ASEPTIC TECHNIQUES STERILIZATION & DISINFECTION

SU 14.1

Dr Sanjeev R Navalyal
Asst. Prof. Dept. of General Surgery
KLE’S JGMMMC Hubballi

Source
Accessible version
https://www.cdc*.gov/infection control
*US Centers for Disease Control & Prevention / Updated June 2024
 INTRODUCTION
Each procedure involves contact by medical device / instrument with patient’s
sterile tissue / mucosa
MAJOR RISK
Introduction of pathogens leading to infection
Risk with breach of host barriers / person to person transmission (hepatitis B )
Transmission of environmental pathogens (Pseudomonas aeruginosa)
Disinfection & sterilization are essential for surgical instruments
Must identify items intended to use
Whether cleaning /disinfection / sterilization is indicated
 DEFINITION OF TERMS

STERILIZATION

Process carried out in health care facilities by physical / chemical methods that

destroys / eliminates all forms of microbial life

CHEMICAL STERILANTS

Chemicals used to destroy all forms of microbiologic life

Same germicides used for shorter exposure periods can be part of disinfection

process (high-level disinfection)

 DISINFECTION
Process that eliminates many / all pathogenic microorganisms except bacterial
spores on inanimate objects disinfection is not sporicidal

CHEMICAL STERILANTS
Disinfectants that kill spores with prolonged exposure times (3–12 hours)
HIGH LEVEL DISINFECTANTS
At similar concentrations but with shorter exposure periods (20 min.)
disinfectants that kill all microorganisms except large numbers of bacterial spores
LOW LEVEL DISINFECTANTS
Can kill most vegetative bacteria / fungi /viruses in period of time (≤10 minutes)
INTERMEDIATE LEVEL DISINFECTANTS
Might be cidal for mycobacteria / vegetative bacteria /viruses / fungi but do not
kill bacterial spores
 CLEANING
Removal of visible soil (organic & inorganic material) from objects & surfaces
accomplished manually / mechanically using water with detergents / enzymatic
products

DECONTAMINATION
Removes pathogenic micro-organisms from objects so they are safe to
handle / use / discard
 GERMICIDE
Agent that can kill pathogenic organisms & includes both antiseptics &
disinfectants

ANTISEPTICS
Germicides applied to living tissue & skin & not for surface disinfection

DISINFECTANTS
Antimicrobials applied only to inanimate objects & are not used for skin
antisepsis as they injure skin & other tissues
 RATIONAL APPROACH TO DISINFECTION & STERILIZATION
Instruments & items for patient care are categorized as Critical / semi-critical &
Non-critical according to degree of risk for infection involved in use of the items

CRITICAL ITEMS
Objects that enter sterile tissue / vascular
Surgical instruments
Cardiac & urinary catheters
Implants & ultrasound probes used in sterile body cavities
 SEMI-CRITICAL ITEMS

Items that contact mucous membranes / non-intact skin

Respiratory therapy & anesthesia equipment

Endoscopes / laryngoscope blades / esophageal Manometry probes

Cystoscopes / anorectal manometry catheters & diaphragm fitting rings

Laparoscopes & arthroscopes

 NON-CRITICAL ITEMS

Those that come in contact with intact skin but not mucous membranes

NON-CRITICAL PATIENT CARE ITEMS

Bedpans / blood pressure cuffs /crutches & computer monitors

NON-CRITCAL ENVIRONMENTAL SURFACES

Bed rails / food utensils / bedside tables / patient furniture & floors

Mops & reusable cleaning cloths

 DISINFECTION OF HEALTHCARE EQUIPMENT
REPROCESSING OF ENDOSCOPES
All heat sensitive endoscopes must be properly cleaned & subjected to high-
level disinfection after each use
FDA CLEARED & MARKETED FORMULATIONS
 ≥2.4% Glutaraldehyde
 0.55% ortho-phthalaldehyde (OPA)
 0.95% glutaraldehyde with 1.64% phenol / phenate
 7.35% hydrogen peroxide with 0.23% peracetic acid
 1.0% hydrogen peroxide with 0.08% peracetic acid
 7.5% hydrogen peroxide
Reprocessing Of Endoscopes Contd’

PRODUCT MOST COMMONLY USED

GLUTARALDEHYDE
Without surfactants as the soapy residues of surfactants are difficult to remove
during rinsing
FDA cleared labels for high-level disinfection with >2% glutaraldehyde at 25°C
range from 20-90 minute with adequate cleaning prior to disinfection
ORTHO-PHTHALALDEHYDE
Advantages over glutaraldehyde is not known to irritate the eyes & nasal
passages
Does not require activation / exposure monitoring
Has a 12-minute high-level disinfection
Reprocessing Of Endoscopes Contd’

EtO STERILIZATION
Ethylene Oxide sterilization process utilizes a gas to eliminate microorganisms
EtO is flammable / toxic & carcinogenic
Infrequently done as it requires lengthy processing & aeration time (12 hours)
Is a potential hazard to staff & patients

AUTOMATED ENDOSCOPE REPROCESSORS (AER)

They automate & standardize several important reprocessing steps reduce the
likelihood that an essential reprocessing step will be skipped
Reduce personnel exposure to high-level disinfectants / chemical sterilant
 REPROCESSING LAPAROSCOPES
HIGH-LEVEL DISINFECTION VERSUS STERILIZATION

PROPONENTS OF HIGH-LEVEL DISINFECTION

Cite a low risk for infection (<0.3%) when high-level disinfection is used
With advent of laparoscopic cholecystectomy concern about high-level
disinfection is justifiable

PROPONENTS OF STERILIZATION
Focus on possibility of transmitting infection by spore forming organisms
 REPROCESSING ARTHROSCOPES
 High-level disinfection rather than sterilization has been used because the

incidence of infection is low

 Laparoscopes / arthroscopes & other scopes that enter normally sterile tissue

should be sterilized before each use

 If this is not feasible they should receive at least high-level disinfection
 DISINFECTION OF ENDOCAVITARY PROBES IN SONOGRAPHIC SCANNING
Use of new condom/probe cover for the probe for each patient
The probe also should be high-level disinfected
Condoms have been found superior to probe covers for covering ultrasound
probe (1.7% for condoms versus 8.3% leakage for probe covers)

DISINFECTION OF HBV / HCV / HIV

CDC recommendation for high-level disinfection is appropriate
EtO is not routinely used because of lengthy processing time
 SURFACE DISINFECTION
Non-critical medical equipment surfaces should be disinfected low- or
intermediate-level disinfectant
Use a germicidal detergent on noncritical surfaces
Use products that have the shortened contact time

AIR DISINFECTION
Disinfectant spray-fog techniques in hospital rooms is an unsatisfactory method
Filtration / ultraviolet germicidal irradiation /chlorine dioxide to reduce air
contamination are used
 CHEMICAL DISINFECTANTS
ALCOHOL
OVERVIEW
Two water soluble chemical compounds
ETHYL ALCOHOL
ISOPROPYL ALCOHOL
 FDA has not cleared any liquid chemical sterilant / high-level disinfectant with
alcohol as the main active ingredient
 They are rapidly bactericidal than bacteriostatic
 Activity drops when diluted below 50% concentration
 Optimum bactericidal concentration is 60%–90% solutions in water(v/v)
Chemical Disinfectants / Alcohol Contd’

MODE OF ACTION OF ALCOHOL

Denaturation of proteins
Inhibition of production of metabolites essential for rapid cell division
MICROBICIDAL ACTIVITY
PSEUDOMONAS AERUGINOSA & E. COLI
Was killed in 10 seconds by ethanol from 30% to 100% (v/v)
GRAM-POSITIVE STAPHYLOCOCCUS AUREUS & STREPTOCOCCUS PYOGENES
More resistant being killed in 10 seconds by ethyl alcohol 60%–95%(v/v)
HERPES / INFLUENZA / ADENOVIRUS /ROTAVIRUSES
Ethyl alcohol at concentrations of 60%–80% is a potent virucidal agent
Chemical Disinfectants / Alcohol Contd’

USES OF ALCOHOL
Disinfect oral & rectal thermometers / hospital pagers / scissors / stethoscopes
Disinfect fibreoptic endoscopes / rubber stoppers of vials / vaccine bottles

SHORTCOMINGS OF ALCOHOL
 Damage mountings of lensed instruments
 Tend to swell & harden rubber / plastic tubing
 Are flammable & must be stored in cool well-ventilated area
 Evaporate rapidly making extended exposure time difficult to achieve
Chemical Disinfectants Contd’

CHLORINE & CHLORINE COMPOUNDS

OVERVIEW
LIQUID
Sodium hypochlorite
SOLID
Calcium hypochlorite
MODE OF ACTION
 Oxidation & Chlorination of amino acids
 Loss of intracellular contents / Inhibition of protein synthesis
 Decreased uptake of nutrients / oxygen / ATP production
 Decreased breaks in DNA & depressed DNA synthesis
Chemical Disinfectants / Chlorine & Chlorine Compounds Contd’

MICROBICIDAL ACTIVITY OF CHLORINE & CHLORINE COMPOUNDS

 Low concentrations have biocidal effect on mycoplasma & vegetative bacteria
 Higher concentrations are required to kill M. tuberculosis
 Inactivate Clostridium difficile spores in ≤10 minutes
 Can inactivate HIV / inhibit Candida after 30 seconds of exposure

USES OF CHLORINE & CHLORINE COMPOUNDS

 Decontaminating small spills of drops of blood on noncritical surfaces
 Recommended for self disinfection of needles & syringes
 Recommended for decontaminating CPR training manikin for 10 minutes
 Used as disinfectant in contaminated hospital water treatment
Chemical Disinfectants Contd’

FORMALDEHYDE

OVERVIEW
 Used as disinfectant & sterilant in both liquid & gaseous states

 Sold & used as water based solution called formalin (37% formaldehyde)

 Aqueous solution is bactericide / tuberculocide / fungicide / virucide / sporicide

 Should be handled in workplace as potential carcinogen

 Set exposure standard that limits an 8-hour time weighted average exposure

 Ingestion can be fatal & long term exposure can cause asthma / dermatitis
Chemical Disinfectants Formaldehyde Contd’

MODE OF ACTION OF FORMALDEHYDE

Inactivates micro-organisms by alkylating amino groups of proteins & nitrogen
MICROBICIDAL ACTIVITY
Inactivation of poliovirus in 10 minutes at 8% concentration
4% formaldehyde is tuberculocidal
2.5% inactivates Salmonella Typhi in 10 minutes
Requires 2 hours of contact to achieve an inactivation factor
USES
Prepare viral vaccines / embalming agent / preserve anatomic specimens
Sterilize surgical instruments
Disinfect internal fluid pathways of dialysis machines
Chemical Disinfectants Contd’
GLUTARALDEHYDE
OVERVIEW
Once activated has a shelf life of minimally 14 days
Possess microbicidal & anticorrosion properties
MODE OF ACTION
Alkylation of amino groups of microorganisms
Alters RNA / DNA / & protein synthesis
MICROBICIDAL ACTIVITY
Vegetative bacteria/M.tuberculosis /fungi /viruses /spores of Bacillus clostridium
USES
High-level disinfectant of endoscopes / tubing / dialyzers / laparoscopic
disposable trocars
Chemical Disinfectants Contd’

HYDROGEN PEROXIDE
OVERVIEW
Has bactericidal / virucidal / sporicidal / fungicidal properties
MODE OF ACTION
Destructive hydroxyl free radicals that attack membrane lipids / DNA
MICROBICIDAL ACTIVITY
 Bactericidal & virucidal activity in 1 minute
 Mycobactericidal & fungicidal activity in 5 minutes
 S. Aureus requires 30–60 minutes of exposure to 0.6% hydrogen peroxide
 E. Coli / Streptococcus / Pseudomonas required only 15 minutes’ exposure
USES
Disinfecting contact lenses / ventilators / endoscopes/ fabrics in patients’ rooms
Chemical Disinfectants Contd’
PHENOLICS / PHENOL
Ortho- phenylphenol & ortho-benzyl-para- chlorophenol
Are absorbed by porous materials & residual disinfectant can irritate tissues
MODE OF ACTION
Protoplasmic poison penetrating & disrupting cell wall / precipitating cell protein
Bacterial death by inactivation of essential enzyme systems
Leakage of essential metabolites from cell wall
MICROBICIDAL ACTIVITY
Bactericidal / fungicidal / virucidal / tuberculocidal
USES
Disinfectants for use on environmental surfaces
Pre clean / decontaminate critical & semi-critical devices before terminal
 STERILIZATION

OVERVIEW

Medical & surgical devices are made of materials that are heat stable

Undergo heat / primarily steam sterilization

Devices & instruments made of plastics require low temperature sterilization

Ethylene oxide gas has been used for heat & moisture sensitive medical devices
NEW LOW TEMPERATURE STERILIZATION SYSTEMS

Hydrogen peroxide gas plasma

Peracetic acid immersion

 STEAM STERILIZATION
OVERVIEW

Moist heat / saturated steam under pressure is most widely used & dependable

Non toxic / inexpensive / microbicidal / sporicidal & penetrates fabrics

DELETERIOUS EFFECTS

Corrosion & combustion of lubricants associated with dental hand pieces

Reduction in ability to transmit light associated with laryngoscopes

Increased hardening time with plaster cast

 BASIC PRINCIPLE OF STEAM STERILIZATION

Expose each item to direct steam contact at required temperature & pressure for
specified time

PARAMETERS OF STEAM STERILIZATION

Steam

Pressure

Temperature

Time
Steam Sterilization Contd’

IDEAL STEAM

Dry saturated steam & entrained water (dryness fraction ≥ 97%)

PRESSURE

To obtain high temperatures necessary to quickly kill microorganisms

TEMPERATURES

Sterilizing temperatures are 121°C (250°F) & 132°C (270°F)

MINIMUM EXPOSURE PERIOD

Wrapped health care supplies are 30 minutes at 121°C (250°F) in gravity

displacement sterilizer
4 minutes at 132°C (270°C) in pre vacuum sterilizer
Steam Sterilization Contd’

TYPES OF STEAM STERILIZERS / AUTOCLAVES

*GRAVITY DISPLACEMENT AUTOCLAVE

*HIGH SPEED PRE VACUUM STERILIZER

GRAVITY DISPLACEMENT AUTOCLAVE

Steam is admitted at top / sides of sterilizing chamber

Forces air out at bottom of chamber

PRIMARY USE

Process laboratory media / water / pharmaceutical products / non porous articles

Steam Sterilization Contd’

HIGH-SPEED PRE-VACUUM STERILIZERS

Fitted with vacuum pump/ejector to ensure air removal from sterilizing chamber
& load before steam is admitted
ADVANTAGES
Instantaneous steam penetration into porous load

PORTABLE (TABLE-TOP) STEAM STERILIZERS

Are used in outpatient / dental & rural clinics 840
Designed for small instruments (syringes / needles & dental instrument)
Steam Sterilization Contd’

MODE OF ACTION OF STEAM STERILIZERS

Moist heat destroys microorganisms by irreversible coagulation & denaturation

of enzymes & structural proteins

USES OF STEAM STERILIZERS

Used on all critical & semi-critical items that are heat & moisture resistant

Decontaminate microbiological waste & sharps containers

 ETHYLENE OXIDE "GAS" STERILIZATION

ETO is a colorless gas that is flammable & explosive

ESSENTIAL PARAMETERS / OPERATIONAL RANGES

Gas concentration (450 to 1200 mg/l)

Temperature (37 to 63°C)

Relative humidity (40 to 80%)

Exposure time (1 to 6 hours)

Ethylene Oxide "Gas" Sterilization Contd’

STAGES OF ETO STERILIZATION

Preconditioning & humidification
Gas introduction
Exposure
Evacuation
Air washes
DURATION
Takes approximately 2 1/2 hrs excluding aeration time
Mechanical aeration for 8-12 hrs at 50-60°C allows desorption of toxic residue
Ambient room aeration requires 7 days at 20°C
Ethylene Oxide "Gas" Sterilization Contd’

MODE OF ACTION OF ETO

Alkylation of protein / DNA & RNA of micro-organisms
Prevents normal cellular metabolism & replication

USES OF ETO
Sterilize critical items that are moisture / heat sensitive
Without deleterious effects on material
Those that cannot be sterilized by steam sterilization
Ethylene Oxide "Gas" Sterilization Contd’

DISADVANTAGES OF ETO

Lengthy cycle time / cost / potential hazards to patients & staff

Acute exposure may result in irritation to skin / eyes / GI / respiratory tracts

Central nervous system depression / Seizures

Formation of cataracts / cognitive impairment /neurologic dysfunction

Increased risk of spontaneous abortions & various cancers

 OTHER STERILIZATION METHODS
IONIZING RADIATION
Cobalt 60 gamma rays / electron accelerators / low temperature sterilization
Used tissue for transplantation / pharmaceuticals / medical devices
Suitable for large scale sterilization
No FDA cleared ionizing radiation sterilization processes for healthcare facilities
DELETERIOUS EFFECTS
Induced oxidation in polyethylene & delamination & cracking in polyethylene
knee bearings
 DRY HEAT STERILIZERS

Used only for materials that might be damaged by moist heat

Impenetrable to moist heat ( powders / petroleum products / sharp instruments)

TIME-TEMPERATURE RELATIONSHIPS FOR STERILIZATION

170°C (340°F) for 60 minutes

160°C (320°F) for 120 minutes

150°C (300°F) for 150 minutes

Dry Heat Sterilizers Contd’

ADVANTAGES OF HEAT STERILIZERS

Nontoxic & does not harm the environment

Dry heat cabinet is easy to install / low operating costs

Penetrates materials / is noncorrosive for metal & sharp instruments

DISADVANTAGES OF HEAT STERILIZERS

Slow rate of heat penetration & microbial killing / time consuming method

High temperatures are not suitable for most materials

 OZONE
OVERVIEW
Ozone consists of O2 with loosely bonded third oxygen atom
Additional oxygen atom makes it powerful oxidant that destroys microorganisms
COMPATIBILITY
Is compatible with stainless steel / titanium / anodized aluminum / ceramic
Glass / silica / PVC / Teflon / silicone / polypropylene /polyethylene / acrylic
ADVANTAGES
Safe for use by operator because there is no handling of the sterilant
No toxic emissions / no residue to aerate
No danger of an accidental burn
 FORMALDEHYDE STEAM
Formalin vaporized into formaldehyde gas & admitted into sterilization chamber
Formaldehyde concentration of 8-16 mg/l is generated at temperature of 70-75°C
STERILIZATION CYCLE / STAGES
Initial vacuum to remove air from chamber followed by steam into chamber
Followed by series of pulses of formaldehyde gas & steam
Formaldehyde is removed by repeated evacuations & flushing with steam & air
MICROBIAL ACTIVITY
Vegetative bacteria / mycobacteria & Candida albicans
USES
Used in healthcare facilities to sterilize heat sensitive medical equipment
Cycle time is faster than that for ETO & cost per cycle is relatively low
*Has not been FDA cleared for use in healthcare facilities
 RECOMMENDATIONS
DISINFECTION & STERILIZATION IN HEALTHCARE FACILITIES
OCCUPATIONAL HEALTH & EXPOSURE

*Inform each worker of health effects of his / her exposure to infectious agents

(HBV / HCV / HIV]) and/or chemicals (EtO / formaldehyde)

*Educate health care workers in proper use of personal protective equipment

*Ensure that workers wear appropriate PPE to prevent exposure to infectious

agents / chemicals through respiratory system / skin / mucous membranes

*Exclude healthcare workers with weeping dermatitis of hands from direct

contact with patient care equipment

 CLEANING OF PATIENT CARE DEVICES

*Perform cleaning of patient care devices in central processing department

*Meticulously clean patient care items with water & detergent/enzymatic agents

*Remove visible organic residue (blood & tissue) & inorganic salts

*Clean medical devices as soon as practical after use

*Ensure detergents / enzymatic cleaners selected are compatible

*Ensure rinse step is adequate for removing cleaning residues

*Inspect equipment surfaces for breaks

 CLEANING & DISINFECTING ENVIRONMENTAL SURFACES

*Clean housekeeping surfaces (floors / tabletops) on regular basis

*Disinfect environmental surfaces daily / three times per week

*Proper use of disinfecting products (dilution / compatibility / storage/ shelf life)

*Clean walls / blinds & window curtains in patient care areas

*Replace with fresh solution (floor mopping solution every three patient rooms )

*Decontaminate mop heads & cleaning cloths regularly

 METHODS OF STERILIZATION & DISINFECTION
SMOOTH & HARD SURFACE
STERILIZATION STERILIZATION HIGH LEVEL INTERMEDIATE LOW LEVEL
PROCEDURE EXPOSURE DISINFECTION DISINFECTION DISINFECTION
TIME EXPOSURE TIME 12-30 M EXPOSURE TIME ≥1 M EXPOSURE TIME ≥1 M
Heat/steam or 3-30 minutes Glutaraldehyde based Ethyl / isopropyl Ethyl / isopropyl
hot air formulation alcohol (70–90%) alcohol (70–90%)
Ethylene oxide 1-6 hrs Ortho-phthalaldehyde Sodium hypochlorite Sodium hypochlorite
gas processing (OPA) 0.55% Household bleach Household bleach
time & diluted 1:500 diluted
aeration time 1:500
8-12 hrs at 50 -
60°C)
Glutaraldehyde 10 h at 20– Hydrogen peroxide Iodophor germicidal Iodophor germicidal
formulations 25°C (7.35%) hydrogen detergent solution detergent solution
(>2%) peroxide 1% & peracetic
acid 0.08%
 METHODS OF STERILIZATION & DISINFECTION
RUBBER TUBING & CATHETERS
STERILIZATION STERILIZATION HIGH LEVEL DISINFECTION INTERMEDIATE LOW LEVEL
PROCEDURE EXPOSURE EXPOSURE TIME 12-30 M DISINFECTION DISINFECTION
TIME EXPOSURE TIME ≥1 M EXPOSURE TIME ≥1 M
Heat/steam or 3-30 minutes Glutaraldehyde based N/A N/A
hot air formulation
Ethylene oxide 1-6 hrs Ortho-phthalaldehyde N/A N/A
gas processing (OPA) 0.55%
time &
aeration time
8-12 hrs at 50
-60°C)
Glutaraldehyde 10 h at Hydrogen peroxide (7.35%) N/A N/A
formulations 20–25°C hydrogen peroxide 1% &
(>2%) peracetic acid 0.08%
 METHODS OF STERILIZATION & DISINFECTION
POLYETHYLENE TUBING & CATHETERS
STERILIZATION STERILIZATION HIGH LEVEL INTERMEDIATE LOW LEVEL
PROCEDURE EXPOSURE DISINFECTION DISINFECTION DISINFECTION
TIME EXPOSURE TIME 12-30 M EXPOSURE TIME ≥1 M EXPOSURE TIME ≥1 M
Heat/steam or 3-30 minutes Glutaraldehyde based N/A N/A
hot air formulation
Ethylene oxide 1-6 hrs Ortho-phthalaldehyde N/A N/A
gas processing time (OPA) 0.55%
& aeration time
8-12 hrs at
(50 -60°C)
Glutaraldehyde 10 h at 20– Hydrogen peroxide N/A N/A
formulations 25°C (7.35%) hydrogen
(>2%) peroxide 1% & peracetic
acid 0.08%
 METHODS OF STERILIZATION & DISINFECTION
LENSED INSTRUMENTS
STERILIZATION STERILIZATION HIGH LEVEL DISINFECTION INTERMEDIATE LOW LEVEL
PROCEDURE EXPOSURE EXPOSURE TIME 12-30 M DISINFECTION DISINFECTION
TIME EXPOSURE TIME ≥1 M EXPOSURE TIME ≥1 M
Heat/steam or 3-30 minutes Glutaraldehyde based N/A N/A
hot air formulation
Ethylene oxide 1-6 hrs Ortho-phthalaldehyde N/A N/A
gas processing (OPA) 0.55%
time &
aeration time
8-12 hrs at
(50 -60°C)
Glutaraldehyde 10 h at 20– Hydrogen peroxide N/A N/A
formulations 25°C (7.35%) hydrogen
(>2%) peroxide 1% & peracetic
acid 0.08%
 METHODS OF STERILIZATION & DISINFECTION
HINGED INSTRUMENTS
STERILIZATION STERILIZATION HIGH LEVEL DISINFECTION INTERMEDIATE LOW LEVEL DISINFECTION
PROCEDURE EXPOSURE EXPOSURE TIME 12-30 M DISINFECTION EXPOSURE TIME ≥1 M
TIME EXPOSURE TIME ≥1 M
Heat/steam or 3-30 minutes Glutaraldehyde based N/A N/A
hot air formulation
Ethylene 1-6 hrs Ortho-phthalaldehyde N/A N/A
oxide gas processing (OPA) 0.55%
time &
aeration time
8-12 hrs at
(50 -60°C)
Glutaraldehyd 10 h at 20– Hydrogen peroxide N/A N/A
e formulations 25°C (7.35%) hydrogen
(>2%) peroxide 1% & peracetic
acid 0.08%
 METHODS OF STERILIZATION & DISINFECTION

STERILISATION METHODS MATERIALS

Autoclave / Steam All theatre appliances / Syringes / Clothes / bed sheets
Glutaraldehyde 2% Sharp instruments (scissors / needles / blades) plastic
materials. Endoscopes / Rubber equipment / Ward / furniture
Hot air oven Syringes / Lab glassware
Gamma radiation Disposable articles
Ethylene oxide Heart lung machine
Lysol Sharp instruments (scissors / needles / blades) plastic
materials / Excreta / Cleaning ward
Iodophors Ward / sick room / furniture / Excreta / Cleaning skin before
surgery / infected wounds / Hand wash
 ADVANTAGES & DISADVANTAGES OF COMMONLY USED STERILIZATION
TECHNOLOGIES

STERILIZATION ADVANTAGES DISADVANTAGES

METHOD
Steam Non toxic to patient / staff / environment Deleterious for heat sensitive
Easy to control & monitor/ Least affected instruments. Damaged by
by organic / inorganic / soils. Rapid cycle repeated exposure/ leave
time / Penetrates packing devices lumens instruments wet causing to
rust / potential for burns
100% Ethylene Penetrates packaging materials / device Requires aeration time to
Oxide lumens remove ETO residue / Lengthy
(ETO) Simple to operate & monitor/Compatible cycle / Toxic / carcinogen &
with most medical materials inflammable
 FACTORS AFFECTING EFFICACY OF STERILIZATION
FACTORS EFFECT
Cleaning Failure to adequately clean instrument results in higher bioburden / protein load / &
salt concentration & will decrease sterilization efficacy
Pathogen type Spore forming organisms are most resistant to sterilization & contaminating microflora
on used surgical instruments consists of vegetative bacteria
Protein Residual protein decreases efficacy of sterilization
Salt Residual salt decreases efficacy of sterilization more than protein load
Biofilm accumulation Reduces efficacy by impairing exposure of sterilant to microbial cell
Lumen length. Increasing lumen length impairs sterilant penetration & require forced flow through
lumen to achieve sterilization
Lumen diameter Decreasing lumen diameter impairs sterilant penetration & require forced flow
through lumen to achieve sterilization
Restricted flow Sterilant must come into contact with microorganisms. Device designs that prevent /
inhibit this contact (sharp bends / blind lumens) will decrease sterilization efficacy
Device design & Materials used in construction may affect compatibility with different sterilization
construction processes & affect sterilization efficacy. Design issues (screws / hinges) will also affect
sterilization efficacy
THANK YOU