Académique Documents
Professionnel Documents
Culture Documents
Mohit Gupta,
Roll No.:45
Mohit Verma,
Roll No.:46
STERILIZATION:
It is the process by which the article, a surface, or
medium is freed of all microorganisms including viruses, bacteria, and
spores, fungi both pathogenic and nonpathogenic.
DISINFECTION:
ANTISEPSIS:
CLEANING:
Packaging:
Instruments should be prepackaged before processing through a sterilizer
so they will protected from contamination after sterilization.
Unwrapping instrument at chair side in front of patient can help build
patient confidence about cleanliness of clinic.
Sterilization monitoring:
Sterilization can be monitored by chemical indicator i.e. color change but
effectiveness cannot or can be biologically monitored by routine spore
testing.
AGENTS OF
STERILIZATION
Physical Agents Chemical Agents
Sunlight Alcohols
Drying Phenols and phenolic
Heat compounds
Filtration Halogens
Radiation Heavy metals and their
Low temperature salts
Dyes
Desiccation
Quaternary tertiary
compounds
Aldehydes
Gases
SUNLIGHT
DRYING
Flaming:
Scalpel blades, needles, mouths of culture tubes, bottles,
glass slides, cover slips, by passing through Bunsen flame
without red hot
Incineration:
Soiled dressing and pathological
materials are burned to ash and
are physically destroyed
Incineration
plant
HOT AIR OVEN:
Hot Air
Oven
WET HEAT
Tyndallization:
It is a lengthy process designed to reduce
the level of activity of sporulating bacteria
that are left by a simple boiling water
method.
Complete sterilization is ensured after an
exposure of 1000C for 20 minutes on three
consecutive days. This process is also
called as intermittent sterilization.
The three incubating periods are to allow
heat resistant spores surviving previous
boiling periods to germinate to form heat
sensitive vegetative stage, which can be
killed by next boiling step.
This is effective because many spores are
stimulated to grow by heat shock. This
procedure only works for media that
supports bacterial growth. TYNDALLI
ZATION
At temperature above
1000C
AUTOCLAVE:
Gamma Rays:
These are commonly used as they are very penetrating.
Used for syringes, needles, cannulas. It requires bulky
shielding for safety of operator. Require storage of
radioisotope (Co-60) which continuously emits gamma
rays.
Its disadvantage is that it cannot be turned off and always
present a hazard in area of facility.
Electron Beam:
These are commonly used. It uses an on-off technology.
It provides a much higher dosing rate than gamma or X
rays. Due to higher dose, less exposure time is needed
and thereby any potential degradation is reduced.
Limitation of electron beams is that they are less
penetrating than gamma rays or X rays
X Rays:
These are less penetrating and require longer exposure.
Require less shielding. It is generated by X ray machine
that can be turned off when not in use.
Ultraviolet Lamps:
Ethylene
Oxide
gas
chamber
Beta-propiolactone is a condensation product of ketane and
formaldehyde known as betapropiolactone with boiling point of
1630C. it has low penetrating power but effective for fumigation
purposes than formaldehyde. Limitation is that it is carcinogenic
therefore 0.2% BPL is used.
OZONE
GAS
CHAMBER
Low temperature gas plasma (LTGP)
used as an alternative to ethylene
oxide. It uses a small amount of liquid
hydrogen peroxide which is energizes
with radio frequency waves into gas
plasma, leading to generation of free
radicals and other chemical species
which destroy organisms
Intermediate-level disinfectants:
These may kill mycobacterium, vegetative bacteria,
most viruses, and most fungi but do not necessarily kill
bacterial spores.
Low-level disinfectants:
These may kill most vegetative bacteria, some fungi,
and some viruses.
SPAULDING'S
CLASSIFICATION
In 1968 Earle Spaulding devised a rational approach to
disinfection and sterilization.
This is now referred to as Spaulding's classification and
it has been refined and retained over the years because
it is so clear and logical.
Spaulding believed that instruments and equipment
should be cleaned and reprocessed according to the
level of risk associated with their intended use.
The three categories he described were critical, semi-
critical and noncritical as in the table below.
FACTORS IMPACTING ON
STERILIZATION &
DISINFECTION
There are a number of factors that may nullify or limit the
efficacy of sterilization and disinfection processes. These
will be discussed in the next section and include:
prior cleaning of the object
the organic load present
the type and level of microbial contamination
the concentration of, and exposure time to, the biocide
the nature of the object (e.g., crevices, hinges, lumens)
the temperature and pH of the process
FACTORS
Exponential relationship between the number of organisms killed
and the time taken to kill them.
Microorganisms vary greatly in their resistance to chemical
biocides.
More concentrated the biocide the greater its efficacy and the
shorter the time necessary to kill all the microorganisms
Activity of most biocides increases as the temperature increases
The production of thick masses of cells and extracellular materials
or biofilms can protect microorganisms from the cidal action
of biocides.
Biofilms are microbial masses attached to surfaces that are
bathed with liquids. A biocide must saturate or penetrate the
biofilm matrix before it can kill the microorganisms within it.
An increase in pH improves the antimicrobial activity of some
agents as with glutaraldehyde, but decreases the activity of
others such as hypochlorite's.
Relative humidity influences the activity of gaseous agents such
as ethylene oxide.
Water hardness reduces the rate of kill of some biocides
because divalent cations such as magnesium and calcium
interact with soap to form insoluble precipitates.
Organic matter such as serum, blood, pus or faecal material may
interfere with the activity of biocides in at least two ways.
Sterilize or disinfect an item it must be exposed to the
appropriate concentration of biocide for a certain minimum
contact time. All surfaces of the item must come in contact with
the biocide for that period of time.
NEW METHODS OF
STERLIZATION
Table 1. New methods in disinfection and sterilization
Process Agent Regulatory agency action
Carbon steel - ++ ++ ++
Steel + ++ ++ ++
Tungsten-carbide + ++ + ++
3. Condensers ++ ++ ++ ++
4. Dappen dishes ++ + + ++
7. Glass slabs ++ ++ ++ ++
S. No. Item Steam Dry heat oven Chemical Ethylene oxide Other methods
sterilizer vapour
8. Hand instruments
Stainless steel ++ ++ ++ ++
Nonautoclavable - - - ++
Prophylaxis angles + + + +
10 Impression trays
Aluminum metal ++ + ++ ++
Chrome plated ++ ++ ++ ++
13 Mirrors - ++ ++ ++
Hoses ++ --- ++ ++
16 Orthodontic pliers
High quality ss ++ ++ ++ ++
Low quality ss - ++ ++ ++
17. Pluggers ++ ++ ++ ++
Rag ++ - - ++
Rubber + - - ++
S. No. Item Steam Dry heat oven Chemical Ethylene oxide Other methods
sterilizer vapour
19 Prostheses, removable - - - +
Metal frames ++ ++ ++ ++
Plastic frames - - - ++
Punches - ++ ++ ++
22 Rubber items
24 Stones
Diamond + ++ ++ ++
Polishing ++ + ++ ++
Sharpening ++ ++ ++ -
S. No. Item Steam Dry heat oven Chemical Ethylene oxide Other methods
sterilizer vapour
25 Surgical instruments
Stainless steel ++ ++ ++ ++
28 X-ray equipment
Chlorhexidine 2.5% / 70% alcohol solution in a glycerine base Hibisol hand rub Hand rub
Chlorhexidine 0.5% in 70% alcohol Alcoholic chlorhexidine Skin disinfection prior to peri-oral
biopsy, implant surgery and periodontal
surgery
2.
IODOPHORS
Povidone iodine 7.5% solution Betadine surgical scrub Hand washing
3.
ALCOHOLS
Alcohol gel/solutions Purell, Sterillium, Desderman Hand rub
70% Isopropyl alcohol wipes Azowipes or Cliniwipes Surgery hard surface disinfection or
external surface of handpieces
Ethanol and 1-propanol alcohol spray Mikrozoid Surgery hard surface disinfection
4.
TRICLOSAN
Triclosan 2% Aquasept Hand disinfection
References: