Transcript Cleaning and Sterilization Techniques/Infection Control

Cleaning and
Sterilization Techniques
Infection Control
Grant funds provided by
Continuing nursing education
credit provided by
LEARNER OBJECTIVES
 Explain the importance of infection
prevention in patient care
 Identify the steps involved with surgical
instrument decontamination and
cleaning
 Define the Spaulding Classification
 Describe the difference between
sterilization and high level disinfection
 Distinguish the various methods of
sterilization
 Explain the importance of sterilization
monitoring
 Identify special considerations for sterile
processing
Prevention
Investigation
Management
Infection Control practices should
focus on prevention
 Importance of cleaning, disinfection
and sterilization
INFECTION CONTROL
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 The Compendium of Strategies to Prevent
Healthcare-Associated Infections in Acute
Care Hospitals
 The Society for Healthcare Epidemiology of
America (SHEA)
 The Infectious Disease Society of America (IDSA)
 The American Hospital Association (AHA)
 The Association for Professionals in Infection
Control and Epidemiology (APIC)
 The Joint Commission
HOSPITAL ACQUIRED
INFECTIONS (HAIs)
October 2008
 One of the nation’s highest priority
public health and patient safety goals
 Incidence
 Deaths
 Costs
 Sterile processing and preventing
adverse patient outcomes
HOSPITAL ACQUIRED
INFECTIONS (HAIs)
Preventing HAIs
 Presence of a pathogenic
microorganism
 Reservoir
 Portal of exit
 Transmission
 Portal of entry
 Host susceptibility
TRANSMISSION OF
INFECTION
Chain of events
TRANSMISSION
 Cleaning, disinfection and
sterilization can provide this break
PREVENTION OF
 Prevention occurs when there is a
break in the chain of events
DECONTAMINATION &
CLEANING
Surgical instruments
DECONTAMINATION &
CLEANING
During surgical procedures
DECONTAMINATION &
CLEANING
Instrument transport
DECONTAMINATION &
CLEANING
Prevent Biofilm
DECONTAMINATION &
CLEANING
Ultrasonic cleaning
Decontamination
Sterile
Processing &
Storage
DECONTAMINATION &
CLEANING
Prevent cross-contamination
DECONTAMINATION &
CLEANING
Water Quality
DECONTAMINATION &
CLEANING
Manufacture’s Instructions
 Follow manufacture’s instructions
for selection of cleaning agents
 Follow manufacture’s instructions
for type of cleaning
 Cleanliness
 Alignment
 Corrosion, pitting, burrs, nicks, and
cracks
 Sharpness of cutting edges
 Loose set pins
 Wear and chipping of inserts and
plated surfaces
 Missing parts
 Any other defects
 Removal of moisture
 Proper functioning
DECONTAMINATION &
CLEANING
Inspection
PREPERATION FOR
STERILIZATION
Packaging
 Classifies equipment and
instruments for disinfection and
sterilization based on the risk of
infection for the patient
 Requirements are based on the
nature of the instrument or device
and the manner in which it is to be
used
SPAULDING
CLASSIFICATION
 Proposed in 1972 by Dr. Earle
Spaulding
 Critical
 Semicritical
 Noncritical
SPAULDING CLASSIFICATION
 Instruments and devices are
classified
 The blood stream
 Other normally sterile areas of the
body
 These items require
sterilization
CRITICAL
 Instruments or devices that are
introduced directly into
 These items may be either sterilized or
high level disinfected
SEMICRTICAL
 Instruments or devices that come in
contact with intact mucous membranes,
but do not ordinarily penetrate the blood
barrier
 These items can be cleaned and
then disinfected
NONCRITICAL
 Instruments or devices that do not
normally touch the patient or
only contact intact skin
DISINFECTION
 Less lethal process than
sterilization
 Kills some, but not necessarily, all
microbial life on an item or surface
 Reduces the level of microbial life
on an item or surface, but there can
be a broad range of activity that
extends from sterility to a minimal
reduction in microbial contaminants
 Nature and number of contaminating
microorganisms, especially bacterial spores
 Amount of organic matter present
 Type and condition of instruments, devices
and materials to be disinfected
 Concentration, time of exposure, pH and
required temperature
 Water hardness and presence of surfactants
DISINFECTION
 Chemical disinfectants vary in their level
of effectiveness and are influenced by:
 High level disinfection
 Intermediate level disinfection
 Low level disinfection
CLASSIFICATION OF CHEMICAL
GERMICIDES
 Chemical germicides are classified
by activity level
HIGH LEVEL DISINFECTION
 Kills vegetative microorganism
 Inactivates viruses
 Does not necessarily kill high
numbers of bacterial spores
 Used for short periods of contact
time
 May be capable of sterilization with
prolonged contact time
 Kills most fungi and inactivates
most viruses
INTERMEDIATE LEVEL
DISINFECTION
 Kills vegetative microorganisms,
including Mycobacterium
tuberculosis
 Kills some fungi and inactivates
some viruses
LOW LEVEL DISINFECTION
 Kills most vegetative bacteria
except M.tuberculosis
 Kills all microorganisms,
including high numbers
of microbial spores
STERILIZATION
 Defined as the elimination of all
forms of microbial life
STERILITY ASSURANCE LEVEL
 The term “sterile” is measured as
the probability of sterility
 This probability is known as Sterility
Assurance Level (SAL)
 SALs are used to describe the
microbial population that was
destroyed by the sterilization
process
 A 6 log reduction 10-6 will reduce a
million organisms very close to
zero
 Generally, a SAL of 10-6 is an
acceptable SAL in the health care
environment
STERILITY ASSURANCE LEVEL
 Each log reduction 10-1 represents
a 90% reduction in microbial
population
FACTORS AFFECTING
STERILIZATION
 Correct temperature, pressure and
sterilant concentration
 Bioburden
 Sterilant contact time
 Packaging and loading of the
sterilizer
 Sufficient contact of the sterilant on
instruments, devices and items
 Steam
 Ethylene oxide (EO)
 Low temperature hydrogen peroxide
gas plasma
 Peracetic acid
 Ozone
 Dry Heat
METHODS OF STERILIZATION
 Sterilization methods used in the
health care environment include:
STEAM STERILIZATION
 Preferred sterilization method
 Oldest, safest, most economical
and reliable
 Used for heat and moisture-stable
instruments, devices and items
 Manufacturer’s instructions should
be followed
Gravity displacement cycles
Dynamic air-removal (prevacuum)
Steam flush pressure cycles
Flash cycles and express cycles
STEAM STERILIZATION
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Ethylene oxide (EO)
Low temperature gas plasma
Peracetic acid
Ozone
Dry Heat
CHEMICAL STERILIZATION
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ETHYLENE OXIDE
 Colorless gas, odor similar to ether
in high concentrations
 Alkylating agent
 Noncorrosive and non-damaging to
a variety of heat and moisture
sensitive materials
 Known toxicity, carcinogen
FACTORS THAT AFFECT EO
STERILIZATION
 Time of exposure
 Gas concentration
 Temperature, humidity and
penetration
 Thorough drying of instruments,
devices and items
 Aeration
 No toxic by-products,
aeration not required
 Noncarcinogenic and
nonmutagenic
LOW TEMPERATURE HYDROGEN
PEROXIDE GAS PLASMA
 Oxidizing sterilization process
 Items are dry at the end of the
process
FACTORS THAT AFFECT GAS
PLASMA STERILIZATION
 Appropriate packaging materials,
cellulosic-based products are not
recommended
 Lumen restrictions
 Instruments, devices and items
must be dry at the time of
packaging
 Trays and containers must be
approved
 Sterilization times may vary due to
load contents
PERACETIC ACID
 Oxidizing agent, low temperature
 No toxic residue if instruments,
devices and items are rinsed
properly
 Must be handled properly,
neutralized and rinsed
 Instruments, devices and items
must be submersible
 For immediate patient use
FACTORS THAT AFFECT
PERACETIC ACID
 Water temperature, pressure and
fill time
 Materials compatibility
 Selection of appropriate adaptors
and connections devices for items
with lumens
 Transportation to point of use
 Instruments, devices and items
cannot be stored
OZONE
 Oxidizing agent,
low temperature
 No toxic by-products, no aeration
required
 Items are ready for immediate use
FACTORS AFFECTING
OZONE SERILIZATION
 Appropriate packaging materials,
cellulosic-based materials are not
recommended
 Lumen restrictions may apply
 Trays and containers must be
approved for the sterilization
process
 Anhydrous oils, syringes and needles which
must be pyrogen free, petroleum and gauze,
powders, and other oil based products
 Items that cannot be
processed by other
methods
 Oxidation or slow
burning process
DRY HEAT STERILIZATION
 Generally used for specialized purposes
FACTORS THAT AFFECT DRY
HEAT STERILIZATION
 Longer process
 Penetrates materials slowly and
unevenly
 High temperatures are required
 Packaging selection is limited
 Temperature parameters
 Higher the temperature the shorter
the exposure time
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Concentration of the active chemical
Temperature
Amount of contact time
Instrument, device or item must be
submersible
 Lengthy process (6-10 hours)
LIQUID CHEMICAL
STERILIZATION
 Possible with chemical
disinfectants
 Dependent on
 Mechanical
 Chemical
 Biological
 Most accurate
STERILIZATION
MONITORING
 Cycle parameters
 Lot number
 Date
 Cycle number
 Monitoring of chemical
disinfectants
 Minimum effective concentration
(MEC)
STERILIZATION
MONITORING
 Sterilization records
 Loaner Equipment
 Reuse of single-use devices
(SUDs)
SPECIAL
CONSIDERATIONS
 Creutzfeldt-Jakob Disease (CJD)
CREUTZFELDT-JAKOB
DISEASE (CJD)
 Infectious, neurodegenerative and
fatal disease of the CNS
 Prions are a unique class of
pathogens
 Iatrogenic transmissions can occur
 Decontamination and sterilization
considerations
LOANER EQUIPMENT
 Present significant challenges
 Arrival time
 Policies & procedures for receipt
and use of loaner equipment
 AORN “Recommended Practices
for Sterilization in the Perioperative
Practice Setting”
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Patient safety
Efficacy of reprocessing
Ethics
Health care facility liabilities
REUSE of SINGLE-USE
DEVICES
 Began during the 1970’s
 Technology advanced
 Concerns surfaced regarding this
practice
FOOD, DRUG and
COSMETIC ACT
 When a single use medical device
is reprocessed for reuse by
cleaning, repairing or refurbishing,
the FDA considers the device to be
“remanufactured”
 The entity reprocessing the device
is considered to be the
manufacturer
 Take on the responsibility of
reprocessing
 Therefore be considered a device
manufacturer
 Employ the services of a third-party
reprocessor
 Consider reducing costs and waste
 Review multiple information for
decision making
HEALTH CARE FACILITY
RESPONSIBILITY
 Form a committee to decide to
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