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Rutala_Cali-Col
William A. Rutala_Cali-Col
DISCLOSURES
Consultation and Honoraria
Clorox
Honoraria
3M
Grants
CDC, CMS
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William A. Rutala_Cali-Col
Learning Objective
Discuss a rational approach to cleaning, disinfection and
sterilization
Identify best practices for low level disinfection, high level
disinfection and sterilization
Describe methods to prevent HAIs related to reusable
medical and surgical instruments as well as the
environment
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Most Resistant
Sterilization
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Cleaning
Items must be cleaned using water with detergents or
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Washer/Disinfector
Five Chambers
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Washer/Disinfector
WD Conditions
Organism
Inoculum
Log Reduction
Routine
MRSA
2.6x107
Complete
0/8
Routine
VRE
2.6x107
Complete
0/8
Routine
P aeruginosa 2.1x107
Complete
0/8
Routine
M terrae
1.4x108
7.8
2/8
Routine
GS spores
5.3x106
4.8
11/14
2.5x107
Complete
0/10
8.3x106
5.5
8/10
No Enz/Det VRE
No Enz/Det GS spores
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Positives
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Rutala WA, Weber DJ, HICPAC. CDC Disinfection and Sterilization Guideline www.cdc.gov
Heat Resistant
Steam sterilization
Heat Sensitive
Hydrogen peroxide (HP) gas plasma
Ethylene oxide
HP and ozone
Vaporized hydrogen peroxide
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Recommendations
Methods of Sterilization
Rutala WA, Weber DJ, HICPAC. CDC Disinfection and Sterilization Guideline www.cdc.gov
manufacturer
Use low temperature sterilization technologies for
reprocessing critical items damaged by heat
Use immediately critical items that have been sterilized by
peracetic acid immersion process (no long term storage)
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Sterilization Practices
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Sterilization Monitoring
Rutala WA, Weber DJ, HICPAC. CDC Disinfection and Sterilization Guideline www.cdc.gov
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Recommendations
Monitoring of Sterilizers
Rutala WA, Weber DJ, HICPAC. CDC Disinfection and Sterilization Guideline www.cdc.gov
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Recommendations
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Recommendations
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Most Resistant
Most Susceptible
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Scope
Outbreaks
Micro (primary)
Pts
Pts Infected
Contaminated
Cause
(primary)
Upper GI
19
Pa, H. pylori,
Salmonella
169
56
Cleaning/Disinfection (C/D)
Sigmoid/Colon 5
oscopy
Salmonella, HCV 14
Cleaning/Disinfection
ERCP
Pa
152
89
C/D, water
bottle, AER
Pa, Mtb,
Mycobacteria
778
98
C/D, AER,
water
1113
249
23
Bronchoscopy 51
Totals
98
Based on outbreak data, if eliminated deficiencies associated with cleaning, disinfection, AER , contaminated
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water and drying would eliminate about 85% of the outbreaks.
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ENDOSCOPES
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MULTISOCIETY GUIDELINE ON
REPROCESSING GI ENDOSCOPES, 2011
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ENDOSCOPE REPROCESSING
Multi-Society Guideline on Endoscope Reprocessing, 2011
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High-Level Disinfection of
Semicritical Objects
Exposure Time > 8m-45m (US), 20oC
Germicide
Concentration_____
Glutaraldehyde
> 2.0%
Ortho-phthalaldehyde
0.55%
Hydrogen peroxide*
7.5%
Hydrogen peroxide and peracetic acid*
1.0%/0.08%
Hydrogen peroxide and peracetic acid*
7.5%/0.23%
Hypochlorite (free chlorine)*
650-675 ppm
Accelerated hydrogen peroxide
2.0%
Peracetic acid
0.2%
Glut and isopropanol
3.4%/26%
Glut and phenol/phenate**
1.21%/1.93%___
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Performed all 12 steps with only 1.4% of endoscopes using manual versus 75.4% of those processed
using AER
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Scope
Molecular Link
Reference
P. aeruginosa (VIM-2)
Duodenoscope
22
Yes
E. coli (AmpC)
Duodenoscope
Yes (2 scopes)
Yes (PFGE)
Wendort, 2015
No
39
Yes
E. coli (NDM-CRE)
Duodenoscope
Kola A, 2015
Yes (PFGE)
Epstein L, 2014
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Complexity of endoscope
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GI Endoscopes:
Shift from Disinfection to Sterilization
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Exposure
Method
VRE
VRE
Contamination
Contamination
Before HLD
After HLD
(glutaraldehyde)
Passive HLD
(immersed,
not
perfused)
3.6x108
2.0x108
1.1x108
5.0x107
1.0x108
6.8x107
Active HLD
(perfused
HLD into
channel with
syringe)
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8.4x107
1.5x108
2.8x108
1 CFU
0
0
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Most Resistant
Most Susceptible
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MRSA
VRE
Acinetobacter spp.
Clostridium difficile
Norovirus
Rotavirus
SARS
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Education
Audit and feedback
Addition of housekeeping personnel or specialized cleaning staff
Automated technologies
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Use Concentration
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Surface Disinfection
Noncritical Patient Care
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Surface Disinfection
Environmental Surfaces
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Learning Objective
Discuss a rational approach to cleaning, disinfection and
sterilization
Identify best practices for low level disinfection, high level
disinfection and sterilization
Describe methods to prevent HAIs related to reusable
medical and surgical instruments as well as the
environment
CIDEIM
William A. Rutala_Cali-Col
CIDEIM
William A. Rutala_Cali-Col
THANK YOU!
www.disinfectionandsterilization.org
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