Sterilization And Disinfectant

CHEMICAL DISINFECTANTS
FOR MEDICAL DEVICES

Mr. Muhammad Ilyas

Lecturer
Deptt. Surgical Technology
Faculty of Allied Health Science
Defination
• Disinfection is the destruction of some but not all
types of microorganisms.
• The suffix -cidal means to kill.
• A bactericidal chemical is one that kills bacteria a
viricidal chemical kills viruses.
• A sporicidal chemical destroys bacterial spores, and a
fungicidal agent is one that kills fungi. The term
germicide (“germ killing,” or germicidal) is commonly
used by the general public but not in medicine.
• Germ is the lay term for infectious microorganism
Selection of Chemical
• The selection of a disinfectant is based on the result
required.
• Some disinfectants are effective at destroying a
limited number of microorganisms; others are very
effective at killing all organisms, including bacterial
spores.
• Some are extremely corrosive, whereas others are
relatively harmless to common materials found in the
hospital.
• Factors that affect a disinfectant’s activity (or “-cidal”
ability) include the following:
1. Concentration of the solution:
Every chemical disinfectant is used at a prescribed
dilution. Chemicals may require premixing with water.
This must be done with a measuring device.
2. The bioburden on the object:
As the bioburden increases, the effectiveness of the
disinfectant may decrease.
3. Water hardness and pH:
The mineral content and pH of the water used for
dilution may alter the action of the chemical
4. Presence or absence of organic matter on the
item:
Nearly all disinfectants are weakened in the presence of
organic material such as blood, sputum, or tissue
residue. Therefore,items to be disinfected must undergo
cleaning (removal of
organic debris and soil) and thorough drying before the
disinfection process.
Precautions and Hazards
• Many disinfectants are unsafe for use on human
tissue, including skin.
• This means that employees must be extremely
cautious when handling them.
• Warnings and instructions for use must be strictly
followed.
• Do not be misled by the mild odor of some
disinfectants. Many chemicals do not emit noxious
fumes but they are still toxic.
• Every health care facility is required by law to provide
employees with information about hazards in their
work environment.
• This includes specific training and information about
the chemicals they handle.
• Every chemical used in the workplace has a
corresponding Material Safety Data Sheet (MSDS), as
mandated by OSHA
• The MSDS describes the chemical, potential hazards,
and what to do if the chemical comes in contact with
the skin or is splashed into the eyes.
• The MSDS for each chemical is easily accessed and
should be read by all who work in the perioperative
environment.
Safety Guidelines for
Disinfectants
• All disinfectants should be stored in well-ventilated
rooms,and their containers should be kept covered
• All personnel handling disinfectants must wear
personal protective equipment.
• The dilution ratio of a liquid chemical should never be
changed except by hospital protocol.
• A measuring device designated for mixing liquid
disinfectants with water should always be used.
• Personnel should not rely on haphazard techniques or
guesswork when preparing solutions
• Two disinfectants should never be mixed; this could create
toxic fumes or unstable and dangerous compounds.
• Liquid chemicals should be disposed of as directed by
hospital policy and the chemical’s label instructions.
• Some chemicals are unsafe for disposal through standard
sewage systems.
• An unlabeled bottle or container should never be used and
should be discarded.
• Personnel should always be aware of what chemical is
being used and its specific purpose.
Glutaraldehyde
• Glutaraldehyde is a high level disinfectant that is
sporicidal, bactericidal, and viricidal. It is
tuberculocidal in 20 minutes.
• This disinfectant is weakened considerably by
unintentional dilution, which occurs if instruments are
wet when placed in the immersion tank.
• Glutaraldehyde is also weakened by the presence of
organic matter (tissue debris or body fluids)
• When glutaraldehyde solutions are mixed and kept for
repetitive use, the solution must be completely
renewed after 14 days because it is ineffective after
that time.
• In addition, during its time in use, the solution must be
evaluated often with test strips to ensure that the
proper concentration is maintained (2%
glutaraldehyde).
• Occupational hazards of glutaraldehyde most
commonly arise when the solution is kept in open
immersion baths in a poorly ventilated work area.
• The safe levels of formaldehyde or glutaraldehyde in
the air are under 0.2 ppm.
• Any amount over that causes irritation of the eyes and
nasal passages.
• Glutaraldehyde is toxic to tissue; items that have been
disinfected or sterilized in glutaraldehyde must be
completely rinsed with sterile distilled water before
they are used on a patient
Orthophthalaldehyde
• Orthophthalaldehyde 0.55% (Cidex OPA) is a non–
glutaraldehyde-based, high level disinfectant that can
be used for immersible medical devices.
• Instruments and equipment are thoroughly cleaned,
dried, and placed in the solution for 12 minutes.
• The items must be thoroughly rinsed with water three
times
• . Items not properly rinsed will stain the skin of the
handler or the patient.
• Orthophthaldehyde has a shelf life of 14 days; daily
testing is required to ensure that the concentration of
the disinfectant is at the required level.
HIGH LEVEL DISINFECTION
• High level disinfection (HLD) is a process in which
most but not all microorganisms are killed with a liquid
disinfectant.
• HLD does not usually destroy bacterial spores;
therefore it is used only for instruments that will be
used in semicritical areas of the body (e.g., nonintact
skin and mucous membranes). Instruments and other
items that are semicritical include:
• Anesthesia equipment
• Gastrointestinal endoscopes
• Bronchoscopes
• Respiratory therapy equipment
• HLD is used for flexible and rigid endoscopes that are
used in noncritical areas of the body.
• Processing takes place in a special area of the
operating room adjacent to or near the point of use,
such as the endoscopy department or cystoscopy
suite.
• The process uses a commercial reprocessing unit, or
the instrument is simply soaked in a large basin or
tray.
• Before any instrument is disinfected, it must be
thoroughly cleaned to remove all traces of blood,
tissue, and body fluids.
• Cleaning proceeds in a systematic fashion so that no
areas are overlooked
Important Guidelines
for Processing Endoscopes
Manual Cleaning
• Always wear personal protective equipment when
reprocessing instruments in a chemical solution.
• Always leak-test any flexible endoscope before
cleaning.
• Submerge the instrument in detergent solution and
clean all surfaces with a clean cloth.
• Use a suction pump and syringe to flush detergent
through the instrument channels and ports.
• A soft brush can be used to clean channels.
• After cleaning the instrument completely, rinse it
indeionized water to remove all traces of detergent.
• Inspect the instrument for any soil or debris missed
during cleaning.
• If any debris remains, repeat the cleaning process,
including all channels, valves, and stopcocks.
• Remove all water from the instrument channels and
exterior.
• Low level compressed air may be used to dry
channels, valves, and stopcocks
High Level Disinfection
• Processing should be done just before use.
• If an automatic reprocessor is used, following the
manufacturer’s guidelines exactly.
• Make sure the instrument is completely dry before
submerging it in disinfectant.
• For manual processing of items in a tray or basin,
make sure all channels are filled with solution.
• Cover the tray and start timing.
• Do not add any instruments or change the dilution
after processing has begun.
• When timing is complete, remove the item and rinse
thoroughly according to operating room policy at least
three times to remove all traces of disinfectant
LOW LEVEL DISINFECTION:
NONCRITICAL AREAS
• Low level disinfection is performed on equipment that
comes in contact with skin but not mucous
membranes or any other tissue.
• The process of low level disinfection kills most, but not
all, bacteria and viruses.
• This category of disinfection is performed on patient
care items, transport devices, and furniture, such as:
• Operating room table and accessories
• Furniture in the surgical suite
• Floors and walls
• Intravenous (IV) stands
• Stretchers
• Blood pressure cuffs
• Stethoscopes
• Low level disinfection is performed as part of routine
decontamination of the operating room and in all patient
care settings.
 ENVIRONMENTAL
DISINFECTANTS
• Environmental disinfectants are used for routine low
level disinfection and terminal decontamination.
• These disinfectants contain enzymes and other
chemicals that destroy or inhibit microbes by changing
cell proteins (denaturation) or by drying (desiccation)
them
PHENOLICS
• Phenol (carbolic acid) is formulated as a detergent for
hospital cleaning.
• It is not sporicidal, but it is tuberculocidal,
• fungicidal, viricidal, and bactericidal.
• Because scant information is available on the specific
effects of phenol on microorganisms, its use is
restricted to disinfection of noncritical items.
• It is extremely important to follow the manufacturer’s
instructions for dilution and mixing, because phenolic
mixtures can be very toxic.
• Phenol has a very noxious odor and causes skin
lesions and respiratory irritation in some individuals
QUATERNARY AMMONIUM
COMPOUNDS
• Quaternary ammonium compounds, or quats, are
fungicidal and bactericidal but not effective at killing
spores.
• This group of disinfectants is less effective in hard
water, which can limit their use in some regions.
• Benzalkonium chloride and dimethyl benzyl
ammonium chloride are common quaternary
ammonium compounds widely used as disinfectants
HYPOCHLORITE
• Hypochlorite is sporicidal and
tuberculocidal and effective against the
human immunodeficiency virus (HIV).
• The CDC (centers for disease control and
prevention) recommends this product for
use in spot cleaning of blood spills,
because it is very fast acting.
• However, it is deactivated in the presence
of organic material; therefore, the area
must be cleaned before hypochlorite is
applied.
• The chemicals in the hypochlorite family are not used
on instruments, because they are corrosive.
• However, they are widely used for environmental
cleaning, because they are effective and inexpensive.
• Sodium hypochlorite, for example, is common
household bleach. Hypochlorite must be diluted
properly to prevent respiratory irritation and skin
burns
ALCOHOL
• Alcohol is a commonly used disinfectant that is composed of
two components: ethyl alcohol and isopropyl alcohol.
• Both are water-soluble (mix easily in water).
• Alcohol is not sporicidal, but it is bactericidal, tuberculocidal,
and viricidal.
• It is effective against cytomegalovirus and HIV.
• Alcohol’s optimum disinfection ability occurs at a 60% to
70% dilution.
• Alcohol must never be used on surgical instruments,
because it is not sporicidal and very corrosive to stainless
steel.
• Alcohol greatly reduces the number of bacteria on skin
when used as a surgical handrub.
• However, it also removes fatty acids from the skin and
has a drying effect when used routinely
• Because it is highly flammable and volatile, alcohol
must never be used around electrosurgery
instruments or lasers.
• It must be stored in a cool, well-ventilated area.
• Skin preparation solutions that contain alcohol must
be allowed to dry completely before draping.