Cleaning & Disinfection

Cleaning&Disinfection

Dr.MuhammadA.Halwani
SupervisorofInfectionControland
CentralSterilisationintheMakkahArea
ConsultantinInfectionControlfortheCentralBoardofAccreditationfor
HealthCareInstitutions(CBAHI)

Cleaning
Cleaningisthephysicalremovalofcontaminationof
g
p y
microorganismsbydetergents
Cleaningwithdetergentsbreaksupgrease,dirt,andsoil
that protect microorganisms from removal
thatprotectmicroorganismsfromremoval
Itwasfoundthataround80%ofmicroorganismsare
removedduringthecleaningprocedure

Cleaningcont.,
Cleaningisanimportantpartofequipmentand
i
instrumentreprocessing,asitpermitsamaximumefficacy
i
i
i
i
ffi
ofsubsequentdisinfectionandsterilisationtreatments
Bloodandbodyfluidsmustbecompletelyremoved
from instruments before they are subjected to disinfection
frominstrumentsbeforetheyaresubjectedtodisinfection
orsterilisationprocess
Dryingoftheequipmentaftertheyhavebeencleanedis
extremelyimportanttopreventanybacteriafrom
multiplying
li l i

Cleaningcont.,
Cleaning can be for:
Cleaningcanbefor:
Surfaces thatwereexposedtoanypotentially
infectiousmaterials
Instrument thatwereexposedtopatients
h
d

Cleaningcont.,
General Measures in Cleaning
GeneralMeasuresinCleaning
Allchosenproductsshouldbe:

FDAapproved
EPAregistered
Theyalsoneedtobe:
They
also need to be:
Bactericidal
Virucidal
Tuberculocidal

Cleaningcont.,
Exposed Surfaces
Cleanupofexposeditems/surfaceswillinsurethatthey
were left in sanitary and aseptic condition
wereleftinsanitaryandasepticcondition
Productsthatcanbeused:
Products
that can be used:
Isopropylalcohol70%
Quaternaryammoniumcompound
Q t
i
d
Aldehydes+alcoholcompound(incidinespray)
Ethanol+glutaraldehyde(combispray)
QuaternaryAlkylammoniumpropionate(HospiCid)

Cleaningcont.,
Environmental Surfaces
EnvironmentalSurfaces
Preferabledilutedhydrochloricacid
Didecyldimethylammoniumchloride
Quaternaryammoniumcompound(Desnet)
Quaternary ammonium compound (Desnet)
HydrogenPeroxide(HUWASAN)
H d
P
id (HUWA SAN)

InstrumentCleaning
Thisisacompulsorystepbeforesendingthe
instrumentstodisinfectionorsterilisation
Staffwhoareresponsibleforcleaningcontaminated
instrumentsmustbeproperlytrainedandfamiliarwiththe
purposeoftheirtask
Theyshouldwearpersonalprotectiveequipment(PPE)
thatisappropriatetothetaskrequired
TheyshouldbevaccinatedagainsthepatitisB
y
g
p

InstrumentCleaningcont.,
Cleaningisusuallyappliedusingwateranddetergent
Cleaningshouldbeappliedassoonaspossibleafter
C ea g s ou d be app ed as soo as poss b e a te
instrumentshavebeenused
Cleaninginanultrasonicmachineusingenzymatic
compoundsinwarmtemperatureisveryeffective
p
p
y
Immersioninenzymaticcompoundisextremely
Immersion in enzymatic compound is extremely
recommendedifultrasonicmachineisnotavailable

InstrumentCleaningcont.,
Manualcleaningshouldbedoneafter
Manual cleaning should be done after
instrumentsimmersionindetergentisrequired
Warmwaterisalwaysrecommendedforefficient
y
cleaning
Rinsing&dryingarealwaysrequiredbefore
packing

Disinfection
Disinfection isaprocessthatresultsintheeliminationofmanyorall
pathogenic microorganisms without bacterial spores It is usually
pathogenicmicroorganisms,withoutbacterialspores.Itisusually
achievedthroughtheuseofchemicalagents.
Factorsthataffectdisinfectionefficacy:
Previouscleaningoftheobjects
Previous cleaning of the objects
Organicloadontheobjects
Typeandlevelofmicrobialcontamination
Concentrationofandexposuretimetothegermicide
Physicalconfigurationoftheobjects
TemperatureandPHofthedisinfectionprocess
T
t
d PH f th di i f ti

Disinfectioncont.,
Lowleveldisinfection: cankillmostbacteria,some
viruses,andsomefungi
Intermediateleveldisinfection: inactivate
mycobacteriumtuberculosis,vegetativebacteria,most
viruses,andmostfungi,butitdoesnotnecessarilykill
bacterialspores
Highleveldisinfection: candestroyallmicroorganisms,
withtheexceptionofhighnumbersofbacterialspores

PointsmustconsideredinDisinfection
Thelocationofmicroorganismsmustbeconsideredwhen
factorsaffectingtheefficacyofgermicidesareassessed
Medicalinstrumentswithmultiplepiecesmustbe
disassembledbeforeimmersion.
Equipmentsuchasendoscopesthathavecrevices,joints,
q p
p
,j
,
andchannelsshouldbecleanedproperlytoensurethe
penetrationofthedisinfectantofallpartsofthe
equipment.

Disinfectioncont.,
Thebestinusedisinfectants:
Disinfectant

Advantages

Disadvantages

Glutaraldehyde(cidex)

Forallmetalinstruments,plastics,tubes

Skin,eyerespiratoryirritant

Orthophthalaldehyde
(cidexOPA)

Fastacting,skinfriendly,noirritantodour

Slowonspores,expensive,can
causeeyeirritation

Rapidsterilisationtime30min,removeorganic

Expensive,cancauseseriouseyeand

material,sporicidalenvironmentfriendly

skindamage

No bad odour no irritation does not fix proteins to

Nobadodour,noirritation,doesnotfixproteinsto

Seriouseyedamage.Somematerials
Serious
eye damage Some materials
mightbenotcompatible(silver,zinc,
nickel)

PeraceticAcid

Hydrogen Peroxide
HydrogenPeroxide

surfaces,enhanceremovaloforganicmatters

PeraceticAcid/Hydrogen
Peroxide

Nobadodour,noirritation

potentialeffectoneyeandskin
damage.Somematerialsmightbe
notcompatible ( zinc,copper, lead)

Disinfectioncont.,
Thebestinusedisinfectants:
Disinfectant

Advantages

Quaternaryammonium
compound
d

Lessirritation

Phenolics

Bactericidal/Virucidal
Tuberculocidal

Disadvantages

Notsporicidal,maycauseskinirritation.
Inactivatedbyorganicmatter.

Whatweneedinhospitalpolicy?
HospitalDetergents&Disinfectants:
p
g
CompoundName
(EZClean)

EffectiveAgent
Alcholol
70%

Use
Gelusedtodecontaminate
handsbeforeandafter
patient contact when there is
patientcontactwhenthereis
novisiblecontaminationon
thehands

ScrubStat4

Chlorahexadine
4%

Antibacterialsoapusedfor
handscrubbingbefore
surgicaloperation

MicrobialContaminationofDisinfectants
Contaminateddisinfectantsandantisepticshavebeenoccasionalvehiclesof

health care infections for more than 50 years

healthcareinfectionsformorethan50years.
MembersofthegenusPseudomonas(e.g.,P.aeruginosa)arethemostfrequent

isolatesfromcontaminateddisinfectantsrecoveredfrom80%ofcontaminated
products.
Althoughtheconcentratedsolutionsofthedisinfectantshavenotbeen

demonstratedtobecontaminatedatthepointofmanufacture,anundiluted
p
phenoliccanbecomebecontaminatedduringuse.
g
Germicidesusedasdisinfectantsthatwerereportedtohavebeencontaminated

include chlorhexidine quaternary ammonium compounds and phenolics

includechlorhexidine,quaternaryammoniumcompounds,andphenolics.

Howtochooseadisinfectant?
Never
Neverlistenblindlytoacompany
listen blindly to a company
representative!
FDAapprovalnumbercanbetakenfromthe
pp
agencywebsite.
Officialresearchpapersshouldbealways
consideredbeforeapproval

Conclusion
Cleaninganddisinfectionsareessentialstepsbeforethe
g
p
reuseofmultiuseinstruments.

Theuseofanydetergentordisinfectantmustbeafter
Th
f
d
di i f
b f
theconsultationoftheinfectioncontrol.
Infectioncontrolstaffshouldmonitorthecleaning
g
scheduleandanydisinfectantuseregularly.

Any Questions?
AnyQuestions?