Chapter 10
As a result of successfully completing this chapter, readers will be able to:
 Define the term, “disinfection,” and expla...
 Review factors which affect the chemical action of and other
important selection considerations for disinfections
 Prov...
 Disinfectant - A chemical used on
inanimate objects such as medical
instruments to kill all microorganisms ,
except spor...
Reduces the number of
microorganisms on an object
Disinfectants are
designed to be
used at a specific
strength
 Excessive Moisture –
Excessive moisture can cause
disinfectant solutions to
become diluted. Lowering the
concentration o...
 Direct Contact with the Item
 In order to be effective, disinfectants must
make direct contact with all surfaces being
...
 Temperature of the Disinfectant
 pH
 Hardness of the Water
 Material Compatibility
 Positioning of the Device(s) bei...
 Should be based on:
◦ The intended use of the device
◦ The degree of disinfection
required for the device
◦ Risk levels ...
 Items introduced
directly into the
bloodstream or other
normally sterile areas
of the body
 Surgical Instruments,
Impla...
 Items which come in
contact with intact
mucous membranes
 Fiberoptic
Endoscopes,
Cystoscopes, etc.
 Come in direct contact
with the patient’s
unbroken skin
 Crutches, Blood
Pressure Cuffs,
equipment, etc.
Table Modified from Favero and
Bond, 1991
Classification of
Patient Care Items
CriticalSterilizationSterile body cavity
Se...
 High-level
 Intermediate-level
 Low-level
 Process that uses a sterilant for a shorter contact
time that needed for sterilization
 High-level disinfection kills a...
 Process that utilizes a agent that kills viruses,
mycobacteria, fungi, and vegetative bacteria, but
not bacterial spores
 Process that utilizes a agent that kills vegetative
forms of bacteria some fungi and lipid viruses
 Lipid Virus – A virus whose core is
surrounded by a coat of lipoprotein.
Viruses included in this structural
category ar...
Table Modified from Favero and
Bond, 1991
Hierarchy of Disease Producing Agents
Low-Level DisinfectionLipid or medium size...
 Types of devices being disinfected
 Whether items can be disassembled
 Manufacturer’s recommendations
 Positioning of...
 A detailed overview of
common chemical
disinfectant characteristics
can be found on pages
161 – 169 in the text.
Low-Level Disinfectant
Advantages:
◦ Bactericidal, fungicidal and virucidal
against lipophilic viruses
◦ Built-in Deterg...
 Disadvantages:
◦ Not sporicidal
◦ Generally not tuberculocidal or virucidal against
hydrophilic viruses
◦ Not Compatible...
Advantages:
◦ Broad Spectrum of use;
bactericidal for gram-
negative and gram-
positive bacteria, fungi,
and tuberculocid...
 Advantages:
◦ Rapid bactericidal agent
against vegetative
microorganisms,
tuberculocidal, fungicidal,
and virucidal
◦ Fa...
 Chlorine
 Iodophors
 Advantages:
◦ Effective against Gram-
Positive and Gram-
Negative
Microorganisms,
Tuberculocidal,
Fungicidal, and
Viruci...
 Advantages:
◦ Bactericidal,
Tuberculocidal, and
Virucidal
◦ Rapid-Action against
vegetative bacteria
 Disadvantages:
◦ ...
 Advantages:
◦ Kills vegetative bacteria
(within 2 minutes)
◦ Bactericidal (gram-positive
and gram-negative),
tuberculoci...
 Advantages:
◦ Fast-acting
◦ User-friendly
◦ Compatible with a wide
range of endoscopes and
medical devices
◦ Requires no...
 Advantages:
◦ Bactericidal,
tuberculocidal,
fungicidal, and virucidal
◦ Sporicidal (as 8%
Formaldehyde/70%
alcohol)
 Di...
 Follow manufacturers’ instructions
 Use appropriate containers
 Cover the containers
 Wear gloves
 Reuse only those ...
 A Log Book should
be maintained for
high-level
disinfectants
 (See page 171 of
the text for a sample
log book page)
 Wear PPE
 Use an exhaust hood when necessary
 Develop a spill plan
 Provide an eyewash/shower and other first aid
sup...
 Thermal Disinfection –
Disinfection accomplished by
heat
 Check spray arms and nozzles
of mechanical
washer/disinfector...
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Chapter 10 disinfection

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Chapter 10 disinfection

  1. 1. Chapter 10
  2. 2. As a result of successfully completing this chapter, readers will be able to:  Define the term, “disinfection,” and explain how disinfection differs from sterilization  Review factors that impact the effectiveness of a disinfectant  Discuss the relationship between the risk level (intended use) of the device to be disinfected and the selection of a disinfectant  Explain disinfectant activity levels as they relate to the resistance of microorganisms to germicidal agents: ◦ high-level disinfection ◦ intermediate-level disinfection ◦ low-level disinfection
  3. 3.  Review factors which affect the chemical action of and other important selection considerations for disinfections  Provide basic information about the types of disinfectants commonly used in healthcare facilities: quaternary ammonium compounds, phenolics, alcohol, halogens, glutaraldehyde, ortho-phthalaldehyde, and formaldehyde  Review safety requirements that should be followed when using chemical disinfectants  Define the term, “thermal disinfection,” and note key points to ensure that it is occurring
  4. 4.  Disinfectant - A chemical used on inanimate objects such as medical instruments to kill all microorganisms , except spores  Antiseptic – A chemical used on living tissue such as skin, to slow the growth of microorganisms  Sterile – Free from all living organisms  Disinfection – The destruction of nearly all pathogenic microorganisms on an inanimate surface. Disinfection is accomplished using chemical or heat processes
  5. 5. Reduces the number of microorganisms on an object
  6. 6. Disinfectants are designed to be used at a specific strength
  7. 7.  Excessive Moisture – Excessive moisture can cause disinfectant solutions to become diluted. Lowering the concentration of the chemical disinfectant can reduce its ability to kill microorganisms  Type and number of microorganisms present
  8. 8.  Direct Contact with the Item  In order to be effective, disinfectants must make direct contact with all surfaces being disinfected  Time  Disinfectants must be allowed time to work  Check manufacturer’s instructions for the correct exposure time required to achieve the desired biocidal effect
  9. 9.  Temperature of the Disinfectant  pH  Hardness of the Water  Material Compatibility  Positioning of the Device(s) being disinfected
  10. 10.  Should be based on: ◦ The intended use of the device ◦ The degree of disinfection required for the device ◦ Risk levels are based on the Spaulding Classification System
  11. 11.  Items introduced directly into the bloodstream or other normally sterile areas of the body  Surgical Instruments, Implants, etc.
  12. 12.  Items which come in contact with intact mucous membranes  Fiberoptic Endoscopes, Cystoscopes, etc.
  13. 13.  Come in direct contact with the patient’s unbroken skin  Crutches, Blood Pressure Cuffs, equipment, etc.
  14. 14. Table Modified from Favero and Bond, 1991 Classification of Patient Care Items CriticalSterilizationSterile body cavity Semi-criticalHigh-levelMucous membranes Non-criticalLow levelIntact skin Item ClassDestruction Method Body Contact
  15. 15.  High-level  Intermediate-level  Low-level
  16. 16.  Process that uses a sterilant for a shorter contact time that needed for sterilization  High-level disinfection kills all microorganisms, except bacterial spores
  17. 17.  Process that utilizes a agent that kills viruses, mycobacteria, fungi, and vegetative bacteria, but not bacterial spores
  18. 18.  Process that utilizes a agent that kills vegetative forms of bacteria some fungi and lipid viruses
  19. 19.  Lipid Virus – A virus whose core is surrounded by a coat of lipoprotein. Viruses included in this structural category are generally easily inactivated by many types of disinfectants, including low-level disinfectants  Non-lipid Virus – A virus whose core is not surrounded by a lipid envelope. These viruses are generally more resistant to inactivation by disinfectants
  20. 20. Table Modified from Favero and Bond, 1991 Hierarchy of Disease Producing Agents Low-Level DisinfectionLipid or medium sized viruses (Hantavirus, Herpes Simplex Virus) Low-level DisinfectionGram Positive & Negative Vegetative Bacteria Intermediate-level DisinfectionFungi Intermediate-level DisinfectionNonlipid and small viruses (Poliovirus) High Level DisinfectionMycobacteria SterilizationBacterial spores Extended Sterilization TimesPrions Destruction MethodOrganism Producing Disease
  21. 21.  Types of devices being disinfected  Whether items can be disassembled  Manufacturer’s recommendations  Positioning of the device  Process Quality Assurance Tests  Shelf Life and Use Life  Preparation required (mixing, etc.)  Reuse factors  Additional inspections required by the manufacturer
  22. 22.  A detailed overview of common chemical disinfectant characteristics can be found on pages 161 – 169 in the text.
  23. 23. Low-Level Disinfectant Advantages: ◦ Bactericidal, fungicidal and virucidal against lipophilic viruses ◦ Built-in Detergent Properties
  24. 24.  Disadvantages: ◦ Not sporicidal ◦ Generally not tuberculocidal or virucidal against hydrophilic viruses ◦ Not Compatible with Soap ◦ Absorbed or Neutralized by Cotton or Charcoal ◦ Not effective against some gram-negative organisms commonly found in hospitals
  25. 25. Advantages: ◦ Broad Spectrum of use; bactericidal for gram- negative and gram- positive bacteria, fungi, and tuberculocidal against lipophilic viruses. ◦ Residual Activity* (can also be a disadvantage) Disadvantage s: ◦ Not sporicidal ◦ Inactivated by organic material ◦ Corrosive to Rubber and some Plastics
  26. 26.  Advantages: ◦ Rapid bactericidal agent against vegetative microorganisms, tuberculocidal, fungicidal, and virucidal ◦ Fast-Acting ◦ Non-Staining ◦ Leaves No Residue  Disadvantages: ◦ Requires a minimum 5 minute wet contact. ◦ No residual activity ◦ Volatile, flammable ◦ Inactivated by Organic Soil ◦ Can dissolve lens mountings on certain optical instruments ◦ Tends to harden and swell plastic tubing ◦ Not sporicidal
  27. 27.  Chlorine  Iodophors
  28. 28.  Advantages: ◦ Effective against Gram- Positive and Gram- Negative Microorganisms, Tuberculocidal, Fungicidal, and Virucidal ◦ Rapid-Acting  Disadvantages: ◦ Inactivated by Organic Matter ◦ Corrosive to Metals ◦ Not Sporicidal ◦ Stains fabrics, plastics and other synthetic materials ◦ Relatively Unstable
  29. 29.  Advantages: ◦ Bactericidal, Tuberculocidal, and Virucidal ◦ Rapid-Action against vegetative bacteria  Disadvantages: ◦ Corrosive to Metals ◦ Detrimental to Rubber and some Plastics ◦ May burn tissue ◦ Stains fabrics and other materials ◦ May require long contact time to kill some fungi
  30. 30.  Advantages: ◦ Kills vegetative bacteria (within 2 minutes) ◦ Bactericidal (gram-positive and gram-negative), tuberculocidal, fungicidal, virucidal, sporicidal (For sterilization (killing spores) the soak time ranges 6-10 hours).  Disadvantages: ◦ Noxious odors, good ventilation required ◦ Unstable (14-28 product life) ◦ Dilution of product reduces activity ◦ Vaporizes ◦ No cleaning ability ◦ Rinsing Required ◦ Employee Health Concerns
  31. 31.  Advantages: ◦ Fast-acting ◦ User-friendly ◦ Compatible with a wide range of endoscopes and medical devices ◦ Requires no activation or mixing  Disadvantages: ◦ Does not have sterilant label claim ◦ Improper rinsing can cause staining of patient tissues ◦ Patient with a history of bladder cancer should not be exposed to items processed by OPA
  32. 32.  Advantages: ◦ Bactericidal, tuberculocidal, fungicidal, and virucidal ◦ Sporicidal (as 8% Formaldehyde/70% alcohol)  Disadvantages: ◦ Inactivated by organic material ◦ May stain fabrics, plastics, and other synthetic materials ◦ Not sporicidal ◦ Carcinogen (1PPM, 8 hour TWA) ◦ Irritating fumes
  33. 33.  Follow manufacturers’ instructions  Use appropriate containers  Cover the containers  Wear gloves  Reuse only those products labeled for reuse  Watch expiration dates  Test as necessary  Rinse thoroughly  Dispose of according to established guidelines
  34. 34.  A Log Book should be maintained for high-level disinfectants  (See page 171 of the text for a sample log book page)
  35. 35.  Wear PPE  Use an exhaust hood when necessary  Develop a spill plan  Provide an eyewash/shower and other first aid supplies  Provide easy access to a phone and phone numbers for emergencies  Provide yearly staff training  Monitor disinfectants (including air quality)
  36. 36.  Thermal Disinfection – Disinfection accomplished by heat  Check spray arms and nozzles of mechanical washer/disinfectors daily to insure they are working correctly  Medical washers and washer/disinfectors are regulated by the FDA

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