Tuesday, April 9, 2013

Disinfection and sterilization

Importance of sterilization,
In health care setting it is important;
  • To render articles and environment safe from the risk of transmitting infections.
  •  Pathogens on hands & environment are removed or destroyed by ,
–        high standard of cleanliness
–        drying, washing, good ventilation and sun light.
 
o   Wards should be well ventilated and sunny.

● High risk procedures

o       Require absolute sterility

–        Surgery
–        preparation

•         of culture media
•         Iv fluids and other injectable drugs

–        Types of research work

● Sterilization: Complete removal of all microorganisms
● Disinfection:
      • Destruction of microorganisms
      • Excluding bacterial spores.
      • Does not necessarily kill all microorganism
      • Reduce them to a level, which is not harmful.
       ● Decontamination:

          Procedure that makes an inanimate object safe for patient care
         eg. Thermometer, stethoscope

        ● Antisepsis:

           The same procedure applied to living things

        ● Methods of sterilization,

        1) Heat:

                a) Dry heat:

o    Flaming

–        bacteriological loops

–        microscopic slides

–        metal instruments used in labs

o   Incineration - burning

–        discarded dressings

–        needles & syringes

–        human tissues etc….

o   Hot air oven: used in the laboratories to sterilize glassware.

–        160ºc for 1 - 1 1/2 hours

          b) Moist heat:

More penetration and more lethal  to microorganisms  

       Pasteurization

       Boiling

      Autoclaving   -  Autoclaves

o   simplest form - pressure cooker

o   Increased pressure   water boils at very high pressure

–        15 lbs /sq.inch water boils at 121ºC X15 min

–        20 lbs/sq.inch water boils at 126ºC X10 min

–        30 lbs /sq.inch water boils at 134ºc X 3 min.

•          generates steam at high temperatures

•          good penetration into articles

o   used for sterilizing

–        theater equipment and wrapped instruments

–        gloves, gowns, etc…

–        contaminated equipment

       ●   Monitoring of autoclaves:

o   Physical monitoring

o   Autoclave indicator tapes

o   Bowie Dick tape

o   Biological tests

2) Radiation

3) Filtration

4) Chemicals

o    Liquids and gases are used

o   An article should be thoroughly cleaned with soap and water or any detergent before applying chemicals
      • Alcohol, aldehydes, halogens, diguanides,phenolics, quaternary ammonium compounds 
      • Peracetic acid, heavy metals, dyes, oxidizing agnts
      • Peracetic acid
      • Soaps, gases, ethylene oxide, formaldehyde, gas plasma
  ● Factors determining effectiveness of chemical disinfection:

o   Selection of appropriate agent

–        Blood spill - phenolic X, Strong hypochloritea

o   Concentration

o   Prior cleaning

–        presence of inactivating organic matter

o   Time of exposure

o   Correct pH

o   Temperature & volume

o   Container

● Selection of disinfectant level

o   Critical instruments

–    Come into contact with blood, body fluids & penetrate mucous membranes
–    Sterilization recommended
–   Rarely high level disinfection may be OK

o   Semi critical

–        Make contact with mucous membranes
–        Does not penetrate
–        High level disinfection

o   Non critical

–        Touch intact skin
–        Cleaning & low level disinfection

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