethyl alcohol • Isopropyl alcohol • Rapidly bactericidal against against vegetative forms of bacteria • Effective against M. tuberculosis, fungi, enveloped viruses

  43. INTERMEDIATE LEVEL DISINFECTANTS • ALCOHOLS • Optimum bactericidal concentration is 60-90 % in water • Commonly used topical antiseptics (hand) • Also used to disinfect the surface of medical equipment • May not penetrate organic material • Flammable, irriates tissue, expensive for general use

  44. INTERMEDIATE LEVEL DISINFECTANTS • HYPOCHLORITES • Most widely used of the chlorine disinfectants • Most common product is 4-6 % sodium hypochlorite • Inexpensive and fast acting • May produce skin and ocular irritation or gis burns • Corrosive to metals in high concent, inactivated by organic material • Release toxic chlorine gas when mixed with ammonia or acid

  45. INTERMEDIATE LEVEL DISINFECTANTS • HYPOCHLORITES • Eliminate enveloped and non envelopedviruses • Effective against fungi, bacteria, algae, but not spores • Broad spectrum of antimicrobial activity • Most recommended for decontamination of hepatitis and HIV viruses • Used as solution in water (20.000 ppm)

  46. INTERMEDIATE LEVEL DISINFECTANTS • IODINE AND IODOPHOR • Formulations in soaps (surgical scrubs) • Bactericidal, sporicidal, virucidal, fungicidal • Require a prolonged contact time • Is neutralized in the presence of organic material • Frequent application needed • Irrigate tissues, corrosive • Used for disinfection of some medical equipment (not silicone catheters)

  47. HIGH LEVEL DISINFECTANTS • HYDROGEN PEROXIDE • Often used as antiseptic to clean wounds • Greatest effect against anaerobic bacteria • Effective against a broad range of pathogens • Damage tissues in high concentrations • Provides high levelof disinfection in 5 min • May be blended with iodophors, quarterner ammonia, paracetic acid

  48. HIGH LEVEL DISINFECTANTS • GLUTERALDEHYDE • Has a wide germicidal spectrum • Used as disinfectant or sterilant • Highly toxic • Only used in a well ventilated setting

More Related