The document discusses the process of decontaminating and storing surgical instruments. It describes the steps involved which include cleaning, disinfecting, inspection, lubrication, sterilization and storage. The layout of the central sterile supply department and the activities carried out are explained. Key terms like bioburden, decontamination and sterilization are defined. Medical devices are categorized based on the risk of infection and the appropriate processing method is described for each category. Personal protective equipment and methods for decontaminating instruments are also outlined.

1. DECONTAMINATION AND
STORAGE OF INSTRUMENTS

2. MANAGEMENT OF INSTRUMENTS
For an effective surgical instrument management and control
programme, the staff should know the following:
1. The instrument inventory.
2. The routine instruments needed for each type of operation
3. The correct use and handling of instruments
4. The method of instrument processing or preparation e.g.
sterilization
5. The aftercare of the instruments
6. The individual surgeon’s preferences

3. INSTRUMENT CARE INVOLVES THE
FOLLOWING STEPS
1. Cleaning and Disinfecting(decontamination)
2. Inspection
3. Lubrication
4. Sterilization
5. Storage

4. CSSD LAYOUT/parts of a CSSD
1.Dirt zone-
decontamination
2.Clean zone –
wrapping and
sterilization
3.Sterile zone-
stores sterile
packs

5. CSSD CYCLE/ACTIVITIES OF THE CSSD
1. Receipt
2. Rinsing
3. Disinfection
4. Cleaning
5. Drying
6. Inspection
7. Wrapping
8. labelling
9. Sterilization
10.Storage
11.Issue and distribution

6. DEFINATION OF TERMS
•Bioburden is the presence of viable microorganisms on
a surface (or complete item), inside a device, or in a
portion of liquid, before sterilization.
•Decontamination is a term used to describe a process
or treatment that renders a medical device, instrument,
or environmental surface safe to handle. Involves
removing blood ,pus ,excreta etc.Soiled items and
instruments should be carefully decontaminated and
cleaned before being sterilized or subjected to a final
disinfection.

7. •Sterilization is defined as the destruction of all
microbial life including spores
•Disinfection involves the use of a chemical
sterilant/agent to eliminate virtually all recognized
pathogenic microorganisms, but not all types of
microorganisms present on inanimate objects.

8. Medical devices are assigned to one
of three categories
• Critical: A device that enters normally sterile tissue or the vascular
system where blood flows. These devices (e.g., surgical
instruments, needles, intravenous catheters) should undergo
sterilization.
• Semi critical: A device that comes into contact with intact mucous
membranes and does not ordinarily penetrate sterile tissues (e.g.,
laryngoscopes, thermometers, flexible endoscopes). These devices
should receive HLD. Dental instruments not included here
• Noncritical: A device that ordinarily does not come into contact
with the patient or touches only intact skin (e.g., bedpans, blood
pressure cuffs, stethoscopes). These devices should be cleaned
followed by low-level disinfection.

9. category application Type of processing Examples
Critical/high
risk
Come into contact with
Sterile tissues in the body
Sterilisation Surgical instruments,
diagnostic catheters,
intravenous lines
Semi
critical/inter
mediate risk
Non-sterile tissues in
the body – mucous
membrane of the
respiratory, genital and
urinary tracts and skin
that is not intact
High level disinfection Respiratory therapy
equipment, dental
impressions and other
prosthetic appliances,
gastroscopes,
colonoscopes,
endoscopes, ultrasound
Probes(vagina)
Non
critical/low
risk
Instruments that come in
contact with intact skin
intermediate or low-level
disinfection
on some occasions
Bedpans, ECG leads,
thermometers,
sphygmomanometers
stethoscopes, beds,
bedside tables

11. Personal protective equipment
Personal protective equipment's is very important during the process of
decontamination to ensure infection prevention measures. The health care
provider should wear
• Gloves(double gloving)
• Hair cover
• Apron or fluid resistant gown
• boots
• masks
• Goggles
• Face shield(eye protection)
This is because the process of decontamination may involve a lot of splashing of
blood or dirty water and may put you at risk of getting contaminated

12. METHODS OF DECONTAMINATION
After rinsing with running water:
1. Four bucket system –, jik water, clean water, soapy water and clean water
2. Three bucket system-jik water, soapy water and clean water
3. Two bucket system-endozyme, clean water
NOTE
• Gather all required resources
• Prepare your four buckets every start of shift
• Label them appropriately and also label the date of preparation.
• Document on the decontamination chart the time the cleaned instruments
were immersed in jik water and time for removal out of jik.
• Change the water daily (24 hours) at the end of each shift or incase of severe
contamination.

13. How to label the bucket
•Name of the solution-Example jik water, clean water,
soapy water
•Date of preparation
•Time of preparation
•Date of expiry
•Time of expiry
•Name of the person who prepared
•Parts of jik and water for the jik bucket

14. CHART
DATE prepared Time immersed Time of removal signature

15. FACTORS TO CONSIDERS WHEN
DECONTAMINATING INSTRUMENTS
1. Types of equipment's-endoscopes, surgical instruments, sunction tubes,
electrical (not to be immersed in water)
2. Purpose of the equipment-critical ,semi critical,non critical
3. Knowledge and skills of the personnel
4. Number of equipment's
5. The manufacturers’ recommendations
6. How soon the instrument is needed
7. Number of times it can be re-processed
8. Availability of resources-disinfectants, PPES, buckets, water
9. Laid out guidelines or policies
10. Ability of the instrument to be disassembled to facilitate cleaning

16. Process of decontamination
1. sorting
2. Disassembling
3. Manual cleaning with sterile water in the sink
4. Soaking in endozymatic solution or jik solution
5. Rinse with clean water
6. clean in soapy water
7. Rinsing in clean water
8. Drying
9. Inspection
10. sort
11. Lubrication
12. Packaging
13. Sterilization
14. storing

17. 1.Sorting instruments
a. Check if any instrument has fallen down
b. Check in the drapes and mayo cover for missing instrument
c. Wrappers are discarded appropriately
d. Separate the sharp instruments from the rest ,remove all scalpels and
discard in the sharp box and also sort heavy instruments.
e. Separate delicate instruments
f. Separate instruments with dissimilar metals
g. Clean them separately.

18. 2. DIASSEMBLING EQUIPMENTS
Benefits of dissembling theatre instruments with multiple parts
before cleaning
•To allow proper cleaning
• To allow proper drying
•To allow proper inspection of instruments for functionality
•To allow proper inspection of instruments for cleanliness

19. 3.manual cleaning in the sink /pre
soaking
• The cleaning of instruments should begin during the surgical procedure to
prevent drying of blood, soil and debris on the surface and within lumens.
During surgery, the instruments should be wiped clean using a sterile, water-
moistened sponge
• Instruments with lumens should be flushed with a sterile, water-filled
syringe to remove blood and debris and prevent drying of the gross soil.
• Saline must not be used, since the chloride ions can cause pitting and
deterioration of the finish on the surface of the instruments.

21. Note that
Pre rinsing or presoaking before cleaning process can be used to prevent
blood and debris from drying on instruments. The following can be used:-
1. Proteolytic enzymatic detergent
2. Water with a near-neutral detergent
3. Plain clean demineralized water
4. Sodium hypochlorite/chloride bleach
5. Guanidine thiocyanate
6. Sodium hydroxide
7. Phenolic compouds

22. 4.Soaking in disinfectants
Define disinfectant
• Disinfectant is any chemical substance applied to inanimate
objects to kill microorganisms.
• Soaking should be for ten to fifteen minutes in the
disinfectant

23. Guidelines during decontamination
in the buckets
1. Hinged instruments must always be open to allow thorough cleaning
of the joints.
2. Ensure that cleaning bucket/baskets are not overloaded
3. Any instruments with lumens must be sunk in so as to allow through
flow of cleaning agents and rinse water
4. Place large instruments in such a way as to avoid ‘shadowing’ of
other instruments
5. Ensure dissimilar metals are not in contact with each other which can
cause contact corrosions.

24. Examples of disinfectants used
a. Hydrogen peroxide-safe, green, and sustainable for the environment.
This is because they break down into naturally-occurring elements of
water and oxygen. H2O2 disinfectants tend to kill a broad spectrum of
bacteria and viruses quickly, are mildly acidic, and are effective cleaner
b. Iodophors-Can be used for disinfecting some semi-critical medical
equipment but they can stain surfaces and have an unpleasant odor
(think Iodine)
c. Aldehydes- like formalin
d. Phenolic Compounds-Effective against pathogenic bacteria including
Mycobacterium tuberculosis as well as fungi and viruses, but also very
toxic and corrosive, attacking surfaces while they attack the organisms
on them

25. • Chlorine Compounds
• calcium and sodium hypochlorite
• Quaternary Ammonium Compounds (Quats)
• Peracetic acid.
• Alcohol
• 2 % Glutaraldehyde
• Enzymatic solution

26. What to Consider When Choosing
Your Disinfectant
1. Effectiveness
Does a disinfectant kill the microbes and pathogens that are of top concern
in your facility? For example, you may be highly concerned about
Staphylococcus aureus Methicillin Resistant (MRSA)
2. Kill Time
How quickly does a disinfectant product kill a specific pathogen? Does the
product keep surfaces visibly wet in order to comply with these kill times?
Again, disinfectant formulas are registered to kill specific pathogens in a
specific amount of time, and they need to be wet on a surface the entire
time to be actively working. Thirty seconds to five minutes might be a typical
kill time. If a disinfectant needs 10 minutes though, be sure it will actually
stay wet that long.

27. 3. Safety
Is the product safe to use for people and safe for the surfaces it is being applied
to? some categories of disinfectants are toxic, some stain, others are corrosive,
yet others have an undesirable odor.
Check toxicity and flammability ratings on products, as well as any personal
protective equipment (PPE) recommendations for disinfectants you apply. Be
sure a disinfectant will not damage any surface it is intended for
4. Ease of Use
Are the steps required to use a given disinfectant practical for your facility?
Some applications require multiple steps that may not always be feasible. Water
hardness is one factor that can impact the effectiveness of some disinfectant
formulas
5.Cost effectiveness
6.Available

28. Factors that can influence activity of
disinfectants
• Temperature
• Concentration
• Time
• Inactivation by other compounds
• Range of action-Bacteriocidal means kills bacteria,
Bacteriostatic means stalls/stops bacterial cellular activity
without directly causing bacterial death.

29. Jik formula
• Preparation of 0.5%
Total parts of water=(
% 𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑒
% 𝑑𝑖𝑙𝑢𝑡𝑒
)-1
for example ,to make 0.5% dilute from a 5% concentrated liquid household
jik:
5
0.5
− 1 = 10 − 1 = 9
Hence one part of concentrated bleach to nine parts of water
jik water

30. Example :if 1 part of jik is equal to six parts of water the if you chose to
go with 10mls of jik then water to dilute should be 60mls .
If you chose 50mls of jik then water to dilute it should be 300mls .and if
you chose 1 litre of jik then water to dilute it should be 6litres of water
Note: PRESEPT(jik tablets)
• The safe alternative to liquid bleach (sodium Hypochlorite) and often
referred to as Sodium Hypochlorite Tablets, Chlorine Tablets or Bleach
Tablets. 4 tablets is sufficient for 1 litre of water. each tab has 2.5 g of
sodium dichloroisocyanurate
• The chlorine tablets are inexpensive, easy to use, with quick action,

31. Jik tablets

32. ENDOZYME
• Current guidelines have now changed from use of jik to use of
endozyme or enzymatic detergent.
• Endozyme is an excellent for use on micro-organisms.
• Contains protease, amylase, lipase, carbohydrase.
• After the initial pre-wash phase at the sink for gross removal of
blood debris, an enzymatic solution is used to break down
remaining adherent soil followed by use of neutral/alkaline
detergent to further break the organic and inorganic soils and
last is a rinse in clean water.
Prewash at sink -endozyme-soapy water-clean water

33. HOW TO PREPARE
• Add 4 ml of endozyme to 1 liter of warm water .
• Submerge instruments to b cleaned
• Soak for 2 -5 minutes(2 mins for lightly soiled instruments
and 5 mins for heavily soiled) to remove all organic matter
• Rinse thoroughly with tap distilled or sterile water.
NB:
Should only be diluted with water, avoid strong oxidants like
bleach, glutaraldehyde and other that will kill the enzymes in
the detergent making it ineffective

34. • Only work at temperature of 80-150 farenheit.Extremely
high temperatures will kill the enzymes activity.
•Unused endozyme has a shelf life of 3 years.
• Prolonged soaking causes rust.
•Once the solution has been prepared ,the unused
solution remains effective for up to one week but if used
for decontamination it should be discarded at the end of
each day or after each case.

35. Advantages of endozyme
•Effective It is gentle and safe
•Has neutral PH
•Non abrasive-will not harm metals,plastics,rubber and
corrugated tubing
•Free rinsing
•100% bio gradable

36. 5.cleaning with detergent
• Cleaning with detergent It is the next step in processing of
equipment. Cleaning involves removing visible organic or inorganic
material using water with detergents or enzymatic products.
• Cleaning may be performed manually, mechanically or a
combination of both.
• The selection of the cleaning method should be based upon the
type of device and manufacturer’s recommendations.
• Cleaning greatly reduces the number of micro-organisms including
bacteria endospores on instruments and other items.

37. Types of cleaning
The cleaning method should not affect the function of the instruments
or devices .
1. Manual cleaning-it starts by scrubbing with a brush/sponge,
detergent and water before instruments and other items are
sterilized
2. Mechanical cleaning-use of a machine
Recommended as the primary method for decontamination of
instruments and devices that can withstand the process. Mechanical
cleaning equipment provides the advantage of exposing the
instruments and devices to a microbicidal process.
Can be accomplished with the use of washer sanitizers, washer-
decontaminators, washer-disinfectors, and washer sterilizers

38. The following are the ideal
characteristics of a cleaning agent.
1. Low sudsing/foaming(frothy soap bubbles)
2. Easily rinsed off
3. Disperse organic matter
4. Nontoxic
5. Nonabrasive (excess rubbing of a surface )
6. Not corrosive and damaging
7. pH between 7-10 .Detergents that have a pH of higher than 7 are more
effective in the removal of organic debris such as blood, fat and feces
8. Biodegradable(ability to be decomposed)

39. MECHANICAL CLEANING
An example of thermal disinfectant

40. • To ensure proper functioning of the mechanical equipment, routine
maintenance should be performed according to the manufacturer’s
instructions
• The strainer should be cleaned on a daily basis.
• Time and temperature should be monitored and documented.
• The water with detergent should be kept at a temperature in a range of
27º C to 44º C (80º F – 110º F). Temperatures over 110º F cause
coagulation and thus prevent removal of protein substances.
• Water temperatures that are too cold also may not activate the
detergent.
• Be careful when removing hot items from the equipment in order to
avoid burns.
• The items may be wet with hot water. Additionally, water that drips on
the floor may make it slippery; the water should be wiped from the floor

41. Ultrasonic cleaning
• It’s the MOST EFFECTIVE.Ultrasonic cleaning is a process that uses
ultrasound (usually from 20–40 kHz) to agitate a fluid. The ultrasound
can be used with just water, but use of a solvent appropriate for the
object to be cleaned and the type of soiling present enhances the
effect.

42. Preparing detergent solution
• For effective cleaning to take place it is essential that detergents are
prepared at concentration recommended by manufacture.to achieve
correct concentration, correct volume of concentrated detergent has
to be added to the correct volume of water at the correct
temperature.
𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛 𝑟𝑒𝑞𝑢𝑖𝑟𝑒𝑑 𝑥 𝑐𝑎𝑝𝑎𝑐𝑖𝑡𝑦 𝑜𝑓 𝑠𝑖𝑛𝑘 𝑏𝑜𝑤𝑙 𝑖𝑛 𝒎𝒍
𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛 𝑠𝑢𝑝𝑝𝑙𝑖𝑒𝑑
=volume of detergent or chemical
example, if a 1% solution of detergent is required and sink bowl capacity is 10litres and concentration supplied
is 100%
1𝑥10000
100
=100ml
100ml

43. TYPES OF BRUSHES
Laparascopic
Channel
BRUSHES
Soft nylon brushes
Tooth brush
sized for small
delicate
instruments
sponge

44. •Brushes used to clean instruments and devices with lumens
must be the correct size.
•This brushes should be soft not to cause damage
•The brush bristles are made of antimicrobial nylon to
prevent microbial growth
•For instruments with lumen like endoscopic channels, ports
or cannula use channel brushes
•Stainless steel wire brushes are used when cleaning
stubborn stains, stubborn bioburden, burs, bone rasp, files
and amputation saws where nylon brushes will not
adequately clean.

45. A good brush should have the
following qualities
•Heavy duty
•Correct size
•Flexible
•Transparent bristles to verify its cleanliness
•Bristles made of synthetic polypropylene or
nylon that is resistant to microbial growth
•Resistant to chemicals

46. 6.Rinsing with clean water
• Rinsing is very important to remove the loosened soil or residual
detergent.
• Rinse the object in water thoroughly.
7.drying
• Drying is a very important step. Instruments should be dried prior to
sterilization
• Devices can be air dried or dried by hand with a clean-non linting
cloth preferably single use.

47. 8.Inspection and sorting
• This involves inspection and function testing post cleaning. Each
set should be inspected separately.
• You should first assemble all the instruments together for
inspection.
• Disassemble all the instruments-unlock the hinges and box joints.

48. Key areas/aspects to Inspect for
1. Cleanliness
2. Completeness-if the instrument has detachable parts
3. Alignment
4. Firmness
5. Burrs-something that sticks or clings
6. Rust/corrosion
7. cracks
8. Breakages
9. Functionality-if malfunctioned set aside
10. sharpness

49. Parts of instrument to inspect
•Joints
•Tips
•Box locks
•Ratchets
•Serrations
•Jaws
•Cutting edges

50. •Jaws and teeth checked for alignment
•Box joints, serrations and crevices should be critically
inspected for cleanliness for Any blood or debris. re-
cleaning and rinsing should be performed if debris
and/or residue is still present on an instrument or
instruments.
•Cutting edges checked for sharpness
•Incompleteness

51. •Hinges on devices /Box lock
should also be check for firmness that is if the screws
have loosened. Done by holding the instrument down
loosely and estimating the flexibility which should be at
least a third of the total degree of rotation. They should
also be checked for ease of movement.
•All instruments with pins and screws
should be carefully checked to make sure the screws are
completely intact and safely located.

52. •Fine and delicate instruments should be inspected
under an illuminated microscope.
•All hinged instruments such as clamps and forceps
should be checked for stiffness and to ensure the joints
work smoothly.
•The tips of instruments should be of equal length
•Jaws close evenly, approximate initially at the tips and
be fully approximated when closed to the last ratchet

53. A General Guide on How to Inspect
Instruments
• Forceps and Hemostats: A visual test would be to close the jaws
lightly. If they overlap they are out of alignment and need re-aligning.
If the forceps have serrated jaws they should be checked to see that
they mesh fully. There should be no play in the box joint of the
instrument. The ratchet should be closed and the instrument held by
the box and tapped lightly on the other hand. If the ratchet springs
open it is faulty and in need of repair. (this would not be ideal if the
haemostat were on a vessel and sprung off when knocked by a hand
or other instrument!)
• Scissors: The standard test for all operating scissors should be
applied. All Mayo and Metzenbaum type scissors should cut four
layers of gauze at the tip of the blade. Smaller scissors of less than
10cm in length should cut two layers in the same way. Scissors should
close smoothly with no ‘grinding’ around the pivot pin.There should
also be no dull spots, chips or dents in the cutting edges.

54. • Blades: These should be checked for burs and they should be
in good approximation/allingment all the way down the
length. There should not be excessive fretting around the pivot
pin which would lead to possible corrosion and breakage.
• Needle Holders: A needle should be clamped in the jaw and
the instrument closed to the second ratchet. If the needle can
be moved or turned easily then the instrument needs
repairing.
• Plated instruments like gallipot must be checked for chips, as
this would harbor debris, and also for sharp edges and worn
spots. Sharp edges will damage tissue, surgeon’s gloves and
worn spots may be susceptible to rusting and corrosion during
sterilization

55. How often should instruments be
tested for sharpness and
functionality
• Every time they are processed.

56. Advantages of instrument inspection
1. Helps identify instruments in need of further thorough
cleaning and decontamination prior to sterilization.
2. It ensures proper functioning of instruments before
use.
3. To identify instruments in need of maintenance and
repair.
4. It ensures efficiency in service delivery in operation
theatre.
5. It helps in early maintenance of the instruments to
avoid irreparable damage.

57. Tool box to Assemble and
disassemble theatre instruments in
maintenance
Question: what will you need to disassemble or assemble
theatre instruments during maintainance or allow proper
cleaning
• Pliers
•Appropriate spanners
•Appropriate screw driver
•Appropriate Allan key
•Pincers

58. Allan key
pincers
Screw driver
pliers

60. Actions a theatre technician should take on
non-functional instruments in the theatre
1. Separate the functional instruments from non-functional
2. Notify the theatre in charge on the non-functioning
instruments
3. Report to maintenance office about the faulty instruments
4. Take the instruments to maintenance department
5. Record in the inventory book
6. Follow up with the maintenance department for collection of
the instrument after it has been mended.

61. 9.Lubrication
• Even the most careful cleaning can
sometimes still leave an
instrument stiff or hard to work.
• Once a month. It is
recommended to lubricate the
movable parts of your instruments
• Even if all blood and debris have
been removed, mineral deposits
and other impurities from the
water system can collect on the
instrument and may cause
staining, rusting and corrosion.
• To guard against the hazards
endured during sterilization and
storage, a reputable instrument
lubricant must be applied to all
working surfaces and moving parts
of all instruments
• Lubrication helps prevent the
friction of metal on metal which
would lead to retting corrosion
• Uses WD 40
• Wipe off the excess protective oil
• Do not use industrial oil.

62. Functions of WD40(lubricant)
1. Stops squeaks(sound showing friction)-stiffness
2. Drives out moisture
3. Cleans and protects
4. Loosens rust
5. Frees sticky mechanisms

63. 10. Sort and group instrument
1. Group according to their type/likeness that is (cutting and
dissecting, holding and grasping, retracting and exposing,
clamping an occluding)
2. Do initial Count and document number of instruments
3. Document outcome of the inspection, any malfunction
instrument identified and action taken

64. 11.Packing /wrapping
• Devices should be packed prior to sterilization.
• Packaging materials is used to hold and protect the devices in
order to facilitate sterilization and maintain sterility.
• Appropriate size of wrapping material should be selected.
• Trays used for packaging should be perforated to allow penetration
of the sterilant
• Compatibility of the packing material with sterilization process
should be established
• Chemical indicators should be used
• Two barrier wrapping method is recommended as its provides a
tortus pathway to impede microbial migration

65. Guidelines When packing/assembling your
instrument tray
1. Use absorbent material(gauze or paper) as the base for the setting of
instruments .it will absorb extra moisture after sterilization as the
instrument cool
2. Disassemble all defaceable parts
3. Separate dissimilar metals
4. All instruments with hinges should be disassembled(unlocked) when
packing to allow steam or sterilizing agent to penetrate easily.
5. Arrange them according to classification/grouping
6. Ringed instruments should be put on a stringer to facilitate safe
removal during surgery
7. Always start with the heavy instruments followed by light
instruments.

66. 9. All instruments with sharp edges should be arranged facing
downwards and in the same direction away from the heavy
instruments
10.Cupped instruments like the kidney dish and galipot should be
positioned facing down to avoid accumulation of moisture
11.Place instruments with a lumen in a near horizontal position
12.Distribute weight as evenly as possible in the tray
13.Wrap the tray and place a chemical indicator or tape on the
outside wrapper for evidence that the tray is ready for
sterilization

67. Resources needed for packaging
1. Tray
2. Tray liners
3. Instruments
4. Stringer
5. Packaging material
6. Masking tape -to fasten the wrapper
7. Sterilization chemical indicator tape
8. Marking pen
9. Label

68. Type of surgical of trays
Porous tray Non-porous tray

69. Types of packaging materials-things used
to package
1. Sterilization wraps-made of cellulose and non-wovens
synthetic fibers.
2. Reusable fabrics-cotton material that can be washed
3. heavy duty paper: wrapping paper, kraft paper or news paper
4. fenestrated drums or boxes
5. Surgical cassettes
6. Rigid reusable containers-used for heat sterilization of large
sets
7. Sterilization pouches
8. mixed (1 layer of paper, 1 layer of linen)

70. containers
Drums
Sterilization wraps
Reusable fabrics
Surgical cassettes

71. Heavy duty paper Sterilization pouches

72. REQUIREMENTS/CHARACTERISTICS OF
WRAPPING MATERIAL
1. Allows the sterilant to penetrate the wrapper and reach all
parts of the device
2. Allows complete dissipation of the sterilant when the process
is finished
3. Contains no toxic ingredients or nonfast dyes
4. Does not create lint
5. Resists destruction by the sterilizing process (e.g., melting,
delamination, blistering, and alteration of the chemical
structure of an item)
6. Permits complete enclosure of the package contents
7. Produces a package strong enough to withstand storage and
handling

73. 8. Contain no toxic ingredients or dyes
9. resistant to tears and punctures
10. Allows drying of package and contents
11. Is convenient to work with (i.e., pliable and easy to
handle)
12. Facilitates a method of opening and distributing the
device at the point of us that prevents contamination
13. Is cost-effective
14. Matches the method of sterilization to be used
15. Able to withstand high temperatures

74. • It always important to record the number of instruments per
pack-DO the FIRST COUNT, the initial count
• If a stringer is available ,use it

75. Depending on the quality of the wrapper so as to maintain the
sterility of the instruments sterilized:
Heavy duty material-single wrapping is required
Medium duty-double wrapping
Low duty-four wrappers should be used
When wrapping the material always create outwards margins
to allow the user to easily unwrap the pack in preparation for a
procedure and to prevent contamination of a sterile pack when
opening the pack.

76. Types of wrapping method
• Square method
• Envelope wrapping method
• Gift wrapping method

77. ENVELOPE

78. GIFT STYLE

79. SQUARE METHOD

80. Sealing. Indicators and labelling
• Sterilization indicator sealing tape are commonly used to fasten
wrapping and also have a chemical indicator. The chemical
indicator is white visible diagonal stripes that darken or change
color during the sterilization process.
Labelling-you should label:
• Name of product/type of pack
• Name of person who has wrapped(initials)
• sterilization date
• Expiry date
• Load number
• Where appropriate the word sterile

81. 12.STERILIZATION
• This is the process that eliminates all
microorganisms such as bacteria,
viruses, fungi and parasites,
including bacterial endospores.
• It is recommended for critical
instruments and other items that
come into contact with the
bloodstream or tissues under the
skin.
• Can be performed using the
following methods
Physical methods
a. steam under pressure (autoclaving
or moist heat)
b. dry heat
c. Ionizing radiation
d. Sunlight
e. Steaming
f. boiling
g. flaming
Chemical methods
a. use of liquid chemicals
b. Use of gaseous chemicals

82. Factors to consider before choosing
a method of sterilization
a. Effectiveness- in destroying micro-organisms
b. Cost effectiveness
c. Manufacturer recommendations
d. Type of sterilant –steam for heat stable instruments or
chemical for heat sensitive
e. Category of the device-critical, semi critical ,non critical
f. Material of the device
g. Reliability of the sterilant
h. Expertise of the staff
i. Safety of the methods

83. 1. Ionizing radiation
• Sterilization by ionizing radiation, primarily by cobalt 60 gamma
rays or electron accelerators, is a low-temperature sterilization
method that has been used for a number of medical products (e.g.,
tissue for transplantation, pharmaceuticals, medical devices
• Gamma irradiation kills bacteria by breaking down bacterial DNA,
inhibiting bacterial division. Energy of gamma rays passes through
the equipment, disrupting the pathogens that cause
contamination.
• E beam and ultraviolet rays(uv) have also been used

85. Advantages
1. High penetration capability.
2. Very effective
3. Low temperatures.
4. Easy to control
5. No residue
Disadvantages
Can induce structural changes.
Carcinogenic/hazard to the healthcare worker
Expensive
Requires skilled personnel

86. 2. Boiling.
• Boiling is a simple method of HLD performed in any location that has access to
clean water and a heat source.
• Using this method, instruments and other items are placed in a pot or boiler
and the water is heated to boiling for 20 minutes.
• Boiling for 20 min (adding 5 minutes for 1000 altitude) provides high level
disinfection, but not sterilization because it does not destroy bacterial spores
(eg.: tetanus, gangrene).
• Used when autoclaving or hot air sterilization are not possible. It is particularly
useful for needles and syringes (it destroys HIV and hepatitis B virus).
• After needles and syringes have been boiled, they should be kept dry and not
left in the water (which can easily become recontaminated).

87. 3. Steaming
• Items are steamed in a steamer containing one to three
tiers. Steaming is the best method of HLD for gloves, and is a
useful method of HLD for the cannula used during manual
vacuum aspiration (MVA).

88. 4.Flaming
•In a flame its Effective if instruments are made red hot.
•This method should only be used in exceptional
circumstances as it damages metal.

89. 5. sunlight
• Sunlight is an active germicidal due to its ultraviolet
rays.
• Natural method used in the old days

90. 6. Steam Sterilization (Autoclaving)
• It is a method of sterilization that requires moist heat under
pressure. Steam is produced by water and heat.
• The heat maintains the required temperature under pressure.
• Heat can be provided by electricity, gas stove or kerosene
burner.
• Moist heat under pressure allows efficient destruction of micro-
organism
The three parameters /factors for steam sterilization:
a. Steam under Pressure
b. Temperature
c. Time

91. Equipment's that can be
sterilized using autoclave
• Metal Instruments
• Glass
• gauzes
• Safe Rubber
• Safe Plastic
• Gauze swabs
• Drapes
• Needles

92. Example of heat sensitive instruments
• Plastic
• Rubber
• Endoscopes
• Diathermy pencils
• MVA kit
• Surgical staplers
• Surgical masks
• Surgical light handle
• Flammable or explosive material
• Acids

93. TYPES OF AUTOCLAVES

94. 1.Different types of autoclaves categorized
by function
All autoclaves use high-temperature and
high-pressure steam to sterilize medical
equipment and waste. Their function
indicates how they should be loaded, and
how they force in the steam in their
chamber to sterilize the instruments inside.
Vertical autoclaves
• These types of autoclaves are loaded by
opening their top lid. Especially suited for
laboratory use or in smaller clinics with
cramped spaces. As such, they also have a
smaller capacity chamber.
Horizontal autoclaves
• Front-loading steam sterilizers with a
larger capacity chamber. When available
space is not an issue, and you need to
treat many loads a day, this one is
exceptional for reducing the strain on
medical staff.
Gravity displacement autoclaves
• One of the most common type of
autoclave that relies on using dense steam
to force out the air from the machine’s
chamber. They are suitable for the
treatment of basic loads like surgical tools
but are not as versatile as prevacuum
autoclaves.
Pre-vacuum (prevac) autoclaves
• This type of autoclave uses a vacuum
pump to remove all the air from the
autoclave’s chamber, allowing for better
steam penetration, and the sterilization
of more materials and complex loads
such as medical textile products, porous
loads, larger pieces of equipment, and
even objects made from high-density
polyethylene like the syringes of sharps
and pipette tips.

95. 2. Different types of autoclaves categorized by size (capacity)
Large steam sterilizers
• The capacity of these types of autoclaves usually ranges between 110 to
880 liters. Ideal for large medical facilities like hospitals that generate a
notable amount of waste each day and needs to use a lot of medical tools
and equipment to treat patients.
Medium-sized steam sterilizers
• The capacity of these types of autoclaves usually ranges between 75 to
200 liters. An excellent choice for dental and other clinics,
biotechnological applications, or for operating theaters in hospitals.
Small (benchtop) steam sterilizers
• The capacity of these types of autoclaves usually moves around 25 liters.
These compact steam sterilizers are perfectly suited for smaller facilities
with limited available space, and who do not need to sterilize as many
medical tools each day.

96. 3. Different types of autoclaves categorized by class
Class N autoclaves
• These are essentially simple, gravity displacement autoclaves that only
remove a certain portion of the air inside the machine’s chamber. Designed
for the treatment of simpler loads like flat medical tools.
Class S autoclaves
• Another type of gravity displacement autoclave that uses a wall of dense
steam, but by repeating the process 3 times, it can actually extract all the air
from the chamber, and as such, it can already treat bagged instruments and
porous loads. Still less versatile and not as fast a class B autoclave though.
Class B autoclaves
• Premium pre-vacuum autoclaves that can sterilize the most materials and are
also much faster at doing so by removing all the air from their chamber with
a powerful vacuum pump. Some models make the best out of modern
technology and operate with a completely automated process: this ease-of-
use and effectiveness make them very attractive for all kinds of medical
facilities.

97. 4. According to heat source
• Stove top/pressure cooker type
• Electrical
5. According to mobility
• Portable
• Non portable

98. 6. According to sterilizing agent
• Heat autoclaves-uses dry and steam heat.in steam heat water
vapor is used
• Gas autoclaves-formaladehyde and ethylene oxide are the
sterilizing agent
• Ultraviolet autoclaves-uses IV light to kill micro-organisms
7. According to mode of operation
• Manual
• Automatic

99. Non porus loads Porous loads
Also called hard goods load Also called wrapped goods
load
No pre-post vacuum required Pre and post vaccum required
Sterilized by gravity
displacement method or
sterilizers
Pre and post vaccum required
Media cycles in microbiology
lab plus microbiology
glasswares and unwrapped
load
Sterilize
garments,instruments,tubings
etc

101. Prevaccum

102. PARTS OF AN AUTOCLAVE

103. • The inner chamber/mesh basket is the case where the materials
to be sterilized are put.
• Vacuum generator -pulls out the air from the inside of the
chamber to create a vacuum inside the chamber.
• A pressure gauge is present on the lid of the autoclave to indicate
the pressure created in the autoclave during sterilization.
• Lid/ Door-purpose of the lid is to seal off the outside atmosphere
and create a sterilized condition inside of the autoclave. made
airtight via the screw clamps and washer/gasket for tight seal.
• Safety valve is present on the lid of the autoclave, which is crucial
in cases where the autoclave fails to perform its action or the
pressure inside increases uncontrollably.

104. •Drain tap
•Pressure releasing unit/ Whistle-controls the pressure
inside the chamber by releasing a certain amount of
vapor by lifting itself.
•Steam releasing valve-use to release steam at the end of
sterilization

105. Gasket /washer

106. Uses of an autoclave
1. They are used to decontaminate specific biological
waste before disposal a process called waste
treatment
2. Sterilize theatre instruments.
3. In medical laboratory, autoclaves are used to
sterilize medical equipment like pipetes and
glassware.
4. Used for the sterilization of culture media in
laboratory

107. Sterilization cycle
1. Loading phase-instruments are arranged in the autoclaving
chamber
2. Conditioning phase-air is removed from the chamber
3. Heating/coming up phase-steam enters sterilizer jacket and
air is removed from vaccum chamber by gravity displacement
or mechanically(pre vaccum)
4. Sterilization/exposure/destroying phase-load exposed to
steam at a set temperature for a set time
5. Exhaust phase-steam exhausted out of autoclave chamber
6. Cool down/drying phase-sterilization chamber is exhausted
to atmospheric pressure followed by circulating air in the
chamber.

108. Steps of steam sterilization:
1. Assemble the packs to be sterilized
2. Assemble the autoclave and its components: plug, lid,
gasket,mesh basket,tripod stand
3. Before beginning to use the autoclave, it should be
checked for any items left from the previous cycle.
4. Check for cleanliness and Clean autoclave.
5. Check water level of the autoclave and refill if
insufficient.it should be soft distilled water to avoid
formation on scum on your autoclave.
6. Connect the cord and inspect for damages.

109. 7. Put the mesh basket in.
8. Arrange all packs, drums or unwrapped items in the chamber
of the autoclave in a way that allows steam to circulate freely.
The sliding "windows" on drums or containers must be open.
Do not overload the autoclave. Packed items should be placed
vertically in the autoclave basket (not lying flat).
13.Close the lid by tightening the bolts in diametrically opposite
pairs (as the wheel nuts of a vehicle).
14.With the pressure valve open, begin to heat. Switch on the
socket and switch on autoclave
15.When a continuous jet of vapor is coming out of this valve,
close it.

110. 13.Allow the pressure to rise to 0.5 atm pressure, then
open the purge tap/valve for 10 seconds to purge air,
then close it.
14.Repeat this purge at about 0.7 atm, then again at
about 0.9 atm.After this, all air should have been
expelled from the autoclave and only steam will
remain.
15.When desired operating pressure of 15psi or 775
mm of Hg. (and thus temperature 121 degrees
celcius) is obtained, sterilization begins. Start to time
it then, not before

111. 16. After the required duration of sterilization(30 minutes if items are
wrapped, or after 20 minutes if items are unwrapped), shut off the heat
source.
17. Evacuate water and steam: For large autoclaves: through drain tap and also
the steam release valve
18. Once pressure drops to zero, open the lid, lift out the basket, pour out the
water then replace the basket.
19. Leave instrument packs or items in the autoclave until they dry completely.
Allow to cool with the lid slightly open. Residual heat helps dry the
sterilized items (the danger of contamination by ambient air is minimal).
20. Once items are dry, remove them and close the sliding windows on drums.
21. Wait until the packs, drums or items reach room temperature before
storing.

112. DATE AUTOCLAVE
NUMBER
LOAD
NUMBER
START CYCLE START
STERILIZATIO
N TIME
END OF
STERILIZATIO
N TIME
END OF
CYCLE
SIGNATURE
LOG BOOK TO RECORD EACH CYCLE

113. GUIDELINES WHEN USING AUTOCLAVES AND
PACKING INSTRUMENTS IN THE AUTOCLAVE
• Keep instruments disassembled, opened and unlocked.
• Don’t wrap the packages too tightly.
• Don’t arrange the instruments too close to one another.
• When using drums make sure the windows are opened during sterilization
• Ensure that the small drain strainer of the sterilizer is not clogged as this will
trap air inside
• Ensure at least 7-8 centimeters(3inches) of space between the packages and
autoclave chamber walls.
• Observe sterilization contact time, temperature and pressure as specified by
manufacturer
• Allow items to dry before been removed. Once removed from the autoclave,
damp packs draw microorganisms from the environment and should be
considered contaminated

114. • Do not over pack the autoclave and do not cover the chamber drain and
pressure valve .
• Ensure there is plenty of space for steam to travel around the load and
into the drain.
• Make sure the vacuum system is functioning and pulling a deep vacuum
at the end of the cycle.
• Wait until the packs, drums or items reach room temperature before
storing
• Fenestrated containers should be equipped with a filter (accross the
windows within the container or around the load to be sterilized so as to
filter air during the drying phase after auto-craving. The paper should be
checked and renewed regularly.
• Swabs and drapes should not be compressed inside boxes or drums.
• Open the door slowly, just a crack at first. Keep head and body well
behind the door, using it as a shield against any escaping steam

115. Safety measures
• Wear appropriate PPEs
• Check for proper electrical connections
• Ensure the doors are tightly sealed-do a lock check
• Load as per manufactures instructions
• Autoclaves should not be used to sterilize water-proof or water-
resistant substances like oil or powders.
• The autoclave should not be overcrowded, and the materials
should be loaded in a way that ensures sufficient penetration of
articles by the steam.
• Only autoclavable bags are to be used to autoclave

116. • Do not open the door until all the steam has been exhausted
• To ensure sufficient penetration use material that allows
penetration by steam, and materials like aluminum foils
should not be used.
• The items placed inside the chamber should not touch the
sides or top of the chamber.
• The wastes and clean items should be autoclaved separately.
• Attempts to open the lid when the autoclave is working
should never be made.
• Avoid touching items when Hot
• Items removed from the sterilizer should be visibly dry
• Use sterile gloves to remove items from the autoclave.

117. •Liquid components should never be autoclaved in
sealed containers.
•The liquid inside the containers should only be filled
2/3rd of the total volume to prevent the spilling of the
liquid.
•Plastic or polyethylene trays or containers should not be
used as they might melt and damage the autoclave.
•Besides, never autoclave flammable, reactive, corrosive,
toxic, or radioactive materials, household bleach, or
paraffin-embedded tissue.

118. Sliding
windows
DRESSING DRUMS-STAINLESS STEEL

119. To prevent a wet pack
• Make sure the vacuum system is functioning and pulling a deep vacuum at
the end of the cycle.
• Periodic maintenance of autoclaves
• Do not over pack the autoclave and do not cover the chamber drain.
• Ensure there is plenty of space for steam to travel around the load and
into the drain.
• Ensure good quality of wrapping material
• Check and clean the chamber drain strainer
• Check all steam traps
• Verify that the correct cycle is selected with the proper amount of dry
time.
• Properly maintain temperature and humidity of sterile storage area

120. factors to consider when arranging
packs in sterilizing chambers
1. Nature of pack-example fenestrated drums with
holes ensure holes are covered by other packs
2. Size of the pack
3. Quantity of the packs-how many packs in total do
you have
4. Type of instruments in the pack-are they fragile or
delicate

121. Advantages of autoclaving
a. Simple
b. Fast
c. Effective
d. High penetration ability
e. Can destroy spores
f. No toxic residues

122. Disadvantages
a. Due to High temperatures cannot be used on bio gradable plastics
and rubber
b. Costly in terms of purchase, maintenance and servicing
c. Requires skilled personnel-Loading and operating the sterilizer
requires technical know how
d. Can cause burns
e. Steam must have direct contact with all areas for an item to be
sterilized
f. Different materials require time adjustments which are subject to
human error
g. Steam may not be pure- this may cause presence of stains in
apparatus

123. Dangers of autoclaves
• Physical injuries-heavy lifting
• Burns
• Electrocution
• Explosion

124. STERILIZATION INDICATORS
There are three types of indicators for proper
sterilization:
1. Mechanical indicators
2. Chemical indicators
3. Biological indicators

125. 1. Mechanical Indicators:
• Mechanical sterilization indicators include cycle time,
temperature and pressure.
• Temperatures of 121 degree celcius, pressures of 15psi ad
cycle time of 30 minutes
• These parameters can be assessed by examining your
sterilizer’s cycle printout or gauges.

126. 2. Chemical Indicators:
• Chemical indicators are an inexpensive and easy way to
monitor your sterilizer
• Chemical indicators are attached to the outside of each pack
to show that the package has been processed through a
sterilization cycle.
• Provide visual confirmation of exposure to sterilization
process
• Should be used in conjunction with biological indicators.
• They indicate that your machine has reached two or more
sterilization parameters (e.g. time, temperature, pressure)

127. Grouped into six classes based on their ability to monitor one or multiple
sterilization parameters.
Type 1: Process indicators-example is autoclave tape or chemical indicator
strips.
Type 2: Specific-Use-example Bowie-Dick test .Test air removal
Type 3: Single-Variable-example is chemical pellet. Melts at a specified
temperature to show steam sterilization process has been achieved
Type 4: Multi-Variable-example is Chemical indicator tubes. Change color only
when exposed to a given temperature for a specified time in a steam
sterilization.
Type 5: Integrating (Integrators)-example is sterilization strips. Respond to all
critical process parameters
Type 6: Emulating (Cycle Verification)-example cycle-specific indicators.
Typically placed in the pack, pouch or container. Respond to all critical process
parameters

128. Bowie dick test
The Bowie Dick Test will detect air leaks, inadequate air removal hence
inadequate steam penetration

129. Integrators
Emulators
Indicator tape

130. Chemical indicator tubes
Chemical indicator strips

131. 3. Biological indicators
• Biological indicators are recognized by the CDC(center for disease
control) and many other organizations to be the ideal monitor of the
sterilization process because they use the most resistant form of
microorganisms.
• Bacillus spores(eischeria coli, klebsilla,salmonella,anthrax) are typically
used in biological indicators because they are present in higher numbers
than are the common microbial contaminants found on patient care
equipment, which demonstrates that other potential pathogens in the
load have been killed.

132. 7.Dry Heat Sterilization or Hot-Air
Oven (Electric Oven)
• This is the method of
sterilization that requires heat
for a specific period of time. This
method is used for sterilizing
glass or metal objects because
high temperatures are
necessary. Also used to sterilize
instruments with cutting edges
• that time period ensures that
even the most resistant spores
get killed off via oxidation of
their cellular components.
• Need to ensure that the
designated temperature is
reached
170ºC – 1 hour
 160ºC – 2 hours
150ºC – 2½ hours
140ºC – 3 hours

134. 8. CHEMICAL STERILIZATION/COLD
STERILIZATION
• Chemical sterilization is typically used for devices that would be
sensitive to the high heat used in steam sterilization, and for
devices that may be damaged by irradiation (rubbers and
plastics can become more brittle after irradiation.)
• Can also be used when heat sterilization is unavailable.

135. • Example of heat sensitive instruments; endoscopes, diathermy
pencils,MVA kit, surgical staplers
• Safe plastics can be autoclaved however some cannot. If the
plastic is weaker, it can be damages in the process hence chemical
sterilization is used.
• Instruments and other items can be sterilized by soaking them in
a chemical solutions such as glutaraldehyde (cidex) ,peracetic
acid, hydrogen peroxide,alcohol,chlorine, formalin, followed by
rinsing in sterile water.

136. Forms of chemicals
1. Gas chemicals -Gas sterilization involves exposing
equipment to chemical gases in an enclosed heated
or pressurized chamber.
2. Liquid chemicals-Liquid sterilization involves
submerging equipment in a chemical fluid for
enough time to kill all viable microorganisms and
their spores.

138. Examples of Liquid chemicals
used for disinfection
• Ortho-phthalaldehyde (OPA) solutions.
• Peracetic acid–hydrogen peroxide solutions. ...
• Calcium and Sodium hypochlorite solutions.
• 2% glutaraldehyde (cidex)
• peracetic acid
• Ethanol
• hydrogen peroxide
• Alcohol
• Chlorine
• 4% Formalin
• Quaternary Ammonium Compounds (Quats)

140. LEVELS OF DISINFECTANTS
1. High-level disinfectants -semi critical items except dental will come in
contact with mucous membrane or nonintact skin-kills a wider range
of pathogens than a low-level disinfectant but does not kill bacterial
spores.
2. Intermediate-level (some semi critical items1 and noncritical items).
Kills a wider range of pathogens than a low-level disinfectant but does
not kill bacterial spores
3. Low-level (noncritical items); will come in contact with intact skin)
disinfect noncritical items that come into contact with skin. This
includes shared patient-care devices that staff would use on multiple
patients through the course of any given work day, including hard
surfaces like bed rails and equipment like blood pressure cuffs.

141. HIGH LEVEL DISINFECTION
•HLD eliminates bacteria, viruses, fungi and parasites - but
does not reliably kill all bacterial endospores such as
tetanus and gas gangrene.
•Many facilities use a method of HLD as a backup to their
primary method of sterilization.
•There are three methods of HLD:
1. Boiling-boiling for 20 minutes
2. chemical High Level Disinfectants –for 20minutes
3. steaming.

142. Examples of high level disinfectants
•Glutaraldehyde.
•Ortho-Phthaldehyde.
•Peracetic acid.
•Chlorine
•Hydrogen peroxide.
•Hypochlorous acid.

143. How to make HLD effective:
•Follow instructions carefully.
•Make sure that the chemical disinfectant touches all
surfaces of the item being processed.
•When using heat, make sure to use the correct
temperature. For example, if boiling to achieve high level
disinfection, instruments should be put in a container with
a lid and covered by the water. Bring the water to the boil
and boil the items for 20 minutes.
•Be sure all items are thoroughly cleaned and dried before
emersion

144. 2. Intermediate level disinfection
•Intermediate level disinfection is carried out using
chemical agents (e.g. sodium hypochlorite)that
eliminate vegetative bacteria and some bacterial
spores
3.Low level disinfectants
E.G Quaternary ammonium compounds,.Able to kill
fungi, amoebas, mold, many types of microbes and
most viruses

145. SAFETY PRECAUTIONS WHILE USING CHEMICAL
DISINFECTANTS
Use PPES when handling chemicals
Use freshly prepared disinfectants
Follow manufacturer’s directions for preparations
Ensure room is well ventilated
Minimize exposure time
Equipment should be well prepared for sterilization
Fully immerse the equipment into the solution
Leave the instruments in situ for the recommended time
The instruments should be removed by use of forceps and
cleaned in sterile water
Store chemical agents in containers which should always remain
covered

146. GASEOUS ETHYLENE OXIDE
• Ethylene oxide Should be used with precaution because it is
gaseous, toxic carcinogenic and explosive.
• Its colorless
• Its sterilization cycle consists of Five stages :
1. preconditioning and humidification-To safely deliver the
100% ethylene oxide process,97 percent of the air must be
removed from the chamber.
2. gas introduction
3. Exposure
4. Evacuation
5. Air washes-a system that removes unpleasant smells
Sterilization with Ethylene oxide takes approximately 2 1/2 hrs.
excluding aeration time.

147. Factors to consider when choosing the
chemical for sterilization
1. Strength /effectiveness
2. Type/Material of the instrument-Some sterilants can be
chemically damaging to certain materials
3. Safety -The potential harm to humans exposed to the
sterilization chemicals or residuals from the sterilization
process.
4. Ease of use
5. The cost
6. Availability

148. Mechanism of action of the
chemicals
1. Protein coagulation in the micro-organism
2. Disruption of cell membrane resulting in exposure,
damage/loss of contents
3. Removal of sulfhydryl group essential for normal
functioning Of enzyme
4. Substrate competition.

149. Factors Affecting the Efficacy of
Disinfectant
1. Number and Location of Microorganisms.
2. Innate Resistance of Microorganisms.
3. Concentration of Disinfectants.
4. Potency of Disinfectants-ability or capacity
5. Duration of Exposure.
6. temperature-the higher the temperature, the
shorter the processing exposure time

150. Advantages chemical sterilization like
hydrogen peroxide
• Simple to use
• Does not require aeration
• Work with Low temperatures
• Safe for sterilization of heat
sensitive apparatus
• Low cost
• No activation required
• No complex equipment.
• It does not cause corrosion
moisture sensitive instruments
• Fast
• No odor or irritation issues
• Does not coagulate blood or fix
tissues to surfaces

151. Disadvantages
• Not very effective
• Flammable
• Toxic residue
• Explosive
• Irritant
• Serious eye damage with contact

152. Advantages of cidex
1. Not expensive
1. Effective: achieves high-level disinfection
2. Long-lasting efficacy: reusable for up to 14 days when
monitored with CIDEX® OPA Solution Test Strips.
3. Safe for reprocessing heat sensitive semi-critical
medical device
4. Does not cause corrosion

153. Disadvantages
1. Slow-Process requires 30
minutes rather than 10 minutes
to complete, so emergency
sterilization is not possible
2. Irritating odor
3. Not suitable for linen or gauze
swabs
4. Activation required
5. Coagulates blood and fixes
tissue to surfaces
6. Glutaraldehyde vapor
monitoring recommended
7. Workers may be harmed from
exposure to glutaraldehyde
a. Throat and lung irritation
b. Asthma and difficulty breathing
c. Skin Dermatitis
d. Nasal irritation
e. Sneezing
f. Wheezing
g. Burning eyes
h. Conjunctivitis