Sterilization is important in ENT to prevent transmission of microbes between patients and from the environment to patients. There are various methods of sterilization including heat, chemicals, irradiation, high pressure, and filtration. Instruments are categorized as critical, semi-critical, or non-critical depending on the risk of infection, and appropriate sterilization methods must be used for each. Common instruments used in ENT include nasal speculums, aural speculums, and tongue depressors.

1. Submitted by: Mubarka Bushra
Roll no. 117
SterilizationinENT
Department

2. Sterilization refers to any process that eliminates,
removes, kills, or deactivates all forms of life and
other biological agents, such as
-fungi, -bacteria, -viruses, -spore forms,
- prions, -unicellular eukaryotic organisms
present in a specified region
Sterilization can be achieved through various means,
including: heat, chemicals, irradiation, high pressure and
filtration.

3. Prevent transmission of microbes to patients
- Between patient to patient
- From environment to patient
Efficient storage and longevity of instruments
Disposable materials have limitations
WHY?

4. Earl H. Spaulding categorized equipment as:
Critical: pose the greatest risk for infecting a patient.
-include any item that enters or touches sterile tissues,
the vascular system or bodily fluids like blood.
Semi-critical: If an item comes into contact with
mucous membranes but is not used inside sterile tissues,
it is considered semi-critical.
WHEN?

5. These items include anesthesia equipment, some scopes
(endoscope) and temperature probes.
Non-critical: Non-critical items do not come into
contact with mucous membranes but touch intact skin.
Equipment like blood pressure cuffs, surgical beds and
stereotaxic frames are considered non-critical. They
must be thoroughly cleaned, but will not require
sterilization.

6. INSTRUMENTS USED IN ENT OPD
Thudichum Nasal
Speculum
Vienna Nasal Speculum
Aural
Speculum
Tongue Depressors

8. It is the first step toward sterilisation and sometimes is
all that is required.
• Hinged instruments must be open, thus minimizing
obscured surface areas.
• Ensure that the internal surfaces are thoroughly and
completely in contact with the solution
• Pre-rinse under cold water for a minimum of 30
seconds
CLEANING

9. • Instruments should then be completely immersed in
a fresh cleaning solution with a neutral pH.
• A soft cleaning brush, such as one made of nylon
should be used to gently scrub the instrument under
the water level, and cleaning should continue until all
visible debris is removed

10. • If instrumentation is soaked too long, it could cause
corrosion.
• Final rinse should be performed with treated water
• Residues could affect sterilization efficacy and/or
cause adverse reactions in the patient whom the
instrument is subsequently used
• Lubricate the instruments according to the
manufacturer’s IFU.
• Finally, drying should be performed with clean, low-
linting cloths or instrument-grade air.

11. Disinfection can be broken down into three tiers:
 low level disinfection (LLD): eliminates all vegetative
bacteria, lipid viruses, some non-lipid viruses and some fungi in
less than 10 minutes.
 intermediate level disinfection (ILD): destroys tubercle
bacilli, mycobacteria, lipid enveloped and some non-lipid
enveloped viruses and fungus spores.
 high level disinfection (HLD): in addition to killing these
microorganisms, HLD can also kill bacterial spores, though not in
a high number.
DISINFECTION

12. Disinfectant solutions are used to inactivate any
infectious agents that may be present in blood or other
body fluids.
· They must always be available for cleaning working
surfaces, equipment that cannot be autoclaved, non-
disposable items, and for dealing with any spillages
involving pathological specimens or other known
infectious material.
· Needles and instruments should routinely be soaked
in a chemical disinfectant for 30 minutes before cleaning.

13. · It decreases the viral and bacterial burden of an
instrument.
· Purpose is to reduce the risk to those who have to handle
the instruments during further cleaning.
· Reusable needles must always be used with great care.
After use, they should be placed in a special container of
disinfectant before being cleaned and sterilized. Thick
gloves should be worn.

14.  Most widely available antiviral disinfectant is sodium
hypochlorite solution (commonly known as bleach)
 It is important to use all disinfectant solutions within
their expiry date as some solutions, such as
hypochlorite, lose their activity very quickly.
 Linen soiled with blood should be handled with
gloves, and should be collected and transported in
leak-proof bags.
 Wash the linen first in cool water, then disinfect with
a dilute chlorine solution. Then wash it with
detergent for 25 minutes at a temperature of at least
71°C.

15. Always autoclave instruments in an open position. The
steam must circulate freely.
Place in sterilisation trays or wrap in paper or muslin
before autoclaving.
Process the instruments as follows:
• Unwrapped instruments at 121°C for 20 minutes
at 15 PSI above atmospheric pressure or at 134°C
for 3–4 minutes at 30 PSI above atmospheric pressure
• Wrapped instruments at 121°C for 30 minutes at
15 PSI above atmospheric pressure or at 134°C
for 15 minutes at 30 PSI above atmospheric
pressure
AUTOCLAVE

16. Instruments can be wrapped in aluminum foil or placed
in sterilisation trays before putting them in the oven.
They ca be heated to any of the following to be
considered sterilized:
-180°C for 30 minutes
-170°C for 1 hour
-160°C for 2 hours
-149°C for 2.5 hours
-141°C for 3 hours
DRY HEAT

17. Soaking surgical instruments in most cold sterilants
requires 10 hours to sterilise them. If disinfection is
required a 10–90 minute soak in a cold sterilant may be
all that is required. When using instruments with
tungsten carbide inserts avoid using solutions with
benzyl ammonium chloride.
· Sharp and delicate equipment can be sterilized by
exposure to formaldehyde, glutaral or chlorhexidine.
· Glutaral is a disinfectant that is extremely effective
against bacteria, fungi and a wide range of viruses.
COLD STERILIZATION