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Introduction
Decontamination of medical
equipment involves the
destruction or removal of any
organisms present in order to
prevent them infecting other
patients or hospital staff.
decontamination process
Cleaning
is the process that removes contaminants
including dust, soil, large numbers of
micro -organisms and organic matter
(e.g. blood, vomit).
It is an essential prerequisite to
disinfection and sterilization.
It also removes the organic matter on
which micro-organisms might
subsequently thrive.
Disinfection
Is a process used to reduce the
number of micro-organisms but
not usually bacterial spores.
The process does not necessarily
kill or remove all microorganisms, but reduces their
number to a level which is not
harmful to health.
Sterilization
removes or destroys
all forms of microbial
life including bacterial
spores.
Groups of risk
Each instrument or piece of
medical equipment which comes
into contact with a patient is a
potential source of infection.
These are divided into 3 groups
of risk:
High risk
Intermediate risk
Low risk .
Disinfection
Disinfection
Disinfection can also be achieved by using
chemicals which however may themselves
be toxic when allowed contact with skin
or are inhaled.
They can also be corrosive and flammable
so that protective clothing (gloves, apron
and a facemask) should be worn.
Chemical disinfectants
Chemical disinfectants may be supplied
ready to use or may need accurate
dilution to provide an appropriate
solution.
disinfectants can decay and lose activity
Decay is more rapid at high
temperatures and can be accelerated by
the presence of impurities.
All disinfectants take time to work.
Range of Activity of
Disinfectants
Gram positive bacteria.
E.G. Staphylococci, are more sensitive than
gram negative bacteria e.G. Pseudomonas.
Mycobacteria and spores are relatively
resistant.
Enveloped viruses e.G. HIV are killed by most
disinfectants but non-enveloped viruses e.G.
Coxsackie tend to be more resistant.
Spores
Fungal spores are easily killed by
disinfectants.
Other bacterial spores e.g. Clostridia are
resistant to most disinfectants in common
use.
Tubercle bacteria are more resistant to
chemical disinfectants than other bacteria.
They can be killed by exposure to 2% alkaline
Glutaraldehyde solution (Cidex) for 60
minutes.
Viruses.
Hepatitis B virus (HBV) and Human
Immunodeficiency Virus (HIV) are inactivated
by Cidex in 1 - 2 minutes.
to ensure adequate penetration, soiled items
should be placed in a 2% glutaraldehyde
solution for 30 minutes.
Exposure to 70% alcohol solution for 10
minutes is also effective.
Viruses causing Rabies, Lassa fever and
other haemorrhagic fevers are also killed by
Cidex.
Heat
In order to kill microbial agents, heat can be
applied in dry or wet form.
The advantage of wet heat is a better heat
transfer to and into the cell resulting in
overall shorter exposure time and lower
temperature.
Steam sterilization
Steam sterilization uses pressurized steam at
121-132 C (250-270 F) for 30 or 40 minutes.
This type of heat kills all microbial cells
including spores, which are normally heat
resistant.
In order to accomplish the same effect with
dry heat in an oven, the temperature needs to
be increased to 160-170 C (320-338 F) for
periods of 2 to 4 hours.
Resistance of microorganisms
- Microbial agents can be classified
according to increasing resistance to
disinfectants and heat
Chemical
disinfectant
solutions
concentrations 5% to 10 %.
Unpleasant odor
Toxic. protective equipment
used for disinfection of walls, floors, bench tops.
They effectively kill bacteria including
Mycobacterium tuberculosis, fungi and lipidcontaining viruses.
They are not active against spores
Alcohols
Ethyl or isopropyl alcohol in concentration of 70% to 90%
are good general-use disinfectants.
they evaporate fast and therefore have limited exposure
time.
They are less active against non-lipid viruses and
ineffective against bacterial spores.
Concentrations above 90% are less effective.
(eg methanol, ethanol & isopropanolol) have good activity
against bacteria & viruses.
They should only be used after all the visible surface dirt
has been removed from the area to be disinfected.
Aldehydes
Formalin:
Formalin is 37% solution of formaldehyde
in water.
Dilution of formalin to 5% results in an
effective disinfectant.
Formaldehyde is a human carcinogen and
creates respiratory problems at low levels of
concentration.
Glutaraldehyde:
chemically related to formaldehyde, is more
effective against all types of bacteria, fungi,
and viruses.
Vapors of glutaraldehydes are irritating to
the eyes, nasal passages and upper
respiratory tract.
Sterilization
This can be achieved by steam, steam &
formaldehyde, hot air, ethylene oxide or
irradiation.
Autoclaving is the commonest method.
It uses steam under pressure and is the most
reliable way to sterilize instruments.
A temperature of 134C for 3 minutes or
121C for 15 minutes is recommended.
Formaldehyde
Formaldehyde is irritant to the eyes, respiratory tract
and skin.
It can also be absorbed by some materials and
subsequently slowly released with potentially
hazardous results.
Hot air sterilization takes a long time and items
must be able to withstand temperatures of at least
160C for periods of 2 hours or more.
Formaldehyde gas
Formaldehyde gas is primarily used in the
decontamination of spaces or biological
containment equipment like biological
safety cabinets.
Formaldehyde is a toxic substance and a
suspected human carcinogen.
Considerable caution must be exercised in
handling, storing, and using formaldehyde
Ethylene oxide
Ethylene oxide is a colorless gas which is toxic to inhale.
It is effective against all organisms and does not damage
equipment.
The operating cycle ranges from 2 - 24 hours so the
turnaround time is prolonged and it is a relatively
expensive process.
A variety of vapors and gases possess germicidal
properties.
The most commonly used are formaldehyde and ethylene
oxide.
Sterilisation by irradiation
Sterilisation by irradiation is an industrial
process and particularly suited to the
sterilization of large batches of products.
Irradiation can cause serious deterioration
of materials and is therefore not a suitable
method for the resterilisation of equipment
items
Radiation
Gamma and X-ray are two principal types of
ionizing radiation used in sterilization.
Their application is mainly centered on the
sterilization of prepackaged medical devices.
Ultraviolet (UV) radiation is a practical method
for inactivating viruses, mycoplasma, bacteria and
fungi.
UV radiation is successfully used in the
destruction of airborne microorganisms.
UV light sterilizing capabilities are limited on
surfaces because of its lack of penetrating power .