DISINFECTION

and
STERILIZATION
SOME DEFINITIONS
 DECONTAMINATION
 Is the combination of processes, including cleaning,
disinfection and/or sterilization used to a re-useable items
safe for further use.

The decontamination process is intended to:

– make the item safe for staff to handle without presenting an infection
hazard;
–make the item safe for use on a patient.
 ASEPSIS
Aseptic practices refer to precautions designed to prevent
contamination of a person, object or area by
microorganisms.
Aseptic practices are indicated if performing any invasive
procedure, for example surgical procedures, dressing open
wounds or insertion of indwelling cannulae.
Measures employed to achieve asepsis include:
• preoperative skin and body cavity preparation,
• performance of appropriate hand washing,
• processing, supply and storage of sterile equipment,
• antiseptic and disinfectant use,
• management of indwelling devices,
• environmental controls such as air filtration.
 HANDWASHING
 Hands should be washed before significant contact with any
patient.
 Significant contact activities include: examination of a patient, inspection
of a wound, emptying a catheter or drainage reservoir, changing an I.V. flask,
delivery of I.M. or I.V. injections.
 Hands should be washed after activities likely to cause
significant contamination.
 Activities known to cause significant contamination: handling objects or
materials soiled with body secretions or excretions, direct contact with body
secretions or excretions, personal hygiene after toileting.
 Gloves should be used as an adjunct to hand washing when
contamination of hands with blood or body fluids is anticipated.
 Gloves should be changed and hands washed between patients.
 HANDWASHING PROCEDURE
1. Ensure all skin surfaces are accessible.
2. Ensure nails are clean, short and unvarnished.
3. Wet hands thoroughly.
4. Hands should then be lathered with soap or skin cleanser and
vigorously rubbed together for at least 15 seconds.
5. Commonly missed areas are finger tips, interdigital areas,
thumbs.
6. Rinse under a moderate stream of water.
7. Thoroughly dry hands with paper towel.
8. To minimize "chapping" of hands, pat dry rather than rubbing
them.
9. If elbow operated taps are unavailable, whilst still holding
towel, use this to turn off the tap.
 DISINFECTION

Disinfection is considered to be the primary

mechanism for the inactivation/destruction of
pathogenic organisms to prevent the spread of
infectious diseases.
DISINFECTANTS
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,
• for equipment that cannot be autoclaved,
• for non-disposable items
• for dealing with any spillages involving
pathological specimens or other known infectious
material.
 THE IDEAL DISINFECTANT

An ideal disinfectant should be:

» resistantto inactivation
» broadly active
» not poisonous or otherwise harmful
» penetrating
» not damaging to non-living materials
» stable
» easily prepared
» not unpleasant to work with
 EFFECTIVE DISINFECTION
To ensure effective disinfection:
– Dilute the concentrated solution to the correct working strength.

– It is important to use all disinfectant solutions within their expiry

date.
» as some solutions, such as hypochlorite, lose their activity very quickly.

– Disinfection must be performed before cleaning with detergent.

– All disinfectants have what is known as a “contact time”,

» which means that they must be left in contact with an infectious agent for a certain
period of time to ensure that it is completely inactivated.
 MECHANISM OF ACTION OF
CHEMICAL AGENTS
Different disinfectants have different mechanisms of
action
All disinfectants act by harming microorganisms in
some manner.
Mechanisms of harm include:
– Protein denaturation.
– Membrane disruption.
– Nucleic acid damage.
– Inhibition of metabolism.
 DISINFECTION
Is done with disinfectants by:
– Washing.
– Immersion.
– Wiping.
– Spraying.
– In the form of foam or aerosol.
 DISINFECTION CHEMICAL
TECHNIQUE

Chemical disinfection

q Disinfecting solution is prepared by exact measuring

and dissolving in water
q Improved effect is possible at higher temperatures
 MECHANICAL CLEANING
Mechanical cleanup
1/ Ablution

q Tools, instrument, furniture - detergents, detergent

with disinfecting effect
q Soft surgical instrument - ultrasonic cleaning with a
frequentation of 35 kHz

2/ Drying

q Mechanical
q Dry heat drying
DESINFECTION ASSOCIATED WITH
CLEANING

q Each department has own cleaning room

q Cleaning equipment and devices
q Detergents with disinfection effects
q Regular cleaning, disinfection and
decontamination
q Daily waste disposal
q Infection material- storing as dangerous -
infection material- in special room, special
containers, designated as infection material!!
INFECTION MATERIAL
q Applied syringes, needles, tampoons,
dressings, boiling tubes.
q Biologic secretions, excretions
q Parts of organs, amputated extremities
q Digestive, enteric liquid
q Liquor
q Urine and stool
q Substance from fistulas, wounds
 BIOLOGICAL WASTE
 Contaminated materials are also potentially hazardous and
must be treated accordingly.
 If biological waste and contaminated materials are not disposed
of properly, staff and members of the community could be
exposed to infectious material and become infected.
 It is essential for the hospital to have protocols for dealing with
biological waste and contaminated materials.
 All staff must be familiar with them and follow them.

All biological waste must be carefully stored and disposed of

safely
 MANIPULATION WITH CLOTHES,
BED CLOTHES
q To perform the change of clothes as necessary
q Application of disposables materials - ambulances, examiners rooms
q Storing, manipulation and transport of clothes - according to special
sanitary rules
q To store an applied clothes in special jackets to protect the
contamination of environment
q The storing jackets are washingable, desinficable or disposable
q Storing of applied clothes in special rooms- the walls are washingable
and desinficable
q Personnel who manipulate with applied clothes has to use personal
protective equipment
q When finishing the manipulation with applied clothes is necessary to
achieve a personal hygiene and disinfection
PHYSICAL – CHEMICAL
DESINFECTION
q Pharaformaldehyd chamber - disinfection of
textiles, fur, wool

q Laundering , washing, and cleaning machines-

disinfection proceeds at a temperature of 60 C
with chemical and disinfecting additives
 PHYSICAL TECHNIQUE
Physical disinfection
q Boiling in atmosphere for minimum of 30 minutes
q Boiling in a pressurized vessel for minimum of 20 minutes
q Disinfection of devices at a temperature higher than 90 C
q Ultraviolet radiation
q Filtering, annealing
 AN ULTRAVIOLET DISINFECTION

 An Ultraviolet (UV) disinfection system transfers

electromagnetic energy from a mercury arc lamp to an
organism's genetic material (DNA and RNA).
 When UV radiation penetrates the cell wall of an
organism, it destroys the cell's ability to reproduce.
 UV radiation, generated by an electrical discharge
through mercury vapour, penetrates the genetic material
of microorganisms and retards their ability to
reproduce.
 OZONE DISINFECTION

Airfiltration
Germicidal lamps

Especially in surgery
rooms
 STERILIZATION
Necessary part of the program
ensuring an antiseptic environment

Sterilization is the elimination of all transmissible

agents (such as bacteria, prions and viruses) from a surface,
a piece of equipment, food or biological culture medium.

This is different from disinfection, where only organisms that

can cause disease are removed by a disinfectant.
 STERILIZATION IN SURGERY
The methods of sterilization in common use are:
 Autoclaving or steam sterilization
–Autoclaving should be the main form of sterilization at the district
hospital.
 Exposure to dry heat
 Treatment with chemical antiseptics.
 STERILIZATION TECHNIQUES

Physical sterilization
q Moist heat

- metallic, porcelain, glass, rubber and plastic instruments and

tools.

q Dry heat sterilization

- metallic, porcelain, glass and clay instruments and tools.

 DRY HEAT
 If items cannot be autoclaved, they can be sterilized by
dry heat for 1–2 hours at 170°C.
– Instruments must be clean and free of grease or oil.

 However, sterilizing by hot air is a poor alternative to

autoclaving since it is suitable only for metal instruments
and a few natural suture materials.
 Boiling instruments is now regarded as an unreliable
means of sterilization and is not recommended as a routine
in hospital practice.
 AUTOCLAVING
 Steam sterilization (autoclaving) for 20 minutes at 121°C –
132°C or for 30 minutes if the instruments are in wrapped pack.
 Before sterilizing medical items, they must first be disinfected
and vigorously cleaned to remove all organic material.
 Proper disinfection decreases the risk for the person who will
be cleaning the instruments.
Low-Temperature Sterilization Technology:
Hydrogen Peroxide Plasma
 STERILIZATION TECHNIQUES

Plasmatic sterilization
- Is established in a high frequency
electromagnetic field, in a vacuum using ionized
hydrogen peroxide.
- Free radicals are capable of interaction with
cellular membranes and destructive for the life
functions of microorganisms.
 STERILIZATION TECHNIQUES
Chemical sterilization
 Is meant for material that cannot by sterilized by physical means
- thermally unstable.
 The sterilization medium are gases of prescribes composition and
concentration.
 Happens in a machine at a given excess pressure or a negative
pressure ( vacuum) at temperature of 80 C.
 Ensure the equipment is properly sealed.
 Formaldehyde sterilization
 Ethylenoxide sterilization
ETHYLENOXIDE STERILIZATION

 Because of its toxic, carcinogenic and mutagenic

properties, ethylene oxide is considered to be a hazardous
gas and as such it is subject to the relevant regulations in
force.

 Low sterilization temperature and high penetration

capacity characterize this form of sterilization.
– The desorption of ethylene oxide must occur within the
sterilization chamber until the ambient concentration has
undoubtedly fallen below the required threshold concentration.
 FORMALDEHYDE STERILIZATION

 As a consequence of its toxic properties, formaldehyde is a

hazardous substance, even though it is less toxic than
ethylene oxide.
– Operating temperatures are between 48 °C and 60 °C.
 For reasons of safety, the sterilizer should always be operated at the
highest temperature tolerated by the sterilization good as stated by the
item’s manufacturer.
 When performed correctly and carefully, the efficacy of formaldehyde
sterilization is comparable to that of ethylene oxide sterilization, with
formaldehyde requiring a shorter aeration time.
 GAMMA RADIATION
 Characterized by deep penetration and low dose
rates, gamma radiation effectively kills microorganisms
throughout the product and its packaging with little
temperature effect.
– Even high-density products such as pre-filled syringes can be
processed and used with confidence.
 Package integrity and efficiency
 Simplicity, reliability and immediate release
 No residuals, no radioactivity
 EXPIRATION OF STERILIZED
MATERIAL
Space of time applicability:

q Glass boxes - from 24 to 48 hours.

q All metal boxes - from usually about 1 week.
q Special paper/combined with foil - from 6
days to 12 weeks (double wrappage).
 SIGN OF STERILIZED MATERIAL

 Date of sterilization process

 Date of expiration
 Code of responsible person
– Responsible person - who has performed the sterilization
and controlled containers integrity and tape control
CONTROL AND DOCUMENTATION OF
STERILIZED MATERIAL
Control
- monitoring of the sterilization process,
- effectiveness of apparatus,
- control the sterility of sterilized materials.

Documentation
- record of data of each sterilization,
- kind of sterilized material,
- name of person who performed sterilization.
 CONTAINERS FOR KEEPING OF
STERILITY

q Glass boxes
q All metal boxes
q Special paper, combined with foil
- with a special tape that change a colour when sterilitation process has
finished.

q Special fabric
STORAGE OF STERILIZED MATERIAL

q Departments of central sterilization - special

aseptic boxes
q During transport - special closed baskets
q At departments - closed cases

 Recommended temperature- 15- 25 C

 Recommended humidity- 40 – 60 %