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IPC: STERILIZATION AND
DISINFECTION:
DR.HAMISI MKINDI,MD.
TO DOWNLOAD CONTACT:
hermyc@live.com
• The foundation of microbiology is strict
procedures of infection prevention
»Cleaning
»Decontamination
»hygiene,
»asepsis
• The objective Infection Prevention & Control is
to reduce the bio-burden to an acceptable
level-in order to reduce the spread of
infections to service users/carers.
Presentation Objectives
• This presentation will explore the methods
and models of infection prevention and
control, current trends and evidence on
infection control- in hospitals and
communities.
• Further, examine the models and their impact
on infection control and prevention.
Definitions of Terms
• Bio-burden is the microbiological load- number and type of
organism sanitization or decontamination
• Decontamination is the process of destroying , inactivating or
removing pathogens
• Sanitization is the ability to reduce the number of microbial
contaminants to a safe level-often linked to chemical interventions
• Disinfection: killing of most microbial forms.
• Disinfectant: a chemical substance used to kill microbes on surfaces
but too toxic to be applied directly to tissue.
• Antisepsis: inhibit or eliminate microbes on skin or other living tissue
• Sterilization: removal of life of every kind by physical or chemical
methods.
• Sterilant: an agent or method used to remove or kill all microbes.
• Septic: presence of pathogenic microbes in living tissue.
• Aseptic: absence of pathogenic microbes.
• Sterile: free of life of every kind.
• Bactericidal: killing bacteria.
Background: Global initiative on IPC
• The revolutionary second meeting of the Infection Prevention
and Control Informal Network took place on 26–27 June 2008,
at the headquarters of the World Health Organization (WHO)
in Geneva, Switzerland.
The objectives of the meeting were:
‘to identify infection prevention and control (IPC) core components for
national programs and for the programs of local health-care facilities, in order
to contribute to the strengthening of capacity for the prevention of health
care-associated infections (HAI) and to prepare an efficient response to
emergencies involving communicable diseases, such as epidemics’.
(WHO2008, p.iii)
World Health Organization. (2008). Core components for infection prevention and control programs Infection Prevention and
Control in Health Care Informal Network Report of the Second Meeting, 26–27 June 2008, Geneva, Switzerland
Infection Prevention and Control
Informal Network, 2008
• Components of IPC highlighted include:
– Organizational structures,
– Technical guidelines,
– Human resources,
– surveillance of infections and compliance,
– Microbiology laboratory,
– Minimum Environment requirements;
– Monitoring and evaluation of IPC programs
Goal and Objective of IPC
• The goal of IPC in health care is to promote high quality
health care with a low risk of HAI for patients, health-
care workers and all people associated with the health-
care setting and its environment, and to accomplish
these goals in a cost-effective manner
These infections may be:
• Endemic, associated or not with the use of devices or
procedures during health care;
• Epidemic, originating within the population of the health-
care facility;
• A consequence of the transmission of community-acquired
infections to patients in the health-care facilities that provide
care, generating the amplification of epidemics of
community-acquired infections (WHA, 2009).
WHA.48.13 & WHA51.17: Prevention and control of communicable diseases;
patient safety on science based systems and quality of care[Online], Retrieved
14 October, 2012, from
Fundamentals of IPC
• INFECTIOUS DISEASE TRANSMISSION CYCLE
AGENT
RESERVOIR
PLACE OF ENTRY PLACE OF EXIT
METHOD OF
TRANSMISSION
SUSCEPTIBLE
HOST
Adapted from Tanzania National Policy on Infection Prevention and Control, 2004;
Fundamentals of IPC: Nosocomial Infections
• Nosocomial infection — also called “hospital acquired
infection” can be defined as:
An infection acquired in hospital by a patient who was admitted for a
reason other than that infection (1).
An infection occurring in a patient in a hospital or other health care
facility in whom the infection was not present or incubating at the time of
admission. This includes infections acquired in the hospital but appearing
after discharge, and also occupational infections among staff of the
facility(2)
1. Ducel G et al. Guide pratique pour la lutte contre l’infection hospitalière. WHO/BAC/79.1.[online]
Accessed on 14.10.2012, retrieved from
http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf
2. Benenson A. S (1995). Control of communicable diseases manual, 16th edition. Washington,
Fundamentals of IPC: Nosocomial Infections
• The most important transmission routes within
the healthcare facilities are contact droplet and
airborne. Common vehicle and vector borne are
additional routes of transmission.
• Grumman and Hellriegel, (2006) in a systematic
literature review of nosocomial infection give
illustrations on mathematical modeling tool for
hospital infection control for adoption and use
in different contexts to reduce the burden of
nosocomial infections.
Grundmann H. & Hellriegel B. (2006). Mathematical modelling: a tool
for hospital infection control . Lancet Infectious Diseases [Online]
2006; 6: 39–45. Accessed on 14.10.2012, Retrieved from:
http://thelancet.com
Fundamentals of IPC: Universal Standard
Precautions
• Precautions developed to protect health care
workers from infections and other blood born
infection.
• Universal precautions were later amended to
represent specific infections, and other
approaches such as the Body Substance
Isolation (BSI) were introduced to offer similar
levels of protection to health care workers.
• Several components standard precautions will
be discussed here under:
Components of IPC: Universal Standard Precautions
• Hand hygiene
• Hand washing,
• Hand antisepsis,
• Antiseptic hand scrubs
• Use of personal protective equipment
• Gloves, masks, goggles, caps, gowns, boots and Apron
• Patient care equipment
• Linen
• Environmental cleaning
• Handling of sharps
• Patient Placement
Hand washing
• Hand washing mechanically removes
contaminants of soil, debris and organisms from
the skin using soap and water:
• Four elements are essential:
• Soap
• Running water
• Friction
• Drying
• According to Curtis et al. (2011) Cited in the Lancet
commentary Vol 12 February 2012; in resource thin settings
simple hygiene measures have a remarkable effect on
decreasing infection transmission.
According to Curtis V, Schmidt W, Luby S, Florez R, Toure O, Biran A.
Hygiene: new hopes, new horizons. Lancet Infect Dis 2011; 11: 312–21.
STERILIZATION
Is the complete elimination or destruction of all
forms of microbial life
• While
DECONTAMINATION
Is a process that eliminates many or all
pathogenic microorganism on inanimate
objects with exception of bacterial spores
• Antisepsis- is used to describe disinfection
applied to living tissue such as
wounds.example hydrogen peroxide and
rubbing alcohol
• Cleaning- soil removing process.
• Sanitization- is the ability to reduce the
number of microbial contaminants to asafe
level often linked to chemical intervention
• Decontamination- treatment used to make
equipment safe to handle.eg.use of chlorine
for decontamination
METHOD OF STERILIZATION:
• HEAT- dry vs moist
• GAS-(ethylene oxide, ozone, vapour hydrogen
peroxide)-plastics + thermolabile materials
• CHEMICALS -(peracetic acid, glutaraldehyde)-
heatlabile fibreoptic instruments e.g. flexible
endoscope.
• IRRADIATION -(uv, microwave, gamma rays)-
single use diaposable items e.g. syringes, latex
catheter.
• FILTRATION-(HEPA filters) – protozoa cyst.
HEAT
• There of 2 types
- Dry –kills by oxidative destruction
-Moist- kills by coagulation and
denaturation
• Dry heat kills at lower/slow rate (e.g. for
spores-160 C for 2hrs) hence needs higher
temperature plus longer exposure time, while
moist heat in the form of steam is efficient,
inexpensive method of sterilization in short
duration(121 c for 15min-spores)
DRY HEAT
• Incinearation-efficient method for sterilization and
disposal of contaminated material e.g. surgical
dressings, sharp needles.
• Red heat – inoculating wires, loops and points of
forceps
• Flaming- currently not significant.
• Hot air sterilizer- empty lab glassware, oils, powder,
carbon steel microsurgical instruments i.e items likely
to be affected by contact with steam
• Microwave oven- currently not used - not reliable
because its heating effect is not uniform.
MOIST HEAT
- Requires temperatures above boiling point of
water hence a need to rise pressure of steam in a
pressure vessel (autoclave).
-Steam is non-toxic and non-corrosive but to be
effective it must be saturated (hold all the water
it can).
- Saturated steam is more efficient than dry heat,
partly because of the greater lethal action of
moist heat but also because it is quicker in
heating up the article to be sterilized.
Types of steam sterilizer
• Sterilizers for porous loads- for dressings, textiles,
wrapped utensils all liable to trap air within
fabrics hence a vacuum-assisted air removal is
needed.
• Sterilizers for fluids in sealed containers – safety
feature for temp control <80c before opening the
door.
• Sterilizers for unwrapped instruments – mainly in
dental clinics and general practice.
• Laboratory sterilizers – lab equipment, culture
media.
Monitoring of steam sterilizers
• Temperature, pressure and time.
• Biological indicators:
The desire end point of sterilization is elimination of
all microbial lives. But some B endospores are
resistant to heat agents, they are taken as biological
indicators, this is because heat resistant varies
among different micro organisms and depends on
type of heat e.g. spores of Bacillus
stearothermophilus are more resistant to moist heat
and were used to monitor sterilization process,
inactivation of 100,000 of these spores by
saturated steam at 121C requires 12min, at same
temp , 1million spores of B. subtilis are inactivated in
less than 1 min, meanwhile S. aureus spores
inactivated at 60c for 12min.
Bowie-Dick test -monitors penetration of steam in a
wrapped pack and will detect un even steam
penetration by a bubble of residual air in the pack.
Factors influencing sterilization by
heat:
• Temperature – higher the temp, lower the time
consumed.
• Microbial load – higher the initial burden of
microbes, more time will be needed to achieve
sterility.
• Species – different species have different heat
tolerability.
• Strain -(vegetative vs spores).
STERILIZATION BY CHEMICALS:
• Materials which cannot be sterilized by heat
or gas can be treated by liquid chemicals after
cleaning.
• Common chemicals used in sterilization are
2% glutaraldehyde, 6% hydrogen peroxide,
0.2% peracetic acid.
• Example of instrument are fibre optic
endoscopes.
STERILIZATION BY GASES:
• Heat sensitive instruments(plastic )are sterilized by
using gas.
• Ethylene oxide is commonly used, it very efficient but
need strict regulations because is explosive and toxic
to living tissue
• It is an alkyating agent
• Vapour formaldehyde is very efficient as mean of
sterilization, but it was found to be carcinogenic
STERILIZATION BY IRRADIATION:
• This is by using UV RAYS,GAMMA RAYS .
- Sterilization is achieved by the use of high speed
electrons from a machine such as a linear
accelerator.
• Good example are suturing materials before packing
and after packing are sterilized by gamma rays.
DISINFECTION:
• There are 3 categories of disinfectants based on
germicidal actions:
1. High level disinfectant.
2. Intermediate level disinfectant.
3. Low level disinfectant.
Cont.
• Instrument can also be classified according to
degree level of infection risk involved by
Spaulding Classification:
• 1.CRITICAL, means instruments come to contact
with blood or blood products.
• 2.SEMICRITICAL, means those come to contact
with mucous membranes.
• 3.NON CRITICAL, means those come to contact
with intact skin.
Example of critical items
Example of semicritical items
Example of noncritical items
High level disinfectants:
• These are used to instruments which has undergone
invasive procedure or those belong to critical
category.
• This procedure inactivate bacteria endospores.
• Chemicals used: are pera acetic acid, chlorine
dioxide, glutaraldehyde, hydrogen peroxide.
• This is less or more similar to sterilization.
Intermediate level disinfectants
• These are used to disinfect instrument in which
contamination with bacteria spores and other
resilient organisms are unlikely.
• E.g. mask, vaginal speculum and laryngoscope.
• Semicritical category instrument are disinfect by this
group
• Agent used are,(ALCOHOL, IODOPHOR and
PHENOLIC COMP)
• Have tuberculoicidal action but not sporocidal action
Low level disinfectants:
• Used to treat instruments which do not
penetrating mucosal surface
• E.g. stethescope and electrocardiogram
electrode
• Chemical used is quatenary ammomnium
comp
• Non critical type of instrument use this
disinfectant.
Method of disinfectant
Moist Heat- Water (70 – 80)C for few min(20min)
kills most non-spore forming bacteria.
Ultraviolet radiation -these are low energy, non-ionising
radiations with poor penetration but lethal to
microorganisms.
Gases- formaladehyde gas- was used to disinfect rooms
previously occupied by patients with chickenpox. It is
still used to disinfect anaesthetic machines and baby
incubators.
Chemicals – pre op prep of incisional sites
COMMONLY USED CHEMICAL
DISINFECTANTS.
ALCOHOLS- Bacteriocidal at conc (70-90)%, not
sporocidal,l imited activity against mycobacteria,
highly recommended as rapid drying disinfectants
for skin and surfaces because they are volatile.
Note:-volatile –avoid heat(diathermy).
- poor penetration in presence of organic
matter.
ALDEHYDES (glutaraldehyde or formaldehyde)-
broad spectrum action against vegetative
bacteria,f ungi and virus. Acts slow on spores.
Note:- an irritant to eyes, skin and respiratory
mucosa.
• HALOGENS
-Hypochlorites -broad spectrum, inexpensive
chlorine releasing disinfectants of choice against
viruses (hepatitis B).
-Inactivated by organic matter and corrode metals
so that contact with metallic instruments and
equipment should be avoided.
- React with formaldehyde to release carcinogenic
products.
• IODINE-inactivated by organic matter + causes
hepersensitivity and stains. However (iodophors-
iodine + anionic detergent) or Povidone iodine
(water soluble complex of iodine and polyvinyl
pyrrolidone), these are lessirritant and cause less
staining.
• PHENOLICS - eg dettol, widely used because they
are cheap and exhibit broad spectrum activity.
Not readily inactivated by organic matter
however are incompatible with cationic
detergents.
CHOICE OF METHOD:
The choice of method of sterilization or
disinfection depends on:
- The nature of item to be treated
- The likely microbial contamination
- The risk of transmitting infection to the
patient or staff in contact with the item, eg
high risk(in contact with a break in skin
entering a sterile body area- sterilization).
RESISTANCE TO STERILIZATION &
DISINFECTION:
Many factors affects the ability of microorganisms
to withstand the lethal effects sterilization and
disinfection, these include:
Species or strain of microorganism- in general
vegetative bacteria and viruses are more
susceptible than spores. However within different
species and strains there may be a wide variation
attributed to morphological and physiological
changes such as alterations in cell proteins or
specific targets in the cell envelope affecting
permeability.
.
• Physiological state- Conditions under which
micro organisms were grown before exposure to
the lethal process. In general, those grown in
nutrient limiting conditions are more resistant
than those in nutrient rich environment.
• Number of micro-organisms - The higher the bio-
burden the more extensive must the process to
achieve the same assurance of sterility.
• Ability to form spores –
• Suspending menstruum- i.e micro-environment
of the organism e.g. presence of organic material
vs. hypochlorite solutions.
.
THANKS FOR
LISTENING!

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IPC -STERILIZATION AND DISINFECTION..pptx

  • 1. IPC: STERILIZATION AND DISINFECTION: DR.HAMISI MKINDI,MD. TO DOWNLOAD CONTACT: hermyc@live.com
  • 2. • The foundation of microbiology is strict procedures of infection prevention »Cleaning »Decontamination »hygiene, »asepsis • The objective Infection Prevention & Control is to reduce the bio-burden to an acceptable level-in order to reduce the spread of infections to service users/carers.
  • 3. Presentation Objectives • This presentation will explore the methods and models of infection prevention and control, current trends and evidence on infection control- in hospitals and communities. • Further, examine the models and their impact on infection control and prevention.
  • 4. Definitions of Terms • Bio-burden is the microbiological load- number and type of organism sanitization or decontamination • Decontamination is the process of destroying , inactivating or removing pathogens • Sanitization is the ability to reduce the number of microbial contaminants to a safe level-often linked to chemical interventions • Disinfection: killing of most microbial forms. • Disinfectant: a chemical substance used to kill microbes on surfaces but too toxic to be applied directly to tissue. • Antisepsis: inhibit or eliminate microbes on skin or other living tissue • Sterilization: removal of life of every kind by physical or chemical methods. • Sterilant: an agent or method used to remove or kill all microbes. • Septic: presence of pathogenic microbes in living tissue. • Aseptic: absence of pathogenic microbes. • Sterile: free of life of every kind. • Bactericidal: killing bacteria.
  • 5. Background: Global initiative on IPC • The revolutionary second meeting of the Infection Prevention and Control Informal Network took place on 26–27 June 2008, at the headquarters of the World Health Organization (WHO) in Geneva, Switzerland. The objectives of the meeting were: ‘to identify infection prevention and control (IPC) core components for national programs and for the programs of local health-care facilities, in order to contribute to the strengthening of capacity for the prevention of health care-associated infections (HAI) and to prepare an efficient response to emergencies involving communicable diseases, such as epidemics’. (WHO2008, p.iii) World Health Organization. (2008). Core components for infection prevention and control programs Infection Prevention and Control in Health Care Informal Network Report of the Second Meeting, 26–27 June 2008, Geneva, Switzerland
  • 6. Infection Prevention and Control Informal Network, 2008 • Components of IPC highlighted include: – Organizational structures, – Technical guidelines, – Human resources, – surveillance of infections and compliance, – Microbiology laboratory, – Minimum Environment requirements; – Monitoring and evaluation of IPC programs
  • 7. Goal and Objective of IPC • The goal of IPC in health care is to promote high quality health care with a low risk of HAI for patients, health- care workers and all people associated with the health- care setting and its environment, and to accomplish these goals in a cost-effective manner These infections may be: • Endemic, associated or not with the use of devices or procedures during health care; • Epidemic, originating within the population of the health- care facility; • A consequence of the transmission of community-acquired infections to patients in the health-care facilities that provide care, generating the amplification of epidemics of community-acquired infections (WHA, 2009). WHA.48.13 & WHA51.17: Prevention and control of communicable diseases; patient safety on science based systems and quality of care[Online], Retrieved 14 October, 2012, from
  • 8. Fundamentals of IPC • INFECTIOUS DISEASE TRANSMISSION CYCLE AGENT RESERVOIR PLACE OF ENTRY PLACE OF EXIT METHOD OF TRANSMISSION SUSCEPTIBLE HOST Adapted from Tanzania National Policy on Infection Prevention and Control, 2004;
  • 9. Fundamentals of IPC: Nosocomial Infections • Nosocomial infection — also called “hospital acquired infection” can be defined as: An infection acquired in hospital by a patient who was admitted for a reason other than that infection (1). An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility(2) 1. Ducel G et al. Guide pratique pour la lutte contre l’infection hospitalière. WHO/BAC/79.1.[online] Accessed on 14.10.2012, retrieved from http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf 2. Benenson A. S (1995). Control of communicable diseases manual, 16th edition. Washington,
  • 10. Fundamentals of IPC: Nosocomial Infections • The most important transmission routes within the healthcare facilities are contact droplet and airborne. Common vehicle and vector borne are additional routes of transmission. • Grumman and Hellriegel, (2006) in a systematic literature review of nosocomial infection give illustrations on mathematical modeling tool for hospital infection control for adoption and use in different contexts to reduce the burden of nosocomial infections. Grundmann H. & Hellriegel B. (2006). Mathematical modelling: a tool for hospital infection control . Lancet Infectious Diseases [Online] 2006; 6: 39–45. Accessed on 14.10.2012, Retrieved from: http://thelancet.com
  • 11. Fundamentals of IPC: Universal Standard Precautions • Precautions developed to protect health care workers from infections and other blood born infection. • Universal precautions were later amended to represent specific infections, and other approaches such as the Body Substance Isolation (BSI) were introduced to offer similar levels of protection to health care workers. • Several components standard precautions will be discussed here under:
  • 12. Components of IPC: Universal Standard Precautions • Hand hygiene • Hand washing, • Hand antisepsis, • Antiseptic hand scrubs • Use of personal protective equipment • Gloves, masks, goggles, caps, gowns, boots and Apron • Patient care equipment • Linen • Environmental cleaning • Handling of sharps • Patient Placement
  • 13. Hand washing • Hand washing mechanically removes contaminants of soil, debris and organisms from the skin using soap and water: • Four elements are essential: • Soap • Running water • Friction • Drying • According to Curtis et al. (2011) Cited in the Lancet commentary Vol 12 February 2012; in resource thin settings simple hygiene measures have a remarkable effect on decreasing infection transmission. According to Curtis V, Schmidt W, Luby S, Florez R, Toure O, Biran A. Hygiene: new hopes, new horizons. Lancet Infect Dis 2011; 11: 312–21.
  • 14.
  • 15. STERILIZATION Is the complete elimination or destruction of all forms of microbial life • While DECONTAMINATION Is a process that eliminates many or all pathogenic microorganism on inanimate objects with exception of bacterial spores
  • 16. • Antisepsis- is used to describe disinfection applied to living tissue such as wounds.example hydrogen peroxide and rubbing alcohol • Cleaning- soil removing process. • Sanitization- is the ability to reduce the number of microbial contaminants to asafe level often linked to chemical intervention • Decontamination- treatment used to make equipment safe to handle.eg.use of chlorine for decontamination
  • 17. METHOD OF STERILIZATION: • HEAT- dry vs moist • GAS-(ethylene oxide, ozone, vapour hydrogen peroxide)-plastics + thermolabile materials • CHEMICALS -(peracetic acid, glutaraldehyde)- heatlabile fibreoptic instruments e.g. flexible endoscope. • IRRADIATION -(uv, microwave, gamma rays)- single use diaposable items e.g. syringes, latex catheter. • FILTRATION-(HEPA filters) – protozoa cyst.
  • 18. HEAT • There of 2 types - Dry –kills by oxidative destruction -Moist- kills by coagulation and denaturation • Dry heat kills at lower/slow rate (e.g. for spores-160 C for 2hrs) hence needs higher temperature plus longer exposure time, while moist heat in the form of steam is efficient, inexpensive method of sterilization in short duration(121 c for 15min-spores)
  • 19. DRY HEAT • Incinearation-efficient method for sterilization and disposal of contaminated material e.g. surgical dressings, sharp needles. • Red heat – inoculating wires, loops and points of forceps • Flaming- currently not significant. • Hot air sterilizer- empty lab glassware, oils, powder, carbon steel microsurgical instruments i.e items likely to be affected by contact with steam • Microwave oven- currently not used - not reliable because its heating effect is not uniform.
  • 20. MOIST HEAT - Requires temperatures above boiling point of water hence a need to rise pressure of steam in a pressure vessel (autoclave). -Steam is non-toxic and non-corrosive but to be effective it must be saturated (hold all the water it can). - Saturated steam is more efficient than dry heat, partly because of the greater lethal action of moist heat but also because it is quicker in heating up the article to be sterilized.
  • 21. Types of steam sterilizer • Sterilizers for porous loads- for dressings, textiles, wrapped utensils all liable to trap air within fabrics hence a vacuum-assisted air removal is needed. • Sterilizers for fluids in sealed containers – safety feature for temp control <80c before opening the door. • Sterilizers for unwrapped instruments – mainly in dental clinics and general practice. • Laboratory sterilizers – lab equipment, culture media.
  • 22. Monitoring of steam sterilizers • Temperature, pressure and time. • Biological indicators: The desire end point of sterilization is elimination of all microbial lives. But some B endospores are resistant to heat agents, they are taken as biological indicators, this is because heat resistant varies among different micro organisms and depends on type of heat e.g. spores of Bacillus stearothermophilus are more resistant to moist heat and were used to monitor sterilization process, inactivation of 100,000 of these spores by
  • 23. saturated steam at 121C requires 12min, at same temp , 1million spores of B. subtilis are inactivated in less than 1 min, meanwhile S. aureus spores inactivated at 60c for 12min. Bowie-Dick test -monitors penetration of steam in a wrapped pack and will detect un even steam penetration by a bubble of residual air in the pack.
  • 24. Factors influencing sterilization by heat: • Temperature – higher the temp, lower the time consumed. • Microbial load – higher the initial burden of microbes, more time will be needed to achieve sterility. • Species – different species have different heat tolerability. • Strain -(vegetative vs spores).
  • 25. STERILIZATION BY CHEMICALS: • Materials which cannot be sterilized by heat or gas can be treated by liquid chemicals after cleaning. • Common chemicals used in sterilization are 2% glutaraldehyde, 6% hydrogen peroxide, 0.2% peracetic acid. • Example of instrument are fibre optic endoscopes.
  • 26. STERILIZATION BY GASES: • Heat sensitive instruments(plastic )are sterilized by using gas. • Ethylene oxide is commonly used, it very efficient but need strict regulations because is explosive and toxic to living tissue • It is an alkyating agent • Vapour formaldehyde is very efficient as mean of sterilization, but it was found to be carcinogenic
  • 27. STERILIZATION BY IRRADIATION: • This is by using UV RAYS,GAMMA RAYS . - Sterilization is achieved by the use of high speed electrons from a machine such as a linear accelerator. • Good example are suturing materials before packing and after packing are sterilized by gamma rays.
  • 28. DISINFECTION: • There are 3 categories of disinfectants based on germicidal actions: 1. High level disinfectant. 2. Intermediate level disinfectant. 3. Low level disinfectant.
  • 29. Cont. • Instrument can also be classified according to degree level of infection risk involved by Spaulding Classification: • 1.CRITICAL, means instruments come to contact with blood or blood products. • 2.SEMICRITICAL, means those come to contact with mucous membranes. • 3.NON CRITICAL, means those come to contact with intact skin.
  • 30.
  • 34. High level disinfectants: • These are used to instruments which has undergone invasive procedure or those belong to critical category. • This procedure inactivate bacteria endospores. • Chemicals used: are pera acetic acid, chlorine dioxide, glutaraldehyde, hydrogen peroxide. • This is less or more similar to sterilization.
  • 35.
  • 36. Intermediate level disinfectants • These are used to disinfect instrument in which contamination with bacteria spores and other resilient organisms are unlikely. • E.g. mask, vaginal speculum and laryngoscope. • Semicritical category instrument are disinfect by this group • Agent used are,(ALCOHOL, IODOPHOR and PHENOLIC COMP) • Have tuberculoicidal action but not sporocidal action
  • 37. Low level disinfectants: • Used to treat instruments which do not penetrating mucosal surface • E.g. stethescope and electrocardiogram electrode • Chemical used is quatenary ammomnium comp • Non critical type of instrument use this disinfectant.
  • 38.
  • 39. Method of disinfectant Moist Heat- Water (70 – 80)C for few min(20min) kills most non-spore forming bacteria. Ultraviolet radiation -these are low energy, non-ionising radiations with poor penetration but lethal to microorganisms. Gases- formaladehyde gas- was used to disinfect rooms previously occupied by patients with chickenpox. It is still used to disinfect anaesthetic machines and baby incubators. Chemicals – pre op prep of incisional sites
  • 40. COMMONLY USED CHEMICAL DISINFECTANTS. ALCOHOLS- Bacteriocidal at conc (70-90)%, not sporocidal,l imited activity against mycobacteria, highly recommended as rapid drying disinfectants for skin and surfaces because they are volatile. Note:-volatile –avoid heat(diathermy). - poor penetration in presence of organic matter. ALDEHYDES (glutaraldehyde or formaldehyde)- broad spectrum action against vegetative bacteria,f ungi and virus. Acts slow on spores. Note:- an irritant to eyes, skin and respiratory mucosa.
  • 41. • HALOGENS -Hypochlorites -broad spectrum, inexpensive chlorine releasing disinfectants of choice against viruses (hepatitis B). -Inactivated by organic matter and corrode metals so that contact with metallic instruments and equipment should be avoided. - React with formaldehyde to release carcinogenic products.
  • 42. • IODINE-inactivated by organic matter + causes hepersensitivity and stains. However (iodophors- iodine + anionic detergent) or Povidone iodine (water soluble complex of iodine and polyvinyl pyrrolidone), these are lessirritant and cause less staining. • PHENOLICS - eg dettol, widely used because they are cheap and exhibit broad spectrum activity. Not readily inactivated by organic matter however are incompatible with cationic detergents.
  • 43. CHOICE OF METHOD: The choice of method of sterilization or disinfection depends on: - The nature of item to be treated - The likely microbial contamination - The risk of transmitting infection to the patient or staff in contact with the item, eg high risk(in contact with a break in skin entering a sterile body area- sterilization).
  • 44. RESISTANCE TO STERILIZATION & DISINFECTION: Many factors affects the ability of microorganisms to withstand the lethal effects sterilization and disinfection, these include: Species or strain of microorganism- in general vegetative bacteria and viruses are more susceptible than spores. However within different species and strains there may be a wide variation attributed to morphological and physiological changes such as alterations in cell proteins or specific targets in the cell envelope affecting permeability.
  • 45. . • Physiological state- Conditions under which micro organisms were grown before exposure to the lethal process. In general, those grown in nutrient limiting conditions are more resistant than those in nutrient rich environment. • Number of micro-organisms - The higher the bio- burden the more extensive must the process to achieve the same assurance of sterility. • Ability to form spores – • Suspending menstruum- i.e micro-environment of the organism e.g. presence of organic material vs. hypochlorite solutions.

Editor's Notes

  1. Agent may be source of infecting agent-patients, health workers or visitors or may include persons with active disease, those in the incubation period or colonized with normal flora Method of transmission-contact, droplet, airborne, common vehicle or vector borne