Transcript Decontamination Procedures for Medical Equipment

Decontamination Procedures
for Medical Equipment
Introduction
Decontamination of medical
equipment involves the
destruction or removal of any
organisms present in order to
prevent them infecting other
patients or hospital staff.
Microbes (bacteria & viruses)
Microbes can be carried from one person to
another on the surface of any equipment that
is shared between them unless it is decontaminated
between use.
They can also be carried on the skin surface
which is why hand washing between examining
patients is important.
Microbes gain access to the body, through open
wounds, inhalation of infected secretions or
by close contact with mucous membranes.
decontamination process
The process by which microbes are
passed from one infected person, to
cause infection in another, is known as
'cross-infection'.
Cleaning, disinfection and sterilization
are all procedures that are used in the
decontamination process.
Decontamination reduces the risks of
cross infection and helps to maintain
the useful life of equipment.
Cleaning
is the process that removes contaminants
including dust, soil, large numbers of
micro -organisms and organic matter
(e.g. blood, vomit).
It is an essential prerequisite to
disinfection and sterilization.
It also removes the organic matter on
which micro-organisms might
subsequently thrive.
Disinfection
Is a process used to reduce the
number of micro-organisms but
not usually bacterial spores.
The process does not necessarily
kill or remove all microorganisms, but reduces their
number to a level which is not
harmful to health.
Sterilization
removes or destroys
all forms of microbial
life including bacterial
spores.
Groups of risk
Each instrument or piece of
medical equipment which comes
into contact with a patient is a
potential source of infection.
These are divided into 3 groups
of risk:
High risk
Intermediate risk
Low risk .
High risk items
come into close contact with a break in the
skin or mucous membranes or are
introduced into a normally sterile body area.
e.g. surgical instruments, needles, urinary
and other catheters.
Sterilization is required for this group.
Intermediate risk items
come into close contact with mucous
membrane or are items contaminated with
particularly virulent or readily transmissible
organisms.
e.g. Items of respiratory equipment including
laryngoscope blades, endotracheal and
tracheostomy tubes, oropharyngeal and nasal
airways.
Disinfection is required for this group.
Low risk items
only come into contact with normal
intact skin.
e.g. stethoscopes or washing bowls.
Cleaning and drying is usually adequate
for this group
Techniques of disinfection and sterilization
Before equipment is to be disinfected or
sterilized, it should be thoroughly cleaned
to remove any visible dirt or secretions.
This involves washing with water and
detergent (soap).
Protective clothing (an apron, gloves and a
facemask) should be worn.
Disinfection
Disinfection is best achieved by moist heat such as
boiling in water (100°C for 10 minutes at sea level)
which kills all organisms except for a few bacterial
spores.
temperature at which water boils decreases with
altitude and a longer boiling time will be required. e.g.
at 4000m above sea level where boiling occurs at 86°C
a minimum of 20 minutes is required for disinfections.
It is important to note that boiling equipment items in
water will not achieve sterilization.
Disinfection
Disinfection can also be achieved by using
chemicals which however may themselves
be toxic when allowed contact with skin
or are inhaled.
They can also be corrosive and flammable
so that protective clothing (gloves, apron
and a facemask) should be worn.
Chemical disinfectants
Chemical disinfectants may be supplied
ready to use or may need accurate
dilution to provide an appropriate
solution.
disinfectants can decay and lose activity
Decay is more rapid at high
temperatures and can be accelerated by
the presence of impurities.
All disinfectants take time to work.
Range of Activity of
Disinfectants
Gram positive bacteria.
E.G. Staphylococci, are more sensitive than
gram negative bacteria e.G. Pseudomonas.
Mycobacteria and spores are relatively
resistant.
Enveloped viruses e.G. HIV are killed by most
disinfectants but non-enveloped viruses e.G.
Coxsackie tend to be more resistant.
Spores
Fungal spores are easily killed by
disinfectants.
Other bacterial spores e.g. Clostridia are
resistant to most disinfectants in common
use.
Tubercle bacteria are more resistant to
chemical disinfectants than other bacteria.
They can be killed by exposure to 2% alkaline
Glutaraldehyde solution (Cidex) for 60
minutes.
Viruses.
Hepatitis B virus (HBV) and Human
Immunodeficiency Virus (HIV) are inactivated
by Cidex in 1 - 2 minutes.
to ensure adequate penetration, soiled items
should be placed in a 2% glutaraldehyde
solution for 30 minutes.
Exposure to 70% alcohol solution for 10
minutes is also effective.
Viruses causing Rabies, Lassa fever and
other haemorrhagic fevers are also killed by
Cidex.
Heat
In order to kill microbial agents, heat can be
applied in dry or wet form.
The advantage of wet heat is a better heat
transfer to and into the cell resulting in
overall shorter exposure time and lower
temperature.
Steam sterilization
Steam sterilization uses pressurized steam at
121-132 C (250-270 F) for 30 or 40 minutes.
This type of heat kills all microbial cells
including spores, which are normally heat
resistant.
In order to accomplish the same effect with
dry heat in an oven, the temperature needs to
be increased to 160-170 C (320-338 F) for
periods of 2 to 4 hours.
Liquid Chemicals Used as
Disinfectants
Liquid disinfectants are preferably used for
solid surfaces and equipment.
They vary greatly in their efficiency,
depending on the chemical constituents and
the agents involved.
Variables to remember when disinfecting:
Nature of surface being disinfected
- Porous or smooth
the more porous and rough the surface, the
longer a disinfectant will need to be
effective.
Number of microorganism present
Higher concentrations require a longer
application time and/or higher concentration
of disinfectant.
Resistance of microorganisms
- Microbial agents can be classified
according to increasing resistance to
disinfectants and heat
Presence of organic material
- The proteins in organic materials such as
blood, bodily fluids, and tissue can prevent
or slow the activity of certain disinfectants.
Duration of exposure and temperature
Increased exposure time increases the
effectiveness of disinfectants.
Low temperatures may slow down the
activity requiring more exposure time.
Surface Disinfectants and
Microbial Activity
Disinfectants work by absorbing onto any
microbial cell.
such absorption increases the permeability of
the cell membrane, ultimately leading to
rupture and leakage of the contents of the
cell.
The cell dies.
There is no chance for mutation.
Chemical
disinfectant
solutions
Phenol and Phenol Derivatives:
concentrations 5% to 10 %.
Unpleasant odor
Toxic. protective equipment
used for disinfection of walls, floors, bench tops.
They effectively kill bacteria including
Mycobacterium tuberculosis, fungi and lipidcontaining viruses.
They are not active against spores
Halogens (Chlorine and Iodine):
Sodium hypochlorite is the most common
Common household bleach (5% available
chlorine) can be diluted 1/10 to 1/100 with water
Always use personal protective equipment
At high concentrations and extended contact time,
considered cold sterilants
Iodine has similar properties to chlorine.
They are most often used as antiseptics and in
surgical soaps and are relatively nontoxic to
humans.
Alcohols
Ethyl or isopropyl alcohol in concentration of 70% to 90%
are good general-use disinfectants.
they evaporate fast and therefore have limited exposure
time.
They are less active against non-lipid viruses and
ineffective against bacterial spores.
Concentrations above 90% are less effective.
(eg methanol, ethanol & isopropanolol) have good activity
against bacteria & viruses.
They should only be used after all the visible surface dirt
has been removed from the area to be disinfected.
Aldehydes
Formalin:
Formalin is 37% solution of formaldehyde
in water.
Dilution of formalin to 5% results in an
effective disinfectant.
Formaldehyde is a human carcinogen and
creates respiratory problems at low levels of
concentration.
Glutaraldehyde:
chemically related to formaldehyde, is more
effective against all types of bacteria, fungi,
and viruses.
Vapors of glutaraldehydes are irritating to
the eyes, nasal passages and upper
respiratory tract.
Quaternary Ammonium Compounds (Quats):
detergents with strong surface activity.
They are active against Gram-positive bacteria
They are less active against Gram-negative
bacteria .
Quats are relatively nontoxic and can be used for
decontamination of food equipment and for
general cleaning.
Sterilization
This can be achieved by steam, steam &
formaldehyde, hot air, ethylene oxide or
irradiation.
Autoclaving is the commonest method.
It uses steam under pressure and is the most
reliable way to sterilize instruments.
A temperature of 134°C for 3 minutes or
121°C for 15 minutes is recommended.
Formaldehyde
Formaldehyde is irritant to the eyes, respiratory tract
and skin.
It can also be absorbed by some materials and
subsequently slowly released with potentially
hazardous results.
Hot air sterilization takes a long time and items
must be able to withstand temperatures of at least
160°C for periods of 2 hours or more.
Formaldehyde gas
Formaldehyde gas is primarily used in the
decontamination of spaces or biological
containment equipment like biological
safety cabinets.
Formaldehyde is a toxic substance and a
suspected human carcinogen.
Considerable caution must be exercised in
handling, storing, and using formaldehyde
Ethylene oxide
Ethylene oxide is a colorless gas which is toxic to inhale.
It is effective against all organisms and does not damage
equipment.
The operating cycle ranges from 2 - 24 hours so the
turnaround time is prolonged and it is a relatively
expensive process.
A variety of vapors and gases possess germicidal
properties.
The most commonly used are formaldehyde and ethylene
oxide.
Applied in closed systems under controlled
conditions (e.g., humidity) these gases
achieve sterility.
Ethylene oxide is used in gas sterilizers
under controlled conditions.
Ethylene oxide is also a human carcinogen
and monitoring is necessary during its use.
Sterilisation by irradiation
Sterilisation by irradiation is an industrial
process and particularly suited to the
sterilization of large batches of products.
Irradiation can cause serious deterioration
of materials and is therefore not a suitable
method for the resterilisation of equipment
items
Radiation
Gamma and X-ray are two principal types of
ionizing radiation used in sterilization.
Their application is mainly centered on the
sterilization of prepackaged medical devices.
Ultraviolet (UV) radiation is a practical method
for inactivating viruses, mycoplasma, bacteria and
fungi.
UV radiation is successfully used in the
destruction of airborne microorganisms.
UV light sterilizing capabilities are limited on
surfaces because of its lack of penetrating power .