CONTACT TRANSMISSION

SPECIAL DIAGNOSTIC PROCEDURES 311 o The most common mode of transmission, contact transmission,
INFECTION CONTROL
PRELIM: WEEK 2
is divided into two subgroups: direct contact and indirect
contact.
INFECTION CONTROL
o Every year, an estimated 722,000 health care– associated
DIRECT TRANSMISSION
infections (HAIs) occur that result in 75,000 deaths. HAIs are
o Direct transmission occurs when microorganisms are transferred
infections that originate in healthcare facilities. An effective
from one infected person to another person without a
infection control program must be established in a health care
contaminated intermediate object or person.
setting to recognize and prevent HAIs.
o Blood or other blood-containing body fluids from a patient
directly enters a caregiver’s body through contact with a mucous
INFECTIOUS DISEASE
membrane or breaks (i.e., cuts, abrasions) in the skin
o SOURCE, SUSCEPTIBLE HOST, MODE OF TRANSMISSION
o Mites from a scabies-infested patient are transferred to the skin
o Infectious diseases are caused by microscopic organisms that
of a caregiver while he/she is having direct ungloved contact
penetrate the body’s natural barriers and multiply to create
with the patient’s skin
symptoms that can range from mild to deadly
o A healthcare provider develops herpetic whitlow on a finger
o EXAMPLE OF INFECTIONS:
after contact with HSV when providing oral care to a patient
- Measles
without using gloves or HSV is transmitted to a patient from a
- Yellow fever
herpetic whitlow on an ungloved hand of a healthcare worker
- Common cold
- Tuberculosis
INDIRECT TRANSMISSION
- Mumps,
o Indirect transmission involves the transfer of an infectious agent
- Hepatitis
through a contaminated intermediate object or person. In the
- Influenza
absence of a point-source outbreak, it is difficult to determine
how indirect transmission occurs.
SOURCE
o Hands of healthcare personnel may transmit pathogens after
o Infectious agents transmitted during healthcare derive primarily
touching an infected or colonized body site on one patient or a
from human sources but inanimate environmental sources also
contaminated inanimate object, if hand hygiene is not
are implicated in transmission.
performed before touching another patient.
o Human reservoirs include:
o Patient-care devices (e.g., electronic thermometers, glucose
- Patients
monitoring devices) may transmit pathogens if devices
- Healthcare personnel
contaminated with blood or body fluids are shared between
- Household members
patients without cleaning and disinfecting between patients
- Visitors
o Shared toys may become a vehicle for transmitting respiratory
o Such source individuals may have active infections, may be in the
viruses (e.g., respiratory syncytial virus or pathogenic bacteria
asymptomatic and/or incubation period of an infectious disease,
(e.g., Pseudomonas aeruginosa) among pediatric patients.
or may be transiently or chronically colonized with pathogenic
o Instruments that are inadequately cleaned between patients
microorganisms, particularly in the respiratory and
before disinfection or sterilization (e.g., endoscopes or surgical
gastrointestinal tracts.
instruments) or that have manufacturing defects that interfere
o Inanimate environmental sources:
with the effectiveness of reprocessing may transmit bacterial
- Dry surfaces in patient care areas (e.g., bed rails, medical
and viral pathogens.
equipment, countertops, and tables)
o Clothing, uniforms, laboratory coats, or isolation gowns used as
- Wet surfaces, moist environments, and biofilms (e.g.,
personal protective equipment (PPE), may become
cooling towers, faucets and sinks, and equipment such as
contaminated with potential pathogens after care of a patient
ventilators)
colonized or infected with an infectious agent, (e.g., MRSA, VRE,
- Indwelling medical devices (e.g., catheters and IV lines)
and C. difficile)
- Dust or decaying debris (e.g., construction dust or wet
materials from water leaks)
DROPLET TRANSMISSION
o Droplet transmission is, technically, a form of contact
SUSCEPTIBLE PERSON
transmission, and some infectious agents transmitted by the
o A susceptible person is someone who is not vaccinated or
droplet route also may be transmitted by the direct and indirect
otherwise immune, or a person with a weakened immune
contact routes
system who has a way for the germs to enter the body. For an
o In contrast to contact transmission, respiratory droplets carrying
infection to occur, germs must enter a susceptible person’s body
infectious pathogens transmit infection when they travel directly
and invade tissues, multiply, and cause a reaction.
from the respiratory tract of the infectious individual to
o Devices like IV catheters and surgical incisions can provide an
susceptible mucosal surfaces of the recipient, generally over
entryway, whereas a healthy immune system helps fight
short distances, necessitating facial protection.
infection.
o Respiratory droplets are generated when an infected person:
o Recognizing the factors that increase patients’ susceptibility to
- Coughs
infection allows providers to recognize risks and perform basic
- Sneezes
infection prevention measures to prevent infection from
- Talks
occurring.
o During procedures such as:
- Suctioning
TRANSMISSION
- Endotracheal intubation
o Several classes of pathogens can cause infection, including
- Cough induction by chest physiotherapy
bacteria, viruses, fungi, parasites, and prions. The modes of
- Cardiopulmonary resuscitation
transmission vary by type of organism and some infectious
o Studies have shown that the nasal mucosa, conjunctivae and less
agents may be transmitted by more than one route
frequently the mouth, are susceptible portals of entry for
- Direct or indirect contact, (e.g., Herpes simplex virus [HSV],
respiratory viruses.
respiratory syncytial virus, Staphylococcus aureus)
- Droplet, (e.g., influenza virus, B. pertussis)
- Airborne routes (e.g., M. tuberculosis)
- Bloodborne viruses (e.g., hepatitis B and C viruses [HBV,
HCV] and HIV)

[SARANILLO, KA.]
 AIRBORNE TRANSMISSION
o Airborne transmission occurs by dissemination of either airborne
droplet nuclei or small particles in the respirable size range
containing infectious agents that remain infective over time and
distance (e.g., spores of Aspergillus spp, and Mycobacterium
tuberculosis). Microorganisms carried in this manner may be
dispersed over long distances by air currents and may be inhaled
by susceptible individuals who have not had face-to-face contact
with (or been in the same room with) the infectious individual.
SUMMARY OF TRANSMISSION
o Microorganisms are spread in health care facilities through
several modes:
- Direct contact - for example, in contaminated food or
intravenous solutions
- Indirect contact - for example, from patient to patient on
the hands of health care workers (MRSA, rotavirus)
- Droplet contact - for example, inhalation of droplets (.5 μm
in diameter) that cannot travel more than 3 feet (pertussis)
- Airborne contact - for example, inhalation of droplets (.5
μm) that can travel large distances on air currents
(tuberculosis)
- Vector-borne contact - for example, disease spread by
vectors, such as mosquitoes (malaria) or rats (rat-bite
fever); this mode of transmission is rare in hospitals within
developed countries
STANDARD PRECAUTION
o How long the virus stays on different surfaces
o There are two tiers of HICPAC/CDC precautions to prevent
transmission of infectious agents, Standard Precautions and
Transmission-Based Precautions.
o Standard Precautions are intended to be applied to the care of
all patients in all healthcare settings, regardless of the suspected
or confirmed presence of an infectious agent. Implementation of
Standard Precautions constitutes the primary strategy for the
prevention of healthcare-associated transmission of infectious
agents among patients and healthcare personnel.
o Standard Precautions combine the major features of Universal
Precautions (UP) and Body Substance Isolation (BSI) and are
based on the principle that all blood, body fluids, secretions,
excretions except sweat, nonintact skin, and mucous
membranes may contain transmissible infectious agents.
o Standard Precautions include a group of infection prevention
practices that apply to all patients, regardless of suspected or
confirmed infection status, in any setting in which healthcare is
delivered.
o Standard Precautions are also intended to protect patients by
ensuring that healthcare personnel do not carry infectious
agents to patients on their hands or via equipment used during
patient care.
o Standard Precautions:
- Hand Hygiene
- Personal Protective Equipment
- Follow respiratory hygiene/cough etiquette
- Ensure appropriate patient placement
- Clean and disinfects the environment appropriately
- Handle textiles and laundry carefully
- Follow safe injection practices.
- Ensure health worker safety including proper handling of
needles and other sharps
HAND HYGIENE
A. Handwashing
- Start by wetting your hands
- Apply some soap carefully
- Rub your hands palm to palm
- Lather the back of your hands
- Scrub between your fingers
- Rub the back of your opposing palms’ fingers
- Clean your thumbs repeatedly
- Clean your fingernails and fingertips
- Rinse your hands thoroughly
- Dry them with a disposable hand towel
- Use the towel to turn off the faucet
- Your hands are now clean!
B. Hand Rubbing
- 60% alcohol
- Fingers
- Palm to palm
- Fingernails
- Wrists
- Thumbs
- Rub until dry
- Disinfected!
PERSONAL PROTECTIVE EQUIPMENT
o Lab coat or apron (wear it correctly)
o Surgical masks and respirators
o Eye or face protection (such as glasses)
o Safety gloves (must be worn to the wrist)
RESPIRATORY HYGIENE / COUGH ETIQUETTE
o Elements of respiratory hygiene:
- education of healthcare facility staff, patients, and visitors;
- posted signs, in language(s) appropriate to the population
served, with instructions to patients and accompanying
family members or friends;
- source control measures (e.g., covering the mouth/nose
with a tissue when coughing and prompt disposal of used
tissues, using surgical masks on the coughing person when
tolerated and appropriate);
- hand hygiene after contact with respiratory secretions; and
- spatial separation, ideally >3 feet, of persons with
respiratory infections in common waiting areas when
possible.
PATIENT PLACEMENT
A. Hospitals and Long-term Care Settings
o Options for patient placement include single patient rooms, two
patient rooms, and multi-bed wards. Of these, single patient
rooms are preferred when there is a concern about transmission
of an infectious agent. However, most hospitals and long-term
care facilities have multi-bed rooms and must consider many
competing priorities when determining the appropriate room
placement for patients:
- Reason for admission
- Patient characteristics (age, gender, mental status)
- Staffing needs
- Family requests
- Psychosocial factors
- Reimbursement concerns
o Cohorting is the practice of grouping together patients who are
colonized or infected with the same organism to confine their
care to one area and prevent contact with other patients.
B. Ambulatory Settings
o Patients actively infected with or incubating transmissible
infectious diseases are seen frequently in ambulatory settings
and potentially expose healthcare personnel and other patients,
family members and visitors.
- Outpatient clinics
- Physicians’ offices
- Emergency departments
o Signs can be posted at the entrance to facilities or at the
reception or registration desk requesting that the patient or
individuals accompanying the patient promptly inform the
receptionist if there are symptoms of a respiratory infection
C. Social Distancing
D. Home Care
o In home care, the patient placement concerns focus on
protecting others in the home from exposure to an infectious
household member. For individuals who are especially
vulnerable to adverse outcomes associated with certain
infections, it may be beneficial to either remove them from the
home or segregate them within the home. Persons who are not
part of the household may need to be prohibited from visiting
during the period of infectivity.
[SARANILLO, KA.]
SAFE INJECTION PRACTICES
o The investigation of four large outbreaks of HBV and HCV among
patients in ambulatory care facilities in the United States
identified a need to define and reinforce safe injection practices.
The primary breaches in infection control practice that
contributed to these outbreaks were:
- reinsertion of used needles into a multiple-dose vial or
solution container (e.g., saline bag) and
- use of a single needle/syringe to administer intravenous
medication to multiple patients.
o In one of these outbreaks, preparation of medications in the
same workspace where used needle/syringes were dismantled
also may have been a contributing factor.
TRANSMISSION BASED PRECAUTION
o Some numbers and data about the spread
CONTACT PRECAUTION
o Use Contact Precautions for patients with known or suspected
infections that represent an increased risk for contact
transmission.
o Contact Precautions are intended to prevent transmission of
infectious agents, including epidemiologically important
microorganisms, which are spread by direct or indirect contact
with the patient or the patient’s environment. Contact
Precautions also apply where the presence of excessive wound
drainage, fecal incontinence, or other discharges from the body
suggest an increased potential for extensive environmental
contamination and risk of transmission.
o A single-patient room is preferred for patients who require
Contact Precautions. When a single-patient room is not
available, consultation with infection control personnel is
recommended to assess the various risks associated with other
patient placement options.
o In multi-patient rooms, ≥3 feet spatial separation between beds
is advised to reduce the opportunities for inadvertent sharing of
items between the infected/colonized patient and other
patients.
o Healthcare personnel caring for patients on Contact Precautions
wear a gown and gloves for all interactions that may involve
contact with the patient or potentially contaminated areas in the
patient’s environment.
DROPLET PRECAUTION
o Droplet Precautions are intended to prevent transmission of
pathogens spread through close respiratory or mucous
membrane contact with respiratory secretions. Because these
pathogens do not remain infectious over long distances in a
healthcare facility, special air handling and ventilation are not
required to prevent droplet transmission.
o A single patient room is preferred for patients who require
Droplet Precautions.
o When a single-patient room is not available, consultation with
infection control personnel is recommended to assess the
various risks associated with other patient placement options.
o Spatial separation of ≥3 feet and drawing the curtain between
patient beds is especially important for patients in multi-bed
rooms with infections transmitted by the droplet route.
o Healthcare personnel wear a mask for close contact with
infectious patient; the mask is generally donned upon room
entry. Patients on Droplet Precautions who must be transported
outside of the room should wear a mask if tolerated and follow
Respiratory Hygiene/Cough Etiquette.
AIRBORNE PRECAUTION
o Airborne Precautions prevent transmission of infectious agents
that remain infectious over long distances when suspended in
the air (e.g., rubeola virus [measles], varicella virus [chickenpox],
M. tuberculosis, and possibly SARS-CoV)
o The preferred placement for patients who require Airborne
Precautions is in an airborne infection isolation room (AIIR).
o An AIIR is a single-patient room that is equipped with special air
handling and ventilation capacity that meet the American
Institute of Architects/Facility Guidelines Institute (AIA/FGI)
standards for AIIRs. (i.e., monitored negative pressure relative to
the surrounding area, 12 air exchanges per hour for new
construction and renovation and 6 air exchanges per hour for
existing facilities, air exhausted directly to the outside or
recirculated through HEPA filtration before return).
o A respiratory protection program that includes education about
use of respirators, fit testing, and user seal checks is required in
any facility with AIIRs. In settings where Airborne Precautions
cannot be implemented due to limited engineering resources
(e.g., physician offices), masking the patient, placing the patient
in a private room (e.g., office examination room) with the door
closed, and providing N95 or higher level respirators or masks.
STERILIZATION VS. DISINFECTION
o Together we can overcome this pandemic
o The scientific use of disinfection and sterilization methods
originated more than 100 years ago when Joseph Lister
introduced the concept of aseptic surgery using carbolic acid,
now called phenol. Since then, the implementation of effective
sterilization and disinfection methods has remained crucial in
the control of infections in the laboratory and health care
facilities (health care–associated infections)
o Sterilization refers to the destruction of all forms of life, including
bacterial spores. By definition, there are no degrees of
sterilization—it is an all-or-nothing process.
o Disinfection refers to a process that eliminates a defined scope
of microorganisms, including some spores
o A substance applied to the skin for the purpose of eliminating or
reducing the number of bacteria present is referred to as an
antiseptic.
FACTORS THAT AFFECTS DEGREE OF KILLING
o Type of organisms o Contact time
o Number of organisms o Temperature
o Concentration of disinfecting agent o pH
o Presence of organic material (e.g., o Biofilms
serum, blood) o Compatibility of
o Nature of surface to be disinfected disinfectants and sterilants
TYPES OF ORGANISMS
o Organisms differ greatly in their ability to withstand chemical
and physical treatment. This variability is due to the biochemical
composition of microorganisms and various mechanisms that
they can use to protect themselves.
o For example, bacterial endospores have coats rich in proteins,
lipids, and carbohydrates as well as cores rich in dipicolinic acid
and calcium, all of which protect the spores.
o Cell walls of mycobacteria are rich in lipids, which may account
for their resistance to chemical and environmental stresses,
particularly desiccation.
o Viruses containing lipid-rich envelopes are more susceptible to
the effects of detergents and wetting agents.
o The organisms known today to be the most resistant to the
actions of heat, chemicals, and radiation are prions. These
infectious agents are extremely resistant to chemical and
physical methods of destruction. Prions can withstand
temperatures exceeding 121° C for several hours while
immersed in acid or basic solutions.
NUMBER OF ORGANISMS
o Another factor to consider is the total number of organisms
present, referred to as the microbial load (bioburden). The
microbial load determines the exposure time that is necessary
for 99.9% elimination of the microorganisms. In general, higher
numbers of organisms require longer exposure times.
CONCENTRATION OF DISINFECTING AGENT
o The concentration of a disinfecting agent is also important. The
amount of disinfectant needed to destroy microorganisms varies
with the different agents. Manufacturers' instructions on
preparation, dilution, and use must be followed very carefully.
o Concentrated disinfectants, such as povidone-iodine, may
actually allow microorganisms to survive because there is not
enough free iodine to kill microorganisms. Proper
concentrations of disinfecting agents ensure the inactivation of
target organisms and promote safe and cost-effective practices.
[SARANILLO, KA.]
PRESENCE OF ORGANIC MATERIAL
o Organic material, such as blood, mucus, and pus, affects killing
activity by inactivating the disinfecting agent. In addition, by
coating the surface to be treated, organic material prevents full
contact between object and agent. Bleach (sodium hypochlorite)
is easily inactivated by organic material. For optimal killing
activity, instruments and surfaces should be cleansed of excess
organic material before disinfection
NATURE OF SURFACE TO BE DISINFECTED
o Certain medical instruments are manufactured of biomaterials
that exclude the use of certain disinfection or sterilization
methods because of possible damage to the instruments. For
example, endoscopic instruments are readily damaged by the
heat generated in an autoclave. Alternative methods must be
used for this class of instruments.
CONTACT TIME
o The amount of time a disinfectant or sterilant is in contact with
the object is critical. Too little contact time does not allow the
agent to work properly. The contact time is a function not only
of the agent itself but also of the bioburden on the object, the
type of microorganism that is to be killed, and the presence of
organic material and the temperature at which the agent is being
used. When disinfecting or sterilizing a contaminated object, it is
critical to know what organisms may be present and the contact
time to use, which is based on the microorganism that is most
resistant. The amount of time that an agent is in contact with an
object can also determine whether it is disinfecting or sterilizing
the object.
o For example, glutaraldehyde can be used as a disinfectant or a
sterilant, with the difference being the amount of time the
glutaraldehyde is in contact with the contaminated object. When
glutaraldehyde is used as a sterilant, the contact time is much
longer than when it is used as a disinfectant.
o Alcohol and iodine preparations (e.g., Betadine) must be in
contact with an object for at least 1 to 2 minutes for them to kill
microorganisms. The spores of both bacteria and fungi must be
in the presence of disinfectants or sterilants for a much longer
time than their vegetative counterpart before they are killed
TEMPERATURE
o Disinfectants are generally used at room temperature (20° to 22°
C). Their activity is generally increased to some degree by an
increase in temperature and decreased by a decrease in
temperature. A disinfectant that is used on the workbench
generally works faster than if the disinfectant is used on a cold
surface such as the walls of a refrigerator. Disinfection of blood
spills in a refrigerator can take longer than disinfection of blood
spills on a room temperature countertop. Disinfectants and
sterilants can be rendered inactive by too high or too low a
temperature.
pH
o The pH of the material to be disinfected or sterilized can affect
the activity of the disinfecting or sterilizing agent. It is critical to
make sure at what pH the agent is active and what the pH of the
material to be exposed to the agent is at the time the process
will be done.
BIOFILMS
o Biofilms are considered a community of bacteria or other
microorganisms. These communities are generally layers of
microorganisms that often have a protective material over them
that shields them from outside environmental factors. These
communities of microorganisms can be on the surface of either
inanimate or animate objects.
o A critical place where biofilms are seen in the hospital is on
catheters.
o Other places may be inside pipes that carry water and on
deionizing columns used to make processed water.
o When dealing with the disinfection of objects that may have a
biofilm, it is critical to realize that the presence of the biofilm
makes disinfection more difficult. To disinfect materials that may
have a biofilm present, the concentration of the disinfectant may
need to be increased, the contact time may need to be
increased, or both.
COMPATIBILITY OF DISINFECTANTS
o A common mistake is to believe that two disinfectants are better
than one. This is not necessarily incorrect, but when more than
one disinfectant is used, the compatibility of the disinfectants
must be taken into consideration. Some disinfectants may
inactivate other disinfectants.
o For example, the use of bleach and a quaternary ammonium
compound together may negate the activity of both
disinfectants.
STERILIZATION
o A process that kills all forms of microbial life, including bacterial
endospores.
PHYSICAL METHOD
o INCINERATION. Incineration is a method of treating infectious
waste. Hazardous material is literally burned to ashes at
temperatures of 870° to 980°C. Incineration is the safest method
to ensure that no infective materials remain in samples or
containers when disposed. Prions, infective proteins, are not
eliminated using conventional methods. Therefore incineration
is recommended. Toxic air emissions and the presence of heavy
metals in ash have limited the use of incineration in the United
States.
o MOIST HEAT. Moist heat (steam under pressure) is used to
sterilize biohazardous trash and heat-stable objects; an
autoclave is used for this purpose. An autoclave is essentially a
large pressure cooker. Moist heat in the form of saturated steam
under 1 atmosphere (15 pounds per square inch [psi]) of
pressure causes the irreversible denaturation of enzymes and
structural proteins.The most commonly used steam sterilizer in
the microbiology laboratory is the gravity displacement
autoclave. The two common sterilization temperatures are
121°C and 132°C.Moist heat is the fastest and simplest physical
method of sterilization.
o DRY HEAT. Dry heat requires longer exposure times (1.5 to 3
hours) and higher temperatures than moist heat (160° to 180°C).
Dry heat ovens are used to sterilize items such as glassware, oil,
petrolatum, or powders.
o FILTRATION. Filtration is the method of choice for antibiotic
solutions, toxic chemicals, radioisotopes, vaccines, and
carbohydrates, which are all heat sensitive. Filtration of liquids is
accomplished by pulling the solution through a cellulose acetate
or cellulose nitrate membrane with a vacuum. Filtration of air is
accomplished using high-efficiency particulate air (HEPA) filters
designed to remove organisms larger than 0.3 mm from isolation
rooms, operating rooms, and biologic safety cabinets (BSCs).
o RADIATION. Radiation may be used in two forms—ionizing and
nonionizing.
a. Ionizing radiation, in the form of gamma rays or electron
beams, is of short wavelength and high energy. This method
of sterilization is used by the medical field for the sterilization
of disposable supplies such as syringes, catheters, and gloves.
b. Nonionizing radiation in the form of ultraviolet rays is of
long wavelength and low energy. It damages deoxyribonucleic
acid (DNA) by forming thymine and cytosine dimers. Because
of its poor penetrability, usefulness is limited; it can be used
to disinfect surfaces, although the parameters (distance to
surface, potential microorganisms to be destroyed) under
which it is to be used need to be determined.
CHEMICAL METHOD
o CHEMOSTERILIZERS.
- The most common chemical sterilant is ethylene oxide (EtO),
which is used in gaseous form for sterilizing heat-sensitive
objects. The main disadvantages of EtO use are the lengthy
cycle times and the potential health hazards it produces.
- Vapor-phase hydrogen peroxide (an oxidizing agent) has been
used to sterilize HEPA filters in BSCs, metals, and nonmetal
devices such as medical instruments (e.g., scissors). There are
no toxic byproducts produced using vapor-phase hydrogen
peroxide. Hydrogen peroxide gas plasma is another method
that uses hydrogen peroxide and generates plasma by exciting
the gas in an enclosed chamber under deep vacuum with the
use of radiofrequency or microwave energy
[SARANILLO, KA.]
 DISINFECTION
PHYSICAL METHOD
o The three physical methods of disinfection are:
a. Boiling at 100°C for 15 minutes, which kills vegetative
bacteria
b. Pasteurizing at 70°C for 30 minutes, which kills food
pathogens without damaging the nutritional value or flavor
c. Using nonionizing radiation such as ultraviolet (UV) light
o UV rays are long wavelength and low energy. They do not
penetrate well, and organisms must have direct surface
exposure, such as the working surface of a BSC, for this form of
disinfection to work.
CHEMICAL METHOD
o Chemicals used to destroy all life are called chemical sterilants,
or biocides; however, these same chemicals, when used for
shorter periods, act as disinfectants. Disinfectants used on living
tissue (skin) are called antiseptics.
o Chemical disinfectants comprise many classes, including:
- Alcohols
- Aldehydes
- Halogens (chlorine and chlorine compounds)
- Peracetic acid
- Hydrogen peroxide
- Quaternary ammonium compounds
- Phenolics
o ALCOHOLS.
- The two most effective alcohols used in hospitals for
disinfection purposes are ethyl alcohol and isopropyl
alcohol. Alcohols have excellent in vitro bactericidal activity
against most gram-positive and gram-negative bacteria.
They also kill Mycobacterium tuberculosis
- various fungi, and inactivate certain enveloped viruses;
however, they are not sporicidal and have poor activity
against nonenveloped viruses. Any solution of an alcohol
that is used as an antiseptic or disinfectant should be
filtered through a 0.22-μm filter to remove any spores that
may be present.
o DETERGENTS: QUATERNARY AMMONIUM COMPOUNDS.
- They are cationic, surface-active agents, or surfactants, that
work by reducing the surface tension of molecules in a
liquid. Their action is mediated through disruption of the
cellular membrane, resulting in leakage of cell contents.
Because they are not sporicidal or tuberculocidal, the use of
quaternary ammonium compounds is limited to
disinfection of noncritical surfaces such as benchtops and
floors.
o PHENOLICS.
- The most common phenolics are ortho-phenylphenol and
ortho-benzyl-para chlorophenol. Phenolics have a fairly
broad spectrum of activity but are not sporicidal. The
addition of detergents to the phenol formulation makes
products that clean and disinfect in one step. Their main use
is in the disinfection of hospital, institutional, and
household environments. They are also commonly found in
germicidal soaps.
o HEAVY METALS DISINFECTANTS.
- Disinfectants containing heavy metals are rarely used in
clinical applications; they have been replaced by safer and
more effective compounds. Heavy metal disinfectants are
slowly bactericidal; their action is primarily bacteriostatic.
Copper and copper alloys (e.g., brass, bronze) are the first
solid surface materials ever to get approval by the EPA to be
considered antimicrobial for health care use. They are being
evaluated for use lining rails and door handles in health care
facilities to mitigate the spread of microorganisms.

o ALDEHYDE.
- Formaldehyde is generally used as formalin, a 37% aqueous
solution, or formaldehyde gas. Formaldehyde gas is often
used to disinfectant biosafety hoods. This type of procedure
should be left to professionals.
- Glutaraldehyde is a a saturated five-carbon dialdehyde that
has broad-spectrum activity and rapid killing action and
remains active in the presence of organic matter.
Glutaraldehyde is extremely susceptible to pH changes and
is active only in an alkaline environment. When used as a
2% solution, it is germicidal in approximately 10 minutes
and sporicidal in 3 to 10 hours.. Because it does not corrode
lenses, metal, or rubber, it is the sterilizer of choice for
medical equipment that is not heat-stable and cannot be
autoclaved as well as for material that cannot be sterilized
with gas. It is a safe, high-level disinfectant for most plastic
and rubber items, such as items used for administering
anesthetic agents or respiratory therapy

o HALOGENS.
- Iodine can be used as a disinfectant in one of two forms:
tincture or iodophor. Tinctures are alcohol and iodine
solutions, used mainly as antiseptics. An iodophor is a
combination of iodine and a neutral polymer carrier that
increases the solubility of the agent.
- Chlorine and chlorine compounds are some of the oldest
and most commonly used disinfectants. They are usually
used in the form of hypochlorite, such as the liquid sodium
hypochlorite (household bleach) and solid calcium
hypochlorite. Solutions should be allowed a contact time of
a least 3 minutes, and longer if organic material is present

[SARANILLO, KA.]