Chapter 10  disinfection
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Chapter 10 disinfection






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Chapter 10  disinfection Chapter 10 disinfection Presentation Transcript

  • Chapter 10
  • 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
  •  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
  •  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
  • 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 of the chemical disinfectant can reduce its ability to kill microorganisms  Type and number of microorganisms present
  •  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
  •  Temperature of the Disinfectant  pH  Hardness of the Water  Material Compatibility  Positioning of the Device(s) being disinfected
  •  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
  •  Items introduced directly into the bloodstream or other normally sterile areas of the body  Surgical Instruments, Implants, etc.
  •  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 Semi-criticalHigh-levelMucous membranes Non-criticalLow levelIntact skin Item ClassDestruction Method Body Contact
  •  High-level  Intermediate-level  Low-level
  •  Process that uses a sterilant for a shorter contact time that needed for sterilization  High-level disinfection kills all microorganisms, except bacterial spores
  •  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 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
  • 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
  •  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
  •  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 Detergent Properties
  •  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
  • 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
  •  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
  •  Chlorine  Iodophors
  •  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
  •  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
  •  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
  •  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
  •  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
  •  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
  •  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 supplies  Provide easy access to a phone and phone numbers for emergencies  Provide yearly staff training  Monitor disinfectants (including air quality)
  •  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