cleaning,disinfection and sterilization

lokesh .k
ICN (RMCH)
Learning Objectives

1. Differentiate between disinfection and sterilisation.

2. Explain different types of sterilisation.
3. Outline the process for cleaning patient care items.
Key points - 1
• Cleaning, disinfection, and sterilisation are the backbone of infection
prevention and control
• Proper cleaning essential before any disinfection or sterilisation
process
• Failure to sterilise or disinfect reusable medical devices properly may
spread infections
• The type and level of device decontamination depends upon the
nature of the item and its intended use
Key points - 2
• Steam sterilisation effective only when preceded by
• Thorough pre-cleaning, proper packaging/loading, and careful
monitoring of autoclaves
• Chemical disinfectants must be selected, used, and discarded to
minimise harm
• Those responsible for processing contaminated items must be fully
trained and wear protective clothing when necessary
• Clearly written policies and procedures must be available on-site for
training personnel and for monitoring their performance
DEFINITION
Cleaning
A process which removes visible contamination, but does not
necessarily destroy microorganisms.
Disinfection
Process which reduces the number of microorganisms present, but may
not inactivate some viruses and bacterial spores.
Sterilization
Process that destroys, eliminates or inactivates (kills) all forms of
microbial life including bacterial endospores.
Depending on the risk of transmitting infection instruments are
classified as:
A. Critical :-(high risk) Instrument that come in contact with Critical
surfaces such as Sterile tissue, body cavity, bloodstream, instruments
that penetrate soft tissue or bone, Enter sterile body cavity eg:
• Implants
• Prosthetic devices
• Surgical instruments
• Needles
• Cardiac catheters
• Urinary catheters
• Biopsy forceps etc.
B. Semi critical :(medium risk)
Instruments that come in contact with semi critical surfaces such as Intact oral
mucosa, non-intact skin, contact with the oral tissue/body fluids , gingiva, teeth
etc. eg;
Flexible fibro-optic endoscopes
• Respiratory therapy equipment
• Anaesthesia equipment
• Endotracheal tubes
• Bronchoscopes
• Vaginal speculum
• Cystoscope
• Hand-piece etc.
C. Non Critical :(low risk)

Instruments or medical devices that comes in contact with the non

critical surfaces such as intact skin.
E.g.
Bedpans
• Blood pressure cuffs
• Crutches
• Stethoscopes
• Face mask
• X-ray machine etc.
Pre-Cleaning/Cleaning
Everyone responsible for handling and reprocessing contaminated
items must:
• Receive adequate training and periodic retraining.
• Wear appropriate personal protective equipment (PPE).
• Receive adequate prophylactic vaccinations.
• Contaminated items should be wiped or sprayed at point of use to
keep them moist prior to cleaning.
• They should not be cleaned or decontaminated in the scrub or
hand sinks.
• Sharps and delicate instruments should be kept separate from
other items.
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• The manufacturers’ specifications for the quality of water used for
cleaning should be followed (i.e., sterile, distilled, de-ionized)
• Completely disassemble each item prior to cleaning; all jointed
instruments must be open and/or unlocked.
• Traffic between the decontamination, preparation, and assembly
areas must be minimized.
DISINFECTION
Process of reducing or eliminating living pathogenic
microorganisms in or on materials, so they are no longer a health
hazard. For example: use of alcohol before drug injection.
ANTISEPTICS / DISINFECTANTS
• Antiseptics: Use on skin and mucous membranes to kill
microorganisms. Not for use on inanimate objects
• Disinfectants: Use to kill microorganisms on inanimate objects. Not
for use on skin or mucous membranes
list of antiseptics
• Chlorohexidine
• polyhexanide,
• povidone-iodine,
• alcohol
• boric acid,
• benzalkonium chloride.etc
list of disinfectants
• Formaldehyde.
• Glutraldehyde.
• Ortho-phathaldehyde.
• Hydrogen peroxide.
• Peracetic acid.
• Hydrogen peroxide/peracetic acid combination.
• Phenolic Disinfectants
• Hypoclorite solution.etc
Inspection of Instruments
• Cleanliness, & absence of corrosive substances
• Free motion of hinged instruments-absence of stiffness
• Proper alignment of jaws & teeth
• Proper tension with closed ratchets
• Sharpness of scissors, trocars etc.
• Screws and pins are clean
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• General integrity-absence of cracks, dents, chipping, worn areas
• Intact insulation sheathing
• Items composed of more than one part are complete & parts fit
together securely
• Powered surgical instruments appropriately lubricated & tested for
proper functioning
Packaging Materials
• Maximize surface area of instruments
• Place instruments in a mesh bottom tray to allow for full exposure of
cleaning mechanism
• Open jointed instruments at box locks
• Disassemble instruments composed of more than one part
• Separate delicate scissors & microsurgical instruments from heavier
instruments to avoid damage
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• All hinged instruments must be opened & secured with stringers in a
wire mesh basket
• The weight of an instrument set should be evenly distributed to avoid
collection of moisture during sterilization
• Delicate instruments require tip guards/foam
• Count sheet in every tray.
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• Remove as much air as possible to facilitate effective sterilization
• Double peel packages should be sequentially sized & sealed to allow
fro proper fit of inner pouch
• Paper sides of both packages are positioned together to allow
adequate penetration of the sterilant.
 STERILIZATION
MOST COMMON METHODS ARE:-
• WET HEAT (Autoclaving)
• ETHYLENE OXIDE.
• DRY HEAT (Flaming, baking)
• LOW-TEMPERATURE STEAM AND FORMALDEHYDE
• FILTRATION
• SOLVENTS
• RADIATION
WET HEAT (Autoclaving)
• The method of choice for sterilization in most labs.
• By using pressurized steam to heat the material to be sterilized.
• Kills all microbes, spores and viruses.
• Kills microbes by hydrolysis and coagulation of cellular proteins.
• Pressurized steam has a high latent heat.
• 15 minutes at 121C.
ETHYLENE OXIDE
• Highly penetrating non corrosive gas that has bactericidal action.
• Used to sterilize heat and moist sensitive materials ,including
electrical equipments.

DRY HEAT (FLAMING, BAKING

• There’s no water, so protein hydrolysis can’t take place.
• Tends to kill microbes by oxidation of cellular components.
• Requires more energy than protein hydrolysis so higher temperatures
are required.
• 15 minutes at 160C.
LOW -TEMPERATURE STEAM AND FORMALDEHIDE

• Combination of dry, saturated steam and formaldehyde.

• Sterilization achieved at low temperature (73 C).
• Suitable for heat –sensitive materials and items of equipments with
integral plastic component.
FILTRATION
• Great way of quickly sterilizing solutions without heating.
• Works by passing the solution through a filter with a pore diameter
that is too small for microbes to pass through.
SOLVENTS
• Ethanol
• Peracetic acid (STERIS).
• Isopropanol -- better solvent for fat.
• Work by denaturing proteins through a process that requires water.
• They must be diluted to 60-90% in water to be effective.
• They have no effect on spores.
RADIATION
• UV, x-rays and gamma rays.
• Damaging effects on DNA.
• UV has limited penetration in air so sterilization only occurs in a fairly small area around
the lamp.
• Relatively safe.
• Useful for sterilizing small areas.
• X-rays and gamma rays are far more penetrating.
• More dangerous.
• Effective for large scale cold sterilization of plastic items e.g. syringes ,
catheters and I/v cannulas.

Techniques of Sterilizaiton

• Steam (121C for 15 mins) - Instruments

• Ethylene oxide Heat- sensitive instruments
• Hot air- Sharp delicate instruments
• Steam (73C) and formaldehyde- Heat sensitive equipment, Plastics
• Irradiation (gamma rays)- Industrial packaging
• Peracetic acid (STERIS) - Flexible endoscopes
storage of sterilised instruments
• After the sterilization cycle is completed inspect all packages for proper color
change by visible chemical indicators.
• The instruments set should be stored in a clean, dry, closed cabinet.
• Storage practices for wrapped sterilized instruments should be event-related.
• Event-related practices recognize that packages remain sterile indefinitely, unless
an event causes a package to become contaminated (e.g., torn, wet, or open
packaging).
• Prior to distribution to the point of use, the sterile instrument units should be
inspected to verify barrier integrity and dryness.
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• When the packaging is compromised (i.e., torn, wet, or open), the
instruments should be re-cleaned, re-packaged in a new wrap, and re-
sterilized.
• The date of sterilization and the sterilizer used, noted on the outside
of the packaging material, should facilitate the retrieval of suspected
instrument units in the event of a sterilization failure.
Indicators for Sterilization
• Biological Indicators: Sterilization indicators, such as spore strips and indicator
tape, enable routine monitoring, qualification,and load monitoring of the steam
sterilization process. They indicate whether the conditions during a steam
autoclave cycle were adequate to achieve a defined level of microbial
inactivation.
• Chemical Indicators:Chemical indicators are designed to respond to one or more
of the physical conditions within the sterilizing chamber. Use them to routinely
monitor the process parameters of your sterilization process to ensure that they
meet your quality assurance goals.