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  1. 1. Dr H.D. Palekar (M.S.) Associate Professor Dept of Surgery Medical College Bhavnagar Sterilization By
  2. 2. OUT LINE <ul><li>Definitions </li></ul><ul><li>History </li></ul><ul><li>Classification </li></ul><ul><li>Commonly Used Disinfectants </li></ul><ul><li>Sterilization-methods of choice </li></ul><ul><li>O.T. Protocols </li></ul><ul><li>Management of spills </li></ul><ul><li>Message </li></ul>
  3. 3. Definitions:- <ul><li>Sterilization :- </li></ul><ul><li>The complete destruction or removal of all viable microorganisms which includes spores and viruses from…. </li></ul><ul><li>instruments & equipments </li></ul><ul><li>surfaces </li></ul><ul><li>medium </li></ul>
  4. 4. Definitions:- <ul><li>A process used to reduce the number of viable microorganisms on a object or surface but may not necessarily inactivate some viruses and bacterial spores (rarely destroy all microorganisms or spores) </li></ul><ul><ul><li>should only be used on heat sensitive items of equipments (e.g. endoscope) </li></ul></ul><ul><ul><li>disinfectants or germicide is a chemical agent . </li></ul></ul><ul><li>Properties:- </li></ul><ul><ul><li>bactericidal or bacteriostatic </li></ul></ul><ul><ul><li>sporicidal </li></ul></ul><ul><ul><li>viricides </li></ul></ul><ul><ul><li>fungicides </li></ul></ul>Disinfection:-
  5. 5. <ul><li>Asepsis :- </li></ul><ul><li>A technique of preventing excess of organisms into the patient’s uninfected tissues. </li></ul><ul><li>Antisepsis :- </li></ul><ul><li>The term indicates the prevention of infection usually by inhibiting the growth of bacteria in wound or tissues. </li></ul><ul><li>Antiseptic :- </li></ul><ul><li>A chemical disinfectant (usually bacteriostatic) that can be safely applied to the skin or mucous membrane. (Living tissue). </li></ul>Definitions:-
  6. 6. Definitions:- <ul><li>Tyndallisation:- </li></ul><ul><li>A steaming of a solution at 100’ C for 30 min. every 24 hrs for three consecutive days to kill the spores. </li></ul><ul><ul><li>Egg content- L J media </li></ul></ul><ul><ul><li>Serum </li></ul></ul><ul><ul><li>Sugar containing media </li></ul></ul>
  7. 7. <ul><li>Pasteurization :- </li></ul><ul><li>Achieved by heating at 72’C for 20 to 30 sec. (or 63’ C for 30 min ) at below atmospheric pressure (not destroy spores and hepatitis virus) </li></ul><ul><li>Cleaning (detergent effect) :- </li></ul><ul><li>A process which physically remove contamination but does not necessarily destroy microorganisms. </li></ul>Definitions:-
  8. 8. HISTORY :- <ul><li> Disease and death was ascribed by ancient humans to divine wrath and other supernatural forces. </li></ul>
  9. 9. <ul><li>VARO AND COLLUMELLA :- </li></ul><ul><li>In 1st century BC postulated that disease was caused by invisible beings (animalia -minuta) inhaled or ingested. </li></ul><ul><li>FRANCOSTORIUM OF VERONA (1546) :- </li></ul><ul><li>Contagium vivum as a possible cause of infectious disease. </li></ul><ul><li>KIRCHER (1659) :- </li></ul><ul><li>Reported finding minute worms in a blood of plague victim. </li></ul><ul><li>VONPLENCIZ (1762) :- </li></ul><ul><li>Each disease caused by separate agent. </li></ul>HISTORY :-
  10. 10. <ul><li>ANTONY VAN LEEUWENHOCK (1683) [MICROSCOPE] :- </li></ul><ul><li>Made accurate description at various types of bacteria and communated them to royal society of London. he called and acknowledged them as world of little animalcules. </li></ul><ul><li>NEEDHAM (IRISH PRIEST) (1745-49) :- </li></ul><ul><li>In 1745 published experiments purporting spontaneous generation (abiogenesis) of microorganisms in putrescible fluid. </li></ul>HISTORY :-
  11. 11. HISTORY :- <ul><li>SPALLANZANI (1765-76) Italian Abbot:- </li></ul><ul><li>Opposed the views. Pasteur provided conclusively that all forms of life even microbes arouse only from their like and not de novo. </li></ul>
  12. 12. <ul><li>DAVAINE & POLLENDER (1850) :- </li></ul><ul><li> Observed anthrax bacilli in blood of </li></ul><ul><li>animal dying by disease. </li></ul>HISTORY :- AUGUSTINO BASSI (1835) :-  Muscardin disease of silk worm was caused by a fungus.
  13. 13. HISTORY :- <ul><li>OLIVER WENDELL HOLMES-USA (1843) :- & IGNAS PHILLIPP SEMMELWEIS- VIENNA (1818-1865) :- Independently concluded that purpural sepsis was contagious </li></ul><ul><li>SEMMELWEIS:- </li></ul><ul><li>Also identified its mode of transmission by doctor and medical students attending on a woman in labour in hospital . and prevented it by simple measure of washing hands in an antiseptic solution. for which service to medicine and humanity he was persecuted by medical orthodoxy and driven insane. </li></ul>
  14. 14. HISTORY :- <ul><li>LOUIS PASTEUR- CHEMIST FROM FRANCE (1822-95)-(father of modern microbiology) :- Studied and made enquiry into origin of microbes. Studied fermentation led him to take interest in microorganisms. </li></ul><ul><li>In the course of these studies he introduce the technique of sterilization and developed the steam sterilizer, hot air oven and autoclave. </li></ul>
  15. 15. HISTORY :- <ul><li>JOSEPH LISTER (1827-1912) :- (Father of antiseptic surgery.) Contemporary of Louis Pasteur. He was a professor of surgery in Glasgow Royal Infirmary. </li></ul>
  16. 16. <ul><li>@ Immediate application of Pasteur’s work was the introduction of antiseptic technique in surgery by Lister effecting pronounced drop in mortality and morbidity due to surgical sepsis. </li></ul><ul><li>@ Lister’s antiseptic surgery involving the use of carbolic acid was cumbersome and hazardous but was a milestone in evolution of surgical practice from the era of laudable pus to modern antiseptic surgery. </li></ul><ul><li>@He utilized phenol as much as possible to abolish microorganisms from the walls of OT- instruments-dressing materials by impregnating in phenol. </li></ul>HISTORY :-
  17. 17. HISTORY :- <ul><li>@ He established the guiding principle of antisepsis for good surgical practice upon which the present day specialist depend. For his this work he is known as FATHER OF ANTISEPTIC SURGERY. </li></ul>
  18. 18. <ul><li>No doubt pasteur was aware of Lister’s work when he said- </li></ul><ul><li>“ if I had a honour of being a surgeon, since I am convinced of a dangerous condition caused by the germs or microbes which are to be found every where especially in hospitals, not I would used only instruments in a perfect state of cleanliness but also having clean my hands with the greatest of the care - I would flame them rapidly……..” </li></ul><ul><li>It is fortunate that it is not necessary in today's hospitals routine to flame the hands to prevent the contamination. </li></ul>HISTORY :-
  19. 19. CLASSIFICATION Methods Physical Chemical Heat Radiation Filtration Ultrasonic Vibrator Dry Heat Moist Heat Non Ionizing Ionizing Earthenware Asbestos Disc Sintered Glass Collodion( Membrane) Slow sand & Rapid
  20. 20. Physical Methods <ul><li> Dry heat :- </li></ul><ul><li>(1) Red heat (for instant sterilization) </li></ul><ul><ul><li>In flame of Bunsen burner </li></ul></ul><ul><li>Metallic objects like… </li></ul><ul><ul><li>Inoculating wires </li></ul></ul><ul><ul><li>Tips of forceps </li></ul></ul><ul><ul><li>Needles etc </li></ul></ul>
  21. 21. <ul><li>(2) Flaming (uncertain efficiency) </li></ul><ul><li>Glass slides </li></ul><ul><li>Scalpels </li></ul><ul><li>Needles </li></ul><ul><li>Cotton wool plug </li></ul>Physical Methods
  22. 22. <ul><li>(3) Hot air oven (160’C – 1 hour) </li></ul><ul><li>Glass wares </li></ul><ul><li>Syringes </li></ul><ul><li>Petri dishes </li></ul><ul><li>Test tubes </li></ul><ul><li>Flasks </li></ul><ul><li>Pipettes </li></ul><ul><li>Surgical instruments </li></ul><ul><li>Forceps </li></ul><ul><li>Scalpels </li></ul><ul><li>Scissors </li></ul><ul><li>Oily fluids </li></ul><ul><li>Chemicals </li></ul><ul><li>Powders </li></ul>Physical Methods
  23. 23. <ul><li>Articles should be dry </li></ul><ul><li>Should not be overheated </li></ul><ul><li>Keep adequate space </li></ul><ul><li>After disconnection allowed to cool for 1-2 hrs. </li></ul><ul><li>Rubber goods, volatile substances should not put….. </li></ul>Physical Methods Precautions:-
  24. 24. <ul><li>(4) Incineration </li></ul><ul><li>Destruction of infective materials </li></ul><ul><li> Solid dressings </li></ul><ul><li> Beddings </li></ul><ul><li> Sputum & stool and carcasses </li></ul>Physical Methods
  25. 25. <ul><li> Moist Heat :- </li></ul><ul><li>a) At a temperature below 100’C </li></ul><ul><ul><ul><li>Serum or body fluids – 56’C – 1 hr </li></ul></ul></ul><ul><ul><ul><li>Bacterial vaccines – 60 ‘C – 1 hr </li></ul></ul></ul><ul><ul><ul><li>Pasteurization of milk -72’C – 30 sec </li></ul></ul></ul><ul><li>b) At a temperature 100’C – 10 to 30 min –Boiling (inadequate sterilization) </li></ul><ul><ul><ul><li>Syringes </li></ul></ul></ul><ul><ul><ul><li>Injection needle </li></ul></ul></ul><ul><ul><ul><li>Surgical instruments except scissors, knives & surface needles </li></ul></ul></ul> Physical Methods
  26. 26. <ul><li>(c) Autoclave </li></ul><ul><li>A sterilizer with steam under pressure </li></ul><ul><li>The principle is based on the fact that with increasing the pressure, the boiling point of the water is increased. (temp is directly related to pressure) </li></ul><ul><li>e.g. </li></ul><ul><li>134’C (30 lb / in2) 3-5 min </li></ul><ul><li>121’C (15 lb / in2) 15 min </li></ul><ul><li>115’C (10 lb /in2) 30 min </li></ul><ul><li>105.5’C (5 lb /in2) 45-60 min </li></ul>Physical Methods At a Temperature Above 100’C
  27. 27. <ul><li>AUTOCLAVE ( cont .) </li></ul><ul><li>Effective against….. </li></ul><ul><li>Vegetative bacteria including TB. </li></ul><ul><li>Viruses </li></ul><ul><li>HBV and HCV </li></ul><ul><li>Heat resistant spores – Cl. tetani, </li></ul><ul><li>Cl. perfringes </li></ul>Physical Methods
  28. 28. <ul><li>Metal instruments (unwrapped)  20 min </li></ul><ul><li>Syringes (unwrapped)  20 min </li></ul><ul><li>Metal and trays (wrapped)  30 min </li></ul><ul><li>Rubber gloves (dry, powdered, </li></ul><ul><li>individually packed in linen)  30 min </li></ul><ul><li>Threads (linen, silk nylon) </li></ul><ul><li>& metal wires  20 min </li></ul><ul><li>Linen, towels, gowns dressings, </li></ul><ul><li>gauze, cotton etc  45 min. </li></ul>Physical Methods USES of autoclave
  29. 29. <ul><li> Radiation:- </li></ul><ul><li>(A) IONISING RADIATION </li></ul><ul><li>Formation of radiation tracks in the DNA of bacteria leading to its death </li></ul><ul><li>γ rays, X rays are in use </li></ul><ul><li>A dose of 2-5 μ radiation is adequate to kill both vegetative bacteria and spores form of bacteria </li></ul>Physical Methods
  30. 30. <ul><li>Disposable plastic syringes </li></ul><ul><li>Swabs </li></ul><ul><li>Catheters </li></ul><ul><li>Suture materials </li></ul><ul><li>Surgical instruments </li></ul><ul><li>IV set </li></ul><ul><li>BT set </li></ul><ul><li>Scalp veins </li></ul><ul><li>Surgical blades </li></ul><ul><li>Eye drops </li></ul><ul><li>Ophthalmic ointment </li></ul><ul><li>Paraffin gauzes </li></ul><ul><li>Heart valve prosthesis </li></ul><ul><li>Orthopedic implants </li></ul><ul><li>Cement </li></ul>Physical Methods To Sterilize( I R )
  31. 31. <ul><li>(B) Non Ionizing Radiation </li></ul><ul><li> Infra red </li></ul><ul><li> Ultra Violet </li></ul><ul><li> Sunrays </li></ul><ul><li> Denaturation of bacterial protein (Damage to DNA so inhibition of DNA replication) </li></ul>Physical Methods
  32. 32. <ul><li>Non I R Contd. </li></ul><ul><li> Infrared:- Rapid Mass sterilization of syringes </li></ul><ul><li> Ultraviolet:- Disinfection of </li></ul><ul><li> Operation Rooms </li></ul><ul><li> Wards </li></ul><ul><li> Entry Ways </li></ul>Physical Methods
  33. 33. Chemical Methods <ul><li>(1) Acids – </li></ul><ul><li>Inorganic – Boric Acid </li></ul><ul><li>Organic - Benzoic Acid </li></ul><ul><li> Salicylic Acid </li></ul><ul><li>(2) Alkalies- </li></ul><ul><li>Na & K Hydroxides </li></ul>
  34. 34. Chemical Methods <ul><li>(3) Alcohols- </li></ul><ul><li>Ethyl Alcohols 70% </li></ul><ul><li>Isopropyl Alcohols 70 % </li></ul><ul><li>Methyl Alcohols 70 % </li></ul><ul><li>(4) Aldehyde- </li></ul><ul><li>Formaldehyde 4% </li></ul><ul><li>Gluteraldehyde 2% </li></ul>
  35. 35. Chemical Methods <ul><li>(5) Surface Acting Agent:- </li></ul>Most IMP Surfece Acting Agents Anionic Cationic Nonionic Amphoteric Common Soap Cetrimide Or Cetavlon Polysorbates Tego compound
  36. 36. Chemical Methods <ul><li>(6) Phenol </li></ul>Phenol Carbolic Acid Cresol ( LYSOL ) Chloroxylenol (DETTOL) Chlorhexidine Chlorocresol
  37. 37. Chemical Methods <ul><li>(7) Halogens:- </li></ul><ul><li>(1) Chlorine & Chloramines </li></ul><ul><li>(2) Iodine & Iodophores </li></ul>
  38. 38. Chemical Methods <ul><li>(8) Oxidizing Agents </li></ul><ul><li>(1) Hydrogen peroxide </li></ul><ul><li>(2) Potassium Permanganate </li></ul><ul><li>(3) Zinc Permanganate </li></ul>
  39. 39. Chemical Methods <ul><li>(9) Dyes:- </li></ul>Dyes Acriflavin Proflavin Methylene Blue Crystal Violet Brilliant Green
  40. 40. Chemical Methods <ul><li>(10) Heavy Metals </li></ul><ul><li>- Silver Nitrate </li></ul><ul><li>- Mercurial Compounds </li></ul><ul><li>(11) Gases:- </li></ul><ul><li>- Ethylene Oxide (ETO) </li></ul><ul><li>- Formaldehyde </li></ul><ul><li>- Beta Propriolactone </li></ul>
  41. 41. Commonly Used Chemical Disinfectants. <ul><li>1. Ethanol/ Isopropyl Alcohol 3-5 min </li></ul><ul><li>Denatured and coagulation of the cell wall protein of bacteria and so bacteria destroyed </li></ul><ul><li>2. Povidone Iodine 2% - 15min </li></ul><ul><li> 5%-2-3 min </li></ul><ul><li>Effective Gram +ve,-ve Bacterial </li></ul><ul><li>Fungi, Viruses, Spores, Protozoa </li></ul><ul><li>It’s action persists as long as color </li></ul><ul><li>remain </li></ul><ul><li>Skin antiseptic </li></ul><ul><li>Alcoholic Hand Wash </li></ul><ul><li>Emergency disinfection of surgical instruments in vicinity to the patient. </li></ul><ul><li>Surface Disinfectant </li></ul><ul><li>Topical Antiseptic </li></ul><ul><li>Surgical Scrub </li></ul><ul><li>Low Conc. Mucous membrane antiseptic </li></ul><ul><li>Instrument tray, head rest hand piece etc. </li></ul>
  42. 42. Commonly Used Chemical Disinfectants. <ul><li>3) Glutaraldehyde2% 10-30 min </li></ul>
  43. 43. Commonly Used Chemical Disinfectants. <ul><li>3 . Glutaraldehyde </li></ul><ul><li>2% 10 -30 min </li></ul><ul><li>Damage the cell- wall membrane and </li></ul><ul><li>cytoplasm </li></ul><ul><li>Complete sterilization – 10 Hrs </li></ul><ul><ul><li>Metal Instruments </li></ul></ul><ul><ul><li>Face masks </li></ul></ul><ul><ul><li>Plastic endotracheal tubes </li></ul></ul><ul><ul><li>Polythene tubing </li></ul></ul><ul><ul><li>Rubber tubing </li></ul></ul><ul><ul><li>Anaesthetic tubing </li></ul></ul>
  44. 44. Commonly Used Chemical Disinfectants. 3. Glutaraldehyde 2% 10-30 min <ul><li>Scopes </li></ul><ul><li>1. Upper GI & Lower GI </li></ul><ul><li>2. Bronchoscopes </li></ul><ul><li>3. Urethroscopes/ Cyscopes </li></ul><ul><li>4. Pharyngoscopes </li></ul><ul><li>5. Otoscopes </li></ul><ul><li>6. Laparoscopes </li></ul><ul><li>7. Colposcopes </li></ul><ul><li>8. Arthroscopes </li></ul><ul><li>9 . Endoscopes </li></ul><ul><li>No deleterious effect on lenses and cement . </li></ul>
  45. 45. Commonly Used Chemical Disinfectants. <ul><li>3. Glutaraldehyde2% </li></ul><ul><li>10-30 min </li></ul>
  46. 46. Commonly Used Chemical Disinfectants. <ul><li>3.(A) .. Glutaraldehyde 2.4% </li></ul><ul><li>( The new generation Cidex Activated GTA) </li></ul><ul><li>Providing superior rate of biocidal action against all microbes including M-tuberculosis </li></ul>
  47. 47. Commonly Used Chemical Disinfectants. <ul><li>4. Formalin 4% 30 min </li></ul><ul><li>Destroy/ Modify the function group of protein ( enzymes) in microorganisms. </li></ul><ul><li>Endoscopes </li></ul><ul><li>Tubings- Cords,cables,adapters,connectors, wires,cautery points </li></ul><ul><li>Surgical instruments & heat sensitive catheters </li></ul><ul><li>Fumigation of OT & wards </li></ul><ul><li>Clothing's & bedding </li></ul><ul><li>Furniture </li></ul>
  48. 48. Commonly Used Chemical Disinfectants. <ul><li>5 . H 2 O 2 30 min </li></ul><ul><ul><li>Destroy/ Modify the function group of protein( enzymes) in microorganisms. </li></ul></ul><ul><li>It is not antiseptic but cleansing agent </li></ul><ul><li>Destroy anaerobic organisms </li></ul>
  49. 49. Commonly Used Chemical Disinfectants. <ul><li>6 . Savlon </li></ul><ul><li>Cetrimide </li></ul><ul><li>Chlorhexidine </li></ul><ul><li>Isopropyl Alcohol </li></ul><ul><li>Reduces surface tension & damage cell wall membrane. </li></ul><ul><li>( of microorganism) </li></ul><ul><li>Detergent-Disinfectant- Antiseptic </li></ul><ul><li>Cleansing & Disinfection of surgical Equipments. </li></ul><ul><li>Storage of previously sterilized Instruments </li></ul><ul><li>Disinfection & Prolong Storage of Thermometer & Cheatle Forceps </li></ul>
  50. 50. Commonly Used Chemical Disinfectants. 7 . Chlorhexidine 2min Cell wall membrane damage. (to microorganism) 8. Cresol ( LYSOL) Cell wall membrane damage. ( to microorganism) <ul><li>Disinfection of surgical instruments </li></ul><ul><li>Cleaning & disinfect the floor of wards & OTs </li></ul><ul><li>Sterilization of infected glass wares in lab </li></ul><ul><li>Disinfections of excreta </li></ul>
  51. 51. Commonly Used Chemical Disinfectants. <ul><li>9. Chloroxylenol </li></ul><ul><li>( DETTOL) </li></ul><ul><li>Cell wall membrane damage. ( to microorganism) </li></ul><ul><li>10 . Sodium hypochlorite sol. (0.5-1 %) </li></ul><ul><li>Used as disinfectant </li></ul><ul><li>Wiping of surfaces & spills </li></ul>
  52. 52. Commonly Used Chemical Disinfectants. 11 . Bleach 1% Solution 12 . Bleaching Powder <ul><li>For disinfections of materials contaminated with blood & body fluids </li></ul><ul><li>For toilets & bathrooms </li></ul>
  53. 53. Commonly Used Chemical Disinfectants. 13 . Basillol-25 <ul><li>Ethanol </li></ul><ul><li>2-Propanol </li></ul><ul><li>1-Propanol </li></ul>Disinfection of electronic Equipments in:  OTs  ICU  NICU  Recovery room  Medical Laboratories It is preferred disinfectant for :  Bronchoscopy  Ophthalmology  Dentistry
  54. 54. Commonly Used Chemical Disinfectants. <ul><li>Basillol-25 </li></ul>
  55. 55. <ul><li> 14. Korsolex </li></ul><ul><li>(Concentrated instrument sterilizing solution) </li></ul><ul><li>For Heat Sensitive & Heat Resistant Instruments </li></ul><ul><li>Chemical Composition (Each 100gm) </li></ul><ul><li> Glutaraldehyde 7.0 gm </li></ul><ul><li> 1,6 dihydroxy, </li></ul><ul><li> 2,5 Dioxahexane 8.2 gm </li></ul><ul><li>  Polymethyl Urea </li></ul><ul><li> Derivatives 17.6gm </li></ul><ul><li>  Rust inhibitors </li></ul>Commonly Used Chemical Disinfectants.
  56. 56. Commonly Used Chemical Disinfectants. korsolex Strength of solution Immersion Time Instruments High Level disinf. ( Standard disinfe). 5% Bacterial Spores X 30 min-1hr only (When speed of action is the need of the hour) Surgical Instruments Emergency disinfection 10% 15 min only All Endoscopes-Laparoscopes Total sterilization ( Sporicidal disinfection) 10% / 5 % 5 hrs / 10 hrs All implants & surgical items
  57. 57. Levels of disinfection <ul><li>1)High level </li></ul><ul><li>A process that eliminates all microorganisms except large populations of bacterial endospores (some critical and semicritical items ) </li></ul><ul><li>2) Intermediate level </li></ul><ul><li>inactivates vegetative bacteria including mycobacteria most viruses and fungi(some semicritical items) </li></ul>
  58. 58. Levels of disinfections <ul><li>3) Low level </li></ul><ul><li>Kills most vegetative bacteria and some viruses and fungi but not tubercle bacilli or bacterial spores(non critical items) </li></ul>
  59. 59. Levels of disinfections <ul><li>CRITICAL ITEMS </li></ul><ul><li>Entovascular or sterile tissues or have blood flowing through them </li></ul><ul><li>1.Surgical instruments: implants , needles and catheters(vasculars and urinary) </li></ul><ul><li>2. Laparoscopes and arthroscopes </li></ul><ul><li>3. Endoscopy accessories(bx forceps, cytology brushes) </li></ul><ul><li>4. Some dental instruments ( scaler burs, forceps and scalpels) </li></ul>
  60. 60. Levels of disinfections <ul><li>SEMICRITICAL ITEMS </li></ul><ul><li>contact with mucous membrane or </li></ul><ul><li>nonintact skin </li></ul><ul><li>1.G.I. endoscope </li></ul><ul><li>2. Laryngoscope </li></ul><ul><li>3. Broncoscope </li></ul><ul><li> 4. E.T. tubes </li></ul><ul><li>5. respiratory therapy and anesthesia equipements </li></ul>
  61. 61. Levels of disinfections <ul><li>6. Dialyzers </li></ul><ul><li>7. Cryosurgical probes </li></ul><ul><li>8. Some dental instruments (condensors air/water syringes) </li></ul><ul><li>9. Hydrotherapy tanks </li></ul><ul><li>10. Thermometers. </li></ul>
  62. 62. Levels of disinfections <ul><li>NONCRITICAL ITEMS </li></ul><ul><li>Contact with intact skin(not mucous membrane) </li></ul><ul><li>1.Stethoscopes </li></ul><ul><li>2 B.P. and tourniquet cuffs </li></ul><ul><li>3. E.C.G. leads </li></ul><ul><li>4. Bed pans </li></ul><ul><li>5. Linens </li></ul><ul><li>6. Environmental surfaces(table tops, bedside stands, furniture,floors) </li></ul>
  63. 63. Levels of disinfections Levels of disinfection Items Time disinfectant High level Critical and semi critical items (except thermometers and hydrotherapy tanks) >=20min. (sterilization X , then HLD) Gluteraldehyde, Hydrogen peroxide, peracetic acid , peracetic acid with hydrogen peroxide, chlorines Intermediate level Semicritical and noncritical(except environmental surfaces) <=10min. Alchohols, Iodophors, Phenolics, chlorines Low level(environmental surfaces) Noncritical Alchohols, Iodophors, Phenolics, chlorines
  64. 64. Commonly Used Chemical Disinfectants. korsolex
  65. 65. <ul><li>15. Triclosan 2 %- phenol derivative </li></ul><ul><li>+ Diphenoxy ethyl ether </li></ul><ul><li>Used for Surgical Hand Scrubbing </li></ul>Commonly Used Chemical Disinfectants.
  66. 66. Commonly Used Chemical Disinfectants. <ul><li>16 . ETO ( Gas or Liquid ) </li></ul><ul><li>Boiling point 10.7’C and so highly explosive </li></ul><ul><li>Liquid ETO Highly inflammable & Volatile so its uses are limited </li></ul><ul><li>With CO2 & N2 explosive tendency eliminated </li></ul><ul><li>Highly Penetrative Gas & is active against bacteria, Spores & Viruses. </li></ul><ul><li>It has irritating, Mutagenic & Carcinogenic effects </li></ul><ul><li>Instruments Sterilized by ETO should ideally be stored for a minimum 6 hrs before use. </li></ul><ul><li>Limited availability & High cost </li></ul>
  67. 67. <ul><li>ETO </li></ul><ul><li>Used to sterilize: </li></ul><ul><li>it is effective against heat sensitive equipments </li></ul><ul><li>Heart- Lung machine </li></ul><ul><li>Respirators </li></ul><ul><li>Sutures </li></ul><ul><li>Lenses </li></ul><ul><li>Dental Equipments </li></ul><ul><li>Single Used Items </li></ul><ul><li>Clothing's & Beddings & Also </li></ul><ul><li>Fumigation of rooms </li></ul>Commonly Used Chemical Disinfectants.
  68. 68. Commonly Used Chemical Disinfectants. <ul><li>Chemical disinfectants effective in inactivating HIV </li></ul><ul><li>Ethanol 70% = 3-5 min </li></ul><ul><li>2-propanol 70% = 3-5 min </li></ul><ul><li>Povidon iodine 2% = 15 min </li></ul><ul><li>Formaline 4% = 30 min </li></ul><ul><li>Gluteraldehyde 2% = 30 min </li></ul><ul><li>Hydrogen peroxide 6% = 30 min </li></ul>
  69. 69. Commonly Used Chemical Disinfectants. <ul><li>ADVANTAGES </li></ul><ul><li>Bactericidal </li></ul><ul><li>Viricidal </li></ul><ul><li>Fungicidal </li></ul><ul><li>Cost effective </li></ul><ul><li>Easily available </li></ul><ul><li>DISADVANTAGE </li></ul><ul><li>Corrodes metal </li></ul><ul><li>Deteriorates rapidly </li></ul><ul><li>Irritants </li></ul><ul><li>Staining to skin </li></ul>
  70. 70. Sterilization- Methods Of Choice 
  71. 73. Cleaning and disinfection, Commonly used in the hospital General Use articles. √ Bath water - Add Savlon when necessary √ Bed Pans - Wash with hot water and keep dry. - Disinfect with phenol after used by infected patients. √ Bowls - Autoclave/ wash with hot water and keep dry. √ Crockery. Cutlery – Wash with hot water and detergent. Keep dry. √ Floors - Vacuum clean  No Broom to be used √ Furniture, Bed Frames - Damp dust with detergent or with phenol or with 2% Lysol solution √ Mattresses/Pillows – Cover with water-impermeable cover. Wash cover with detergent solution and dry. Disinfect with phenol when necessary. √ Trolley tops. – Wipe with warm water and detergent to remove dust and keep dry.
  72. 74. √ Thermometers – Wash with warm water and detergent or 70% alcohol for one minute and keep dry. √ Endoscopes/ Arthroscopes / Laparoscopes / Fiberoptic Endoscopes. - Immerse in 2% alkaline glutaradhyde (CIDEX) under strict controlled conditions. As per manufactures instructions. Alternative Use- - Ethylene oxide sterilization - Alcohol disinfection - Hydrogen peroxide and peracetic acid √ Endotracheal suction catheter - Should be disposable - Or may be stored for 24 hours properly so that it does not get contaminated -Flush catheter with sterile distilled water each use. - Bowl must be washed and dried after each suction.
  73. 75. √ Endotracheal tubes - Recycled after cleaning and autoclaving √ Ambu Bags. - Ideally heat disinfect - Or immerse in 2% glutaraldhyde and then wash with sterile distilled water to reduce to risk of chemical irritation which can precipitate respiratory infection. √ Oxygen delivery face mask - Wash and then dry. - Wipe with 70% isopropyl alcohol to remove mucus. √ Suction drainage bottles - Ideally autoclave √ Ventilatory circuits respiratory equipment in neonatal/pediatric unit - Heat disinfection at 80’C for 3 minutes. - Or autoclave - Or Ethylene oxide sterilization.
  74. 76.  Do not use these instruments for more than 72 hours without sterilization √ Incubators - Clean thoroughly with warm water and soap - Wipe with 70% Isopropyl alcohol √ Humidifiers - Empty daily - Refill with sterile water - Disinfect when contaminated, with 1% hypochlorite for 30 minutes, wash and dry - Autoclave after each patient’s use - Autoclave when respiratory circuit is changed √ Urinary catheter - Ideally single use – disposable.
  75. 77. Operation Theater Protocol <ul><li>Preparation of patient </li></ul><ul><li>Preparation of surgeon </li></ul><ul><li>Hand washing </li></ul><ul><li>Gown Wearing </li></ul><ul><li>Gloves </li></ul><ul><li>OT sterilization & airflow patterns </li></ul><ul><li>Management of spills/blood splashes </li></ul>
  76. 78. Operation Theater Protocol <ul><li>Preparation of patient </li></ul><ul><li>SHOWRING </li></ul>
  77. 79. Operation Theater Protocol <ul><li>Preparation of patient (Cont.) </li></ul><ul><li>SHAVING </li></ul><ul><li>-Razor </li></ul><ul><li>-Depilatory Cream </li></ul><ul><li>-Clipping </li></ul>Cruse PJ, Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973 Aug;107(2):206-10. N = 23,649 if shaved -> -> 2.3% infection rate if no hair removed -> -> 0.9% infection rate
  78. 81. Operation Theater Protocol <ul><li>Preparation of patient (Cont.) </li></ul><ul><li>-Preparation of patient’s skin </li></ul><ul><li>-Drapes </li></ul><ul><li>operative & periphery to operative </li></ul><ul><li>area </li></ul><ul><li>-Transport of the patient to theater in O.T. </li></ul><ul><li>dress </li></ul>
  79. 82. Operation Theatre Protocol <ul><li>Preparation of Surgeon </li></ul><ul><li> SHOWRING </li></ul><ul><li> OT Dress </li></ul><ul><li>-Conventional cotton theatre ware </li></ul><ul><li>(Interstices > 80 micrometer) </li></ul><ul><li>-Disposable non-woven fabrics (fabric 45) </li></ul><ul><li>-Breathable membrane fabrics- Goretex </li></ul>
  80. 83. Operation Theatre Protocol <ul><li>Preparation of Surgeon (Cont.) </li></ul><ul><li> Cap </li></ul><ul><li> Masks </li></ul><ul><li>-Paper masks </li></ul><ul><li>-Cotton masks </li></ul><ul><li>-Disposable masks – contain filter </li></ul><ul><li>-Surgical Anti-fog masks – follow </li></ul><ul><li>facial contours </li></ul>
  81. 84. Operation Theatre Protocol <ul><li>Preparation of Surgeon (Cont.) </li></ul><ul><li> Eye Protection </li></ul><ul><li>-Anti-fog goggles </li></ul><ul><li>-Wrap around spectacles </li></ul><ul><li>-Face shields </li></ul><ul><li> Foot Wear </li></ul><ul><li>-Clean & comfortable </li></ul><ul><li>-Anti-slip & Anti-static </li></ul><ul><li>-Ankle length boots </li></ul>
  82. 85. HAND WASH
  83. 86. HAND WASH RESIDENT FLORA <ul><li>Native to skin and </li></ul><ul><li>non pathogenic but can become pathogenic </li></ul><ul><li>multiply in stratum cornium </li></ul>Coagulation negative staphylococci, micrococci, and coreni bacteria TRANSIENT FLORA (contact organisms) <ul><li>Transferred to hands from direct or indirect contact </li></ul><ul><li>can be pathogenic </li></ul>Gram negative, aerobic spore formers fungi and viruses. TEMPORORY RESIDENT FLORA <ul><li>Basically belongs to transient flora but detectable on the skin for prolonged periods and multiply there </li></ul>Staph aureus INFECTION FLORA <ul><li>Pathogens of existing infections on the hands e.g. abscess, infected eczema, paronychia </li></ul><ul><li>Can not be removed either by washing or disinfection </li></ul>Staph aureus, β haemolytic streptococci
  84. 87. HAND WASH √ Three Types of Hand washing: (1) Social Hand Washing (2) Hygienic Hand Washing (3) Surgical Hand Washing  Scrub Method  Rub Method
  85. 88. HAND WASH <ul><li>(1) Social Hand Washing :- </li></ul><ul><li> Plain Soap & Water- Most Transient Microorganism </li></ul><ul><li>a . Before handling food ,eating and feeding the </li></ul><ul><li>patient </li></ul><ul><li>b. After visiting Toilet </li></ul><ul><li>c. Before & After Nursing the patient ( e g. Bathing, </li></ul><ul><li>Bed making) </li></ul><ul><li>d. Whenever hands are soiled </li></ul>
  86. 89. HAND WASH <ul><li>(1) Social Hand Washing :- </li></ul>
  87. 90. HAND WASH <ul><li>(2) Hygienic Hand Washing : </li></ul><ul><li>Washing Or Disinfection with an antiseptic detergent preparation is used or is disinfected with alcohol </li></ul><ul><li>a. Before & After performing invasive procedures </li></ul><ul><li>b . Before & After caring for susceptible patients ( Immuno compromised ) </li></ul><ul><li>c . Before & After use of gloves </li></ul><ul><li>d . Before & After contact with blood, secretion & other body fluids </li></ul>
  88. 91. HAND WASH <ul><li>(2) Hygienic Hand Washing : </li></ul>
  89. 92. HAND WASH Social & Hygienic Hand Wash
  90. 95. HAND WASH <ul><li>(3) Surgical Hand Washing </li></ul>Rub Method Scrub Method
  91. 96. HAND WASH <ul><li>(3) Surgical Hand Washing </li></ul>SCRUB METHOD :
  92. 97. HAND WASH <ul><li>SCRUB METHOD: </li></ul>
  93. 98. HAND WASH <ul><li>SCRUB METHOD: </li></ul>
  94. 105. HAND WASH (SCRUB METHOD) <ul><li>Use soap or mild liquid soap for washing </li></ul><ul><li>Use only cold to lukewarm water for washing </li></ul><ul><li>Do not wash for too long or too intensively </li></ul><ul><li>Do not use brush </li></ul>
  95. 106. HAND WASH <ul><li>Rub method: </li></ul>
  96. 113. STERILLIUM <ul><li>1-Propanol </li></ul><ul><li>2-Propanol </li></ul><ul><li>Mecetronium etysulfate </li></ul><ul><li>Characteristics- </li></ul><ul><li> Bacterial incl MRSA </li></ul><ul><li>√ Fungicidal </li></ul><ul><li>√ Virus inactivating </li></ul><ul><li>  Non toxic & Emollient </li></ul><ul><li>  Antiperspirant </li></ul><ul><li>  Persistant effect for 3 hours. </li></ul><ul><li>Hygienic Hand Wash - 3ml – keep moist for 30 seconds </li></ul><ul><li>Surgical Hand Disinfection -10ml – keep moist for 3 min. </li></ul>Rub method :
  97. 114. HAND WASH <ul><li>AIMS OF SURGICAL HAND DISINFECTION: </li></ul><ul><li>Primarily destruction of the temporarily resident flora and destruction as far as possible of the resident flora. </li></ul><ul><li>Destruction of the transient flora </li></ul><ul><li>To prevent the transmission of microorganisms from the hands to patients. </li></ul><ul><li>AIMS OF HYGIENIC HAND DISINFECTION: </li></ul><ul><li>Primarily to destroy the transient flora i.e. the pathogens that cause transmissible diseases and nosocomial problem pathogens. </li></ul><ul><li>A reduction in the number of bacteria in the resident flora. </li></ul><ul><li>It’s purpose is not only to protect the patient but also to protect the personnel. </li></ul>
  98. 115. HAND WASH
  99. 116. GOWNING
  100. 117. GOWNING
  101. 118. Operation Theatre Protocol <ul><li>Preparation of Surgeon </li></ul><ul><li>GLOVES- (Latex) </li></ul><ul><li>-To prevent transmission of blood borne viruses </li></ul><ul><li>(HBV,HIV) from pt. to surgeon & surgeon to pt. </li></ul><ul><li>-To prevent transmission of micro-organisms from </li></ul><ul><li>surgeon to pt. (20 to 30% gloves develops holes </li></ul><ul><li>during surgery) </li></ul>
  102. 119. Operation Theatre Protocol <ul><li>Preparation of Surgeon (Cont.) </li></ul><ul><li>GLOVES- (Latex) </li></ul><ul><li>-Should be disposable </li></ul><ul><li>-Should be changed after 1 hour but </li></ul><ul><li>max. can be used for 3 hours </li></ul><ul><li>-After degloving wash the hands </li></ul><ul><li>-Discard gloves if suspicious puncture </li></ul>
  103. 120. Operation Theatre Protocol <ul><li>Preparation of Surgeon (Cont.) </li></ul><ul><li>GLOVES- (Latex) </li></ul>
  104. 121. Operation Theatre Protocol <ul><li>Preparation of Surgeon (Cont.) </li></ul><ul><li>GLOVES- (Latex) </li></ul>
  105. 122. Operation Theatre Protocol <ul><li>OT Discipline </li></ul><ul><li>-OT team & OT staff </li></ul><ul><li>-No excess activity (movements) </li></ul><ul><li>-Designed occlusive clothings </li></ul><ul><li>-Single dose prophylactic anti-biotic </li></ul>
  106. 123. Operation Theatre Protocol OT Sterilization
  107. 124. Operation Theatre Protocol <ul><li>OT Sterilization </li></ul><ul><li>(1) 280 ml Formalin+150 gm Potassium- permanganate  24hrs. </li></ul><ul><li>(10’ X 10’ X 10’) </li></ul>
  108. 125. OT Sterilization (2) BACILLOCID SPECIAL <ul><li>1,6 Dihydroxy 2-5 Dioxahexane ( Chemically bound Formaldehyde) </li></ul><ul><li>Glutaraldehyde </li></ul><ul><li>Benzalkonium Chloride </li></ul><ul><li>Alkyl Urea Derivation </li></ul><ul><li> Sterilization with: </li></ul><ul><li>2%  Weekly </li></ul><ul><li>1%  Alternate days </li></ul><ul><li>0.5%  Daily </li></ul><ul><li> Broad Spectrum: √ Bactericidal </li></ul><ul><li> √ Fungicidal </li></ul><ul><li> √ Sporicidal </li></ul><ul><li> √ Tuberculocidal </li></ul><ul><li> Excellent Viricidal Activity: </li></ul><ul><li>HBV ,HIV, Pollio. </li></ul>
  109. 126. OT Protocol <ul><li>MANAGEMENT OF SPILLS/BLOOD SPLASHES </li></ul>
  110. 129. OT Protocol <ul><li>MANAGEMENT OF SPILLS/BLOOD SPLASHES </li></ul>
  112. 136. <ul><li>Quality Is Costly </li></ul><ul><li>But </li></ul><ul><li>Lack Of Quality Is even </li></ul><ul><li>More Costly </li></ul>
  113. 137. Thank You