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Sterilisation and disinfection
1.
Universities Press© Universities
Press (India) Private Limited STERILISATION AND DISINFECTION
2.
Universities Press© Universities
Press (India) Private Limited Sterilisation A process by which an article, surface or medium is free of all living organisms either in vegetative state or spore state Disinfection Removal or destruction of all pathogenic organisms Asepsis Prevention of infection by inhibiting the growth of bacteria STERILISATIO N
3.
Universities Press© Universities
Press (India) Private Limited Cleaning Removal of soil and dirt to reduce microbial burden and to make sterilisation more effective Decontamination The process of rendering an article or an area free of contamination including microbial, chemical, radioactive, etc. Bactericidal agents: Agents that kill bacteria Bacteriostatic agents: Agents that prevent multiplication of bacteria STERILISATIO N
4.
Universities Press© Universities
Press (India) Private Limited Objective: To destroy microorganisms from materials and areas Choice of method depends on: Purpose for which it is carried out, nature of microorganisms, material to be sterilised Uses of sterilisation: To prevent contamination by extraneous organisms, to prevent sepsis in surgery, for safety in food and drugs STERILISATIO N
5.
Universities Press© Universities
Press (India) Private Limited CLASSIFICATI ON Physical methods Sunlight, drying, Heat Dry heat - flaming- incineration, hot air oven Moist heat- Pasteurisation, boiling - Steam under normal pressure - Steam under pressure Filteration, Radiation Ultrasonic and sonic vibration
6.
Universities Press© Universities
Press (India) Private Limited Chemical methods Alcohols - Ethyl alcohol, isopropyl alcohol Aldehydes - Formaldehyde, glutaraldehyde Dyes Halogens Phenols Surface active agents Metallic salts Gases: ETO, formaldehyde,betapropiolactone CLASSIFICATI ON
7.
Universities Press© Universities
Press (India) Private Limited DRY HEAT
8.
Universities Press© Universities
Press (India) Private Limited Drying MoiMoisture is essential for the growth of bacteria. Four fifths of weight is due to water.Hence drying has a deleterious effect on bacteria but is not a reliable method Spores are unaffected by drying
9.
Universities Press© Universities
Press (India) Private Limited FLAMING • Flaming: Exposing the articles to be sterilised to blue flame of the burner till it becomes red hot. • Inoculating loops, wires, tip of forceps, scalpels,scissors and edges of test tubes,
10.
Universities Press© Universities
Press (India) Private Limited Temperatures >1000c Excellent method for destroying contaminated cloth, animal carcasses, pathological materials, infectious hospital waste Plastics such as PVC and polythene can be dealt with but polyesterine materials emits dense clouds of black smoke INCINERATION
11.
Universities Press© Universities
Press (India) Private Limited Holding period – 160°C for 1 hour - Glassware, instruments, liquid paraffin, dusting powder, fats, grease, etc. - Rubber, cotton avoided Controls - C.tetani spores and Browne’s tubes HOT AIR OVEN
12.
Universities Press© Universities
Press (India) Private Limited HOT AIR OVEN Hot air oven
13.
Universities Press© Universities
Press (India) Private Limited STERILISATION CONTROL Physical Temperature monitoring and thermocouples Chemical Browne’s tube (green spot) Biological Non-toxigenic strain of Clostridium tetani or Bacillus subtilis Paper strips impregnated with 106 spores inserted in pack to be sterilised
14.
Universities Press© Universities
Press (India) Private Limited MOIST HEAT Temp <100°C Pasteurisation – Holder method- 63°C – 30 min – Flash method – 72°C – 20 sec Followed by quickly cooling to 13°C Vaccine bath: Heat inactivation – 60°C – 1 hr Inspissation: 80–85°C 30 min on 3 days
15.
Universities Press© Universities
Press (India) Private Limited Temperature at 100°C Boiling Koch & Arnold steam steriliser: media –90 min Tyndalisation: sugars, gelatin 100°C – 20 min - 3 successive days MOIST HEAT
16.
Universities Press© Universities
Press (India) Private Limited STEAMER Steamer
17.
Universities Press© Universities
Press (India) Private Limited Temp >100°C : (Steam under pressure) Autoclaves MOIST HEAT A simple autoclave; 1. release valve; 2. safety valve; 3. pressure gauge; 4. tightening screws; 5. cover; 6. body; 7. bin containing material; 8. heating element; 9. stand
18.
Universities Press© Universities
Press (India) Private Limited STERILISATION CONTROL Physical Temperature and pressure monitoring gauges, thermocouples Chemical Bowie–Dick tapes Biological Bacillus stearothermophilus 106 spores
19.
Universities Press© Universities
Press (India) Private Limited FILTRATION - Heat labile fluids - sera, antibiotics, enzymes, toxins - Separation of virus from bacteria Types of filters: Candle filters Berkfeld & Mandler: Made of kieselghur, graded porosity, sterilised by steaming or autoclave Chamberland or Doulton: Made of unglazed ceramic
20.
Universities Press© Universities
Press (India) Private Limited FILTERS Asbestos filters: Seitz filter: - pad of asbestos - inserted into metal holder - discarded after use Asbestos filter
21.
Universities Press© Universities
Press (India) Private Limited FILTERS Sintered glass filters: Used for air filtration, made of finely ground glass Glass filter
22.
Universities Press© Universities
Press (India) Private Limited Membrane filters: Cellulose nitrate - Also called gradacol MEM - To separate viruses, to know their size Cellulose acetate or millipore filters or oxoid MEM filters HEPA: High efficacy particulate air filters Membrane filter FILTERS
23.
Universities Press© Universities
Press (India) Private Limited RADIATION Non-ionising radiation - Infrared and ultraviolet rays - low energy type ,low penetrating power - Control of closed environment with UV lamp - Bacteriological laboratory, inoculation hoods, laminar flow
24.
Universities Press© Universities
Press (India) Private Limited RADIATION Ionising radiation - Gamma rays, X rays and cosmic rays lethal to DNA, have high penetrative power No appreciable increase in temperature – ‘cold sterilisation’ Use: Sterilising pharmaceuticals, medical, dental equipment, sterilising plastics, syringes, swabs, catheters, oil grease
25.
Universities Press© Universities
Press (India) Private Limited CHEMICAL METHODS
26.
Universities Press© Universities
Press (India) Private Limited Alcohols Protein denaturation and lipid dissolution Bactericidal, fungicidal Not effective on spores and viruses Commonly used - Ethyl alcohol, isopropyl alcohol Concentration 60-90% in water CHEMICAL METHODS
27.
Universities Press© Universities
Press (India) Private Limited Aldehydes Active against amino group in protein molecule Formaldehyde Used for sterilising instruments, heat-sensitive catheters, fumigation of wards, sick rooms and laboratories Glutaraldehyde Disinfection of medical equipment like cystoscopes and bronchoscope Effective against tubercle bacilli, fungi and viruses CHEMICAL METHODS
28.
Universities Press© Universities
Press (India) Private Limited DYES Aniline dyes Brilliant green, malachite green and crystal violet Non-toxic, non-irritant Active against Gram-positive organisms Used as selective agents in culture media Acridine dyes Proflavine, acriflavine and euflavine Impair DNA, destroy the reproductive capacity of the cell
29.
Universities Press© Universities
Press (India) Private Limited Phenols Lister - antiseptic surgery Distillation of tar between 170°C and 270°C Damage to cell membrane, release cell contents and cell lysis Cresols, chlorhexidine, hexachloraphane Disinfection of floors, excreta, preoperative disinfection of skin CHEMICAL METHODS
30.
Universities Press© Universities
Press (India) Private Limited Halogens Iodine – Skin disinfectant Bactericidal, sporicidal Iodophores more active Chlorine – Used as hypochlorite Bactericidal Disinfect water supplies, swimming pools and used in diary industries CHEMICAL METHODS
31.
Universities Press© Universities
Press (India) Private Limited GASES Ethylene oxide - Kills microorganisms by altering their DNA by alkylation of amino carboxyl, hydroxyl and sulphydryl groups in protein molecules - Used in sterilising packaged and heat-sensitive devices - Respirators, heart–lung machines, dental equipment, sutures, books and clothing
32.
Universities Press© Universities
Press (India) Private Limited GASES Formaldehyde Fumigation of theatres and rooms 150 g of KMnO4 to 280 ml formalin for every 1000 cu ft. Doors sealed, opened after 48 hrs Betapropiolactone (BPL) Condensation product of ketane and formaldehyde Hydrogen peroxide fogging Short cycle time, non-toxic
33.
Universities Press© Universities
Press (India) Private Limited GAS PLASMA STERILISATION Plasma is known as the fourth state of matter.Plasma consists of ions, electrons and neutral particles. Radio frequency energy is applied to create an electromagnetic field- into this Hydrogen peroxide vapours are introduced which generates a state of plasma containing free radicles of hydrogen and oxygen Used for arthroscopes, urethroscopes
34.
Universities Press© Universities
Press (India) Private Limited SURFACE ACTIVE AGENTS Act by altering energy relationship at interfaces - reduction in surface tension Classification Anionic, cationic, amphoteric, non-ionic Antibacterial, fungicidal, virucidal Cetavlon, cetrimide
35.
Universities Press© Universities
Press (India) Private Limited Copper, silver, mercury Combine with sulphydryl groups of cell enzymes, denaturation of enzymes Highly toxic Thiomersal, mercurochrome less toxic, used as mild antiseptics Copper salts - fungicide SALTS OF HEAVY METALS
36.
Universities Press© Universities
Press (India) Private Limited Spaulding Classification Eagle H Spaulding believed that the method used to disinfect an object will depend on the object’s intended use DISINFECTION
37.
Universities Press© Universities
Press (India) Private Limited WHICH PROCEDURE TO USE? Category Items in each category Procedure Critical Items that: (1) enter the tissue; (2) Enter vascular system; (3) through which blood flows High level disinfection Semi-critical Items that: (1) touch mucous membranes; (2) touch non-intact skin (e.g. endoscopes, respiratory therapy equipment, thermometer) Intermediate level disinfection Non-critical Items such as bedpans, blood pressure cuffs, and bedside tables Low level disinfection
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