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CENTRAL STERILIZATION AND SUPPLIES DIVISION. Infection Control Nursing Officer Infection Control Unit Teaching Hospital Jaffna. Definition of terms. Sterilization – complete elimination or destruction of all forms of microbial life (including spores) - PowerPoint PPT Presentation
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Infection Control Nursing OfficerInfection Control Unit
Teaching HospitalJaffna.
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Definition of terms
Sterilization – complete elimination or destruction of all forms of microbial life (including spores)
Disinfection – elimination of micro-organisms on inanimate objects with the exception of bacterial spores
Antisepsis – prevention of infection of tissues and body surfaces by application of germicides
Cleaning – the removal of visible soil (eg; inorganic and organic material) from objects and surfaces
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Disinfection and sterilization practices are essential for ensuring that medical and surgical instruments do not transmit infectious pathogens to patients
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Instruments and items for patient care are divided into 3 categories based on the degree of risk of infection involved in the use of the items
1. Critical/ high risk items2. Semicritical/ intermediate risk items3. Non critical/ low risk items
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1. Critical / high risk items
Objects that enter sterile body tissue or vascular system
Any microbial contamination could result in disease transmission
Must be sterile
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2. Semi-critical / intermediate risk items
Items that come in contact with intact mucous membranes
Generally resistant to infection by common bacterial spores but susceptible to other micro-organisms
Need not be sterile; disinfection acceptable
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3. Non-critical / low risk items Items that come into contact with intact skin
but not mucous membranes
Intact skin is an effective barrier to most micro-organisms, hence low risk of disease transmission
Thorough cleaning is adequate with low level disinfection as necessary
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Factors influence the sterilization processThe temperature of sterilization The period of sterilizationInactivation by organic matterWhether the article was cleaned before
sterilization The sterilization cycle can be divided into
three periods:a.Heating up periodb. Holding periodc. Cooling period
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ObjectiveTo reduce hospital associated infections and protect patients, employees, health care students and visitors.
The functional flow of activities in CSSD
RINSINGCLEANINGDRYINGINSPECTION AND ASSEMBLYPACKAGINGLABELLINGSTERILIZATIONSTORAGEDISTRIBUTION
RINSING
Rinsing of articles after use should not be permitted in patient care areas unless carried out by a trained member of the staff.
CLEANING
All reusable medical devices should be thoroughly cleaned prior to disinfection or sterilization.
DRYING
All articles should be dried appropriately
INSPECTION AND ASSEMBLY
Each item should be inspected for functionality, defects, breakage and then appropriately assembled.
PACKAGING
Articles should preferably be packed in porous material.
LABELLINGEach pack should be marked with nomenclature of the article, contents of the pack, initials of the person who packed it, date and initials of the person who carried out the sterilization.
STORAGEShould be properly managed separately for sterile and non-sterile stores. For sterile goods, clean room conditions should be followed.
Sterile pack should be stored 20-25 cm from the floor, 45-50 cm from the ceiling, 15-20 cm on out side of the wall.
DISTRIBUTION
Refers to clean and dirty articles exchange system. A program should be established for the collection of used items from patient care areas and distribution of sterilized goods.
Moist heat sterilization Moist heat kills microorganisms by coagulating
and denaturing enzymes and structural proteins
Applied in the form of steam Steam under pressure is used to achieve a
higher temperature 4 parameters of steam sterilization1. Steam – saturated and dry steam without air2. Pressure – 2.4 bar / 15lb3. Temperature – 1210C
4. Time - 20 min
Autoclaving at 1210C at 15 lb pressure for 20 min is acceptable for routine hospital use 20
Moist heat sterilization…
Advantages Non toxic Inexpensive Rapid action Good penetration ability
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Sterilization by dry heat
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Dry heat penetrates less well and is less effective than moist heat
Consequently, higher temperatures and longer periods are required for sterilization with dry heat
Used for sterilization of -sharp cutting instruments and -laboratory glass wear -powder, oil
Sterilization by dry heatTotal cycle may be several hours, hence hot
air ovens should have Time lock on the door - items cannot be added
or removed during, the cycleFan to distribute the heat evenly
Dry heating at 1600C for for 2 hours is acceptable for routine
hospital use
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Monitoring of sterilizationMechanical indicators – Observe the machine's
dials and gauges - temperature, pressure, timeChemical indicators – changes colour on
exposure to the appropriate sterilization cycleAutoclave strips Bowie Dick test
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Monitoring of sterilization…Biological indicators – bacterial spores
which require high temperatures to lose viability – spore strips, self contained vials
Geobacillus stearothermophilus – for steam or chemical vapor sterilization
Bacillus subtilis -for dry-heat or ethylene oxide gas sterilization
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StorageOnce sterilized, the instruments should be
maintained in a sterile state until they are used again
Improper storage would result in a break of the 'chain of Sterility'
The expected 'shelf-life' of a sterile package is depend on the type of area in which it is stored and the material used for packaging
A closed, protected area with a minimal airflow such as a cabinet or drawer that can easily be disinfected is preferable to an open stacking system
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DisinfectionMethodsHeat –
Pasteurization - 63-66 0C for 30 min 72 0C for 15 sec. (the flash method)
Boiling - bacterial spores can survive
Physical – ultrasonic, UV radiation - used for
removing debris (cleaning) prior to autoclaving
Chemical
Disinfectant used for one purpose may not be equally effective for another
The antimicrobial activity falls in the presence of organic debris
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Disinfection & Sterilization2% Glutaraldehyde (cidex)
- 2% Alkaline solution- Needs activation- Sterilization time – 10 hours- Disinfection time – 20 mins- Activated solution – 2 weeks/20 times- Sterilization/HLD of heat sensitive items - Irritant to skin, eyes & respiratory tract - Should be handled in a well ventilated area- Should wear protective clothing
- Fixation of protein
Disinfection & Sterilization (cont.)Para Safe
- Combination of per oxygen compound, activator & stabilizer- Non-corrosive- Non-irritant to skin- Eye irritation - No toxic residues- Expensive- Stable for 24 hours only
Disinfection & Sterilization (cont.)Chlorine releasing agents
- Sodium hypochlorite, Calcium hypochlorite, Chlorine granules- Active against bacteria, viruses, fungi & some spores- Less active against mycobacteria - Contact time 20-30 mins - Rapidly inactivated by organic matter- Corrosive to metal - Do not add powder to water- Avoid contact with acid/acidic body fluids e.g.- urine- Avoid contact with skin, eyes & mucus membrane - Unstable - daily preparation is necessary - Blood & body fluid spillages – 1% solution (10000 ppm) - General environmental cleaning – 0.1% (1000 ppm)
Disinfection & Sterilization (cont.)Alcohol
- 70% - 90% Ethyl alcohol/ Isopropyl alcohol- Rapidly active against vegetative bacteria & mycobacteria - Viruses – variable activity - Not sporicidal - Only on clean surfaces - Disinfection of items that cannot be immersed in other disinfectants e.g.- electric equipment- Skin anti-sepsis
Disinfection & Sterilization (cont.)Chlorhexidine – 4%-5% (Hibiscrub/Hibitane)
- Active against Gram positive organisms & fungi- Poorly active against Gram negative organisms- Non toxic- Good residual activity- Pre operative skin disinfection/Surgical hand washing- Savlon – 1.5% Chlorhexidine + 15% Cetrimide Poor bactericidal activity
Disinfection & Sterilization (cont.)Chlorhexidine – 4%-5% (Hibiscrub/Hibitane)
- Active against Gram positive organisms & fungi- Poorly active against Gram negative organisms- Non toxic- Good residual activity- Pre operative skin disinfection/Surgical hand washing- Savlon – 1.5% Chlorhexidine + 15% Cetrimide Poor bactericidal activity
Principles of disinfectionObjects that cannot be heat-treated, should be
disinfected by chemicalsClean the article before disinfectionDilution of concentrates should be accurately
measuredConsider the range of activity, toxicity and costBeware of inactivating substances Use fresh disinfectant solutionsUse clean containersNever 'Top up' disinfection containersItem should kept in contact with the disinfectant
for the required time period and no longer than that
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Chemical disinfectants…Factors affecting the effectiveness/usefulness
of chemical disinfectionRange of activitySatisfactory contactConcentrationpH- alkaline for gluta. and acid for phenolsNeutralization- organic matter, hard water,
soapStabilitySpeed of action- high-hypochloriteCost Potency- high, intermediate, low Lack of adverse effects
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Commonly used disinfectants
Antimicrobial activity
Disinfectant Vegetative bacteria
mycobacteria virus spores
Glutaraldehyde + + + +Hypochlorite + + + +Phenolics + + +(poor) _Alcohol + +(limited) + _Chlorexhidine + _ _ _Povidone-iodine + +(prolong
contact)+ +/-
QAC + _ +(limited) _ 37
Chemical agents used as high-level disinfectants
High level disinfectant
Advantages Disadvantages
Glutaraldehyde (2%)
Relatively inexpensive
Excellent material compatibility
Needs activation
Respiratory irritation
Allergic contact dermatitis
Irritating odor
Hydrogen peroxide (3%)
No activation required
Enhance removal of organic matter and organisms
No odor or irritation
Corrosive
Eye damage with contact
Ortho-phthalaldehyde (0.55%)
Fast acting
No activation required
Good material compatibility
No odor
Stains skin, MM, clothing and environmental surfaces
Expensive
Eye irritation
Peracetic acid (0.2-0.35%)
Good material compatibility
Fully automated system
Environmental friendly by-products
Effective in the presence of organic matter
Expensive
Unstable
Small no. of items only per cycle
Serious eye and skin damage on contact
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Sterilizing medical itemsHigh risk
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Surgical instruments, lumber puncture sets, surgical dressings, surgical protective clothes, rubber gloves, soiled or fouled linen, Tracheostomy tubes
Autoclave
Cannulae & catheters, Prosthesis Nasogastric tubes, endothracheal tubes, syringes and needlesIV Infusions
Radiation
Endoscopes (1) 2% glutaraldehyde for 20 min. (2)0.34%peracetic acid-:10min Thereafter, rinse scope and channels with sterile water
Intermediate risk -High level disinfection
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Thermometer Wipe with 70% alcohol swab & store dry
Vaginal speculem Tongue depressor Proctoscope
Wash with detergent & water and boil for 20 minutes(In high risk patients - autoclave)
Respiraotry equipment; Eg: Masks
Wash thoroughlyDry & wipe over with 70% alcohol
AirwaysAmbu bagTubing
Disinfect by heat or using 2% glutaraldehyde for 30 min.After immersing in glutaraldehyde, rinse thoroughly in sterile water
Nebulizer Use sterile water for nebulization Clean with detergent and hot water after each patient. Tubing can be immersed in 2% glutaraldehyde for 30 min.
Low risk- cleaning and low level disinfection
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Floors Mop with hot water & detergent
Walls Clean with hot water & detergent
Cutlery & crockery Liquid detergent & hot water
Linen All hospital laundry must be heat disinfected
Bed pans, urinals Empty the contents into toilet. Fill the utensil with phenolics, leave for 5min. & wash with water
Management of a blood spillWear heavy duty glovesSoak the spill with an absorbent materialCover with 1% Sodium hypochlorite Leave for 20 minutes Clean
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Take home messageIn failure of sterilization and disinfection
Increase morbidity and mortalityLonger hospital stayExpensive antibioticsIncrease work load- doctors, nurses, laboratoryExtra cost to the state!
Apply your knowledge appropriately43
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