ANES 1502 - M13 PPT - Disinfection

Disinfection
ANES 1502
Anesthesia Technology Fundamentals I
College of DuPage
Copyright IAHCSMM 2007

Objectives:
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

Objectives:
 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.

Terminology
 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.

Terminology
 Sterile – Free from all
living organisms.

Terminology
 Disinfection – The destruction
of nearly all pathogenic
microorganisms on an
inanimate surface. Disinfection
is accomplished using chemical
or heat processes.

Chemical Disinfection
Reduces the number of microorganisms on
an object.

Factors Impacting the
Effectiveness of Disinfectants:
 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.

Dilution
 Disinfectants
are designed
to be used at
a specific
strength.

 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.

Other Factors Impacting the
 Temperature of the Disinfectant
 pH
 Hardness of the Water
 Material Compatibility
 Positioning of the Device(s) being disinfected

Selecting a Disinfectant
 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

Critical Items
 Items introduced
directly into the
bloodstream or other
normally sterile areas
of the body.
 Surgical Instruments,
Implants, etc.

Semi-Critical Items
 Items which come in
contact with intact
mucous membranes.
 Fiberoptic Endoscopes,
Cystoscopes, etc.

Non-Critical Items
 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

Disinfectant Activity Levels
 High-level
 Intermediate-level
 Low-level

High-Level Disinfection
 Process that uses a sterilant for a shorter contact
time that needed for sterilization. High-level
disinfection kills all microorganisms, except
bacterial spores.

Intermediate-Level Disinfection
 Process that utilizes a agent that kills viruses,
mycobacteria, fungi, and vegetative bacteria, but
not bacterial spores.

Low-Level Disinfection
 Process that utilizes a agent that kills vegetative
forms of bacteria some fungi and lipid viruses.

Terminology
 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.
 Nonlipid Virus – A virus whose
core is not surrounded by a
lipidenvelope. 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

Factors Influencing Disinfectant
Effectiveness:
 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.

Common Disinfectants

Common Disinfectant Characteristics
 A detailed overview of
common chemical
disinfectant
characteristics can be
found on pages 161 – 169
in the text.

Quaternary Ammonium
Compounds (QUATS)
 Low-Level Disinfectant
Advantages:
 Bactericidal, fungicidal and virucidal against
lipophilic viruses
 Built-in Detergent Properties

Quats
 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

Phenolics
 Intermediate to Low Level
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)

Phenolics
Disadvantages:
 Not sporicidal
 Inactivated by organic material
 Corrosive to Rubber and some Plastics

Alcohol
 Intermediate-Level
Advantages:
 Rapid bactericidal agent against vegetative
microorganisms, tuberculocidal, fungicidal, and
virucidal.
 Fast-Acting
 Non-Staining
 Leaves No Residue

Alcohol
 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

Halogens
 Chlorine
 Iodophors

Chlorine
 Advantages:
 Effective against Gram-Positive and Gram-Negative
Microorganisms, Tuberculocidal, Fungicidal, and
Virucidal
 Rapid-Acting

Chlorine
 Disadvantages:
 Inactivated by Organic Matter
 Corrosive to Metals
 Not Sporicidal
 Stains fabrics, plastics and other synthetic materials
 Relatively Unstable

Iodophors
(Buffered Iodine)
 Advantages:
 Bactericidal, Tuberculocidal, and Virucidal
 Rapid-Action against vegetative bacteria

Iodophors
(Buffered Iodine)
 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

Glutaraldehyde
 High-Level Disinfectant/Sterilant
 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).

Glutaraldehyde
 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

Ortho-Phthaldaldehyde
(OPA)
 High-Level Disinfectant
 Advantages:
 Fast-acting
 User-friendly
 Compatible with a wide range of endoscopes and medical devices
 Requires no activation or mixing

OPA
 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

Formaldehyde
 Available in different concentrations as a Low,
Intermediate, and High-Level Disinfectant
 Advantages:
 Bactericidal, tuberculocidal, fungicidal, and virucidal
 Sporicidal (as 8% Formaldehyde/70% alcohol)

Formaldehyde
 Disadvantages:
 Inactivated by organic material
 May stain fabrics, plastics, and other synthetic
materials
 Not sporicidal
 Carcinogen (1PPM, 8 hour TWA)
 Irritating fumes
 Corrosive

Using High-Level Disinfectants
 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

Documentation
 A Log Book should be
maintained for high-level
disinfectants.
 (See page 171 of the text
for a sample log book
page.)

Chemical Disinfectant Safety
 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

Chemical Disinfectant Safety
 Provide yearly staff
training
 Monitor disinfectants
(including air quality)

Thermal Disinfection
 Thermal Disinfection – Disinfection accomplished by
heat.

Thermal Disinfection
 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.

Questions?

ANES 1502 - M13 PPT - Disinfection

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to ANES 1502 - M13 PPT - Disinfection

Similar to ANES 1502 - M13 PPT - Disinfection (20)

More from College of DuPage Learning Technologies

More from College of DuPage Learning Technologies (20)

Recently uploaded

Recently uploaded (20)

ANES 1502 - M13 PPT - Disinfection