Federal State Budgetary Educational Institution of Higher

Education "ASTRAKHAN STATE MEDICAL UNIVERSITY" of

the Ministry of Health of the Russian Federation

Department of Perinatology with Nursing Course

Subject: Nursing basics

Lecture topic:
Disinfection. Types and methods of disinfection. Rules for
working with disinfectants.

Teacher: Candidate of Medical Sciences

Shaposhnikov Yuri Yurievich

Astrakhan 2020
 Disinfection
Disinfection (lat. De - prefix, meaning termination,
elimination, inficio - to infect; syn. - disinfection) - a
set of measures to destroy vegetative forms of
pathogenic and conditionally pathogenic
microorganisms. There are two main areas of
disinfection:
• preventive disinfection - prevention of nosocomial
infections;
• focal disinfection - disinfection in the identified
focus of infection.
Disinfection can be carried out by four methods:
mechanical, physical, chemical and combined (tab. 3-
7).
Table 3-7. Disinfection methods
Method Characteristic
Mechanical Wet Cleaning
Dust free rooms (vacuum cleaner, painting and whitewashing)
Dusting of clothing and bedding (knocking out)
Hand washing
Physical Ironing, calcination
The use of sunlight
UV exposure
Processing with boiling water, boiling; boiling in distilled water
for 30 minutes
and with the addition of sodium bicarbonate for 15 minutes
Pasteurization
Processing in a dry oven (air method)
Steam treatment (steam method under overpressure)
Garbage burning

Chemical Treatment of rags and medical instruments with disinfectants

products: irrigation, wiping, full burning, spraying
Combined Steam-air (heating with hot steam to a temperature of 110 ° C
(using special with excessive pressure), steam-formalin (heating with hot steam
disinfection) to a temperature of 90 ° C at overpressure with formaldehyde
added to the chamber)
Table 3-8. The main groups of disinfectants used in medical institutions of Russia
Groups Means
Aldehyde-containing Formaldehyde, Septodor, Gigasept FF, etc.
(used in the disinfection of glassware, plastic
stmassa, rubber, metal)
Guanidines Chlorhexidine, Demos, polyhexamethylene
guanidine
(for example, "Polisept") and others.
Oxygen-containing and Hydrogen peroxide, "Deoxon-1", "Deoxon-
funds for 4",
hydrogen peroxide based Virkon et al.
Surfactants "Alaminol", "Septabic" and others.
Alcohols Ethyl (70%), Octenisept, etc. (used for
disinfection of metal products)

Phenol-containing "Amocide"
Chlorine-containing Chlorine, calcium, sodium hypochlorite,
chlorine min B and others
 Disinfection methods for medical instruments
The main methods of disinfection of medical instruments
include their boiling and immersion in disinfectant solutions.
Boiling method. Boiling is recommended for medical
products made of glass, metal,heat resistant materials,
rubber. Boil in a 2% sodium bicarbonate solution for 15 min.
Method of immersion in a disinfectant solution. The
following solutions are used for immersion disinfection.
• 3% solution of chloramine B with immersion of medical
instruments for 60 min (for processing instruments in
tuberculosis hospitals - in a 5% solution of chloramine for
240 min).
• 6% hydrogen peroxide solution with immersion for 60
minutes or 4% solution for 90 minutes.
• 2% glutaral solution with immersion for 15 minutes.
• 70% alcohol solution with immersion for 30 minutes.
Sterilization (lat. Sterilis - sterile) - the complete release of a
substance or object from microorganisms by exposure to it by
physical or chemical factors. All medical devices must undergo pre-
sterilization cleaning multiple use before sterilization and / or
disinfection to remove protein, fatty, mechanical impurities, as well
as drugs.
Detachable products are subject to pre-sterilization cleaning
disassembled in the following order.
• Rinse with running water for 30 seconds.
• Soaking in a washing complex (“Biolot”, “Lotus”) with full
immersion of the product for 15 min at a temperature of 50 ° С
• Wash each item with a brush, cotton-gauze swab or brush in the
washing complex for 30 s.
• Rinsing with running water when applying “Biolota” for 3 minutes,
“Lotus-medical” for 10 minutes.
• Holding in distilled water for 30 minutes.
• Drying with hot air at a temperature of 80–85 ° С until the
complete disappearance of moisture.
 Quality control of pre-sterilization treatment
of medical instruments
Pre-sterilization treatment is considered
effective if residual amounts of blood are not
found on the products after processing using
an amidopyrine or azopyram test.
Amidopyrine test solution: immediately
before the samples mix equal amounts (2-3 ml
each) of a 5% alcohol solution of
aminophenazone (Amidopyrine), 30% acetic
acid solution and 3% hydrogen peroxide
solution.
Solution for azopyram test: for the preparation of a 1-1.5%
solution of azopyram, dilute aniline hydrochloride in a 95%
solution of 5 ethyl alcohol. The finished solution can be
stored in a tightly closed bottle in the dark in the refrigerator
for 2 months, at room temperature (18–23 ° C) - not more
than 1 month. Immediately before the sample, a working
solution is prepared by mixing equal amounts of azopyram
and 3% hydrogen peroxide. Working solution can be used
within 1-2 hours. With longer storage, spontaneous staining
of the reagent in pink is possible. Do not inspect hot
instruments, nor keep the solution in bright light or near
heating appliances.
To test the suitability of the working solution of azopyram, 2-
3 drops are applied to a blood stain. If no later than after 1
min a violet staining of the spot appears, passing then in
blue, the reagent is usable.
Sample production technology (used for
reusable medical instruments). Reagent is
applied to non-sterile cotton. After a few seconds
in the absence of color reactions on cotton wool
are wiped with a syringe piston, a cylinder on
the outside, a needle, a cannula. Then the
reagent is poured into the syringe barrel, it is
passed through the syringe to another cotton
wool (the syringe barrel is checked). After that,
the needle is fixed on the syringe, the reagent is
again poured into the cylinder and pass it
through the syringe and needle (the needle is
checked).
Interpretation of the result: in the presence of blood
impurities, a blue-green (positive amidopyrine test) or violet-
blue (positive azopyram test) staining appears on the cotton
wool.
If the test is positive, repeated control of the instruments
should be carried out daily until a 3-fold negative result is
obtained.
Self-monitoring in a medical institution is carried out at least 1
time per week. Control is subjected to 1% of simultaneously
processed products of the same name, but not less than 3-5
units. Sanitary and epidemiological station employees quality
control.
Pre-sterilization cleaning is carried out 1 time per quarter.
Disinfection of rooms, furnishings of the treatment room
It is carried out by double wiping with a rag soaked in a 1%
solution of chloramine B with detergent or in a 3% solution
of hydrogen peroxide with detergent.
Rag handling:
1) immersion in one of the solutions (1% solution of chloramine
B, 0.5% calcium hypochlorite solution) for 60 minutes before
use;
2) boiling in a 2% soda solution for 15 minutes
If furnishings or rags are contaminated with blood, you should
immediately switch to the processing mode using a 3% solution
of chloramine B.
Routine cleaning of the treatment room. It is carried out 2
times a day with the use of a 1% solution of chloramine B.
Ultraviolet irradiation and ventilation of the cabinet is carried
out 4 times a day for 15–20 minutes (after cleaning and during
operation, the room should be irradiated with a stationary
outdoor or mobile ultraviolet lamps).
General cleaning of the treatment room. It is performed once a
week with the use of 500 g of a 5% solution of chloramine B per
10 liters of water.
Preparation of working disinfectant chlorine solutions
Chlorine-containing disinfectant solutions are used to disinfect
various rooms, toilets, care items, utensils, patient discharges,
etc. Disinfectants should be carried out centrally in specially
equipped rooms, having a supply and exhaust ventilation.
Necessary equipment.
• Protective clothing (long coat, hat, oilcloth apron,
respirator, protective glasses, rubber gloves, replaceable
shoes).
• Dry bleach, chloramine B (dry powder).
• Capacities (enameled, plastic or dark glass) for
disinfectants solutions with mandatory labeling.
• Measured dishes (1l, 10l) with marking.
• Wooden spatula for stirring the mortar.
• Water.
• Personal hygiene products (towel, soap).
The procedure for preparing a 10% solution bleach.
1. Prepare to prepare a disinfectant solution: wear protective
clothing, believe the equipment, note the start time of the
procedure.
2. Pour 2-3 cups of water into the container.
3. Carefully pour in 1 kg of dry bleach and mix thoroughly,
kneading lumps.
4. Fill the container with water to 10 l, mix until smooth.
5. Close the container tightly with a lid and leave for a day in a
dark room; solution it is necessary to mix several times during the
day.
6. After a day, drain the settled solution into another container
(also carry out the procedure in protective clothing), make an
inscription on it about the date of preparation and store in a dark
place.
7. At the end of the procedure, remove protective clothing, wash
hands.
The procedure for preparing a 1% solution of bleach.
1. Prepare to prepare a disinfectant solution: wear protective
clothing, check equipment, note the time of the start of the
procedure.
2. Pour into a container 1 liter of 10% bleach solution (to obtain a
0.5% solution bleach - 0.5 l).
3. Top up the container with water to 10 l, mix.
4. Close the container tightly with a lid and inscribe on it the date of
preparation.
5. At the end of the procedure, remove protective clothing, wash
hands. Such a solution is used for work immediately after its
preparation.
The procedure for preparing a solution of chloramine B must also be
carried out in compliance with all safety regulations, in protective
clothing and with mandatory labeling of containers with liquid. To
obtain a 1% solution of chloramine B, you need 10 g of dry
chloramine B first mix thoroughly in a special container and then
add water to the mark of 1 liter.
 Ensuring a healthy microclimate
To maintain a healthy microclimate (in the literal
sense, that is, in terms of physical parameters in
the room) in a medical institution, it is necessary
to observe certain requirements for the basic
parameters that ensure a healthy environment
patient environment.
Particular attention is recommended to be paid
to the following factors (tab. 3-9):
• lighting: natural (sunlight), artificial;
•ventilation: airing, conditioning),
• heating (can be water, steam, air).
Table 3-9.The main factors in maintaining a healthy environment in a medical institutio

Adequate microclimate goal

factors
Naturally lit rooms The bactericidal effect of
sunlight
Artificial Lighting Creating comfort for
patients (to a greater extent
- fluorescent lamps)
Ventilation Prevention of nosocomial
infection (replacement
polluted air clean)
Heating Creating comfort for
patients (optimal rate -
winter temperature 20 ° С.
in the summer - 23-24 ° C
Florence Nightingale as early as 1860 in his book Notes on
Nursing for the first time raised the problem of the
influence of sanitary and hygienic factors on the state of
health, and defined patient care as "... the action to use the
patient’s environment to recover”. Particularly F.
Nightingale emphasized the importance of environmental
factors such as cleanliness, fresh air, silence, proper
nutrition.
Providing a sanitary-hygienic regimen in a medical
institution provides for thorough regular cleaning of the
premises. Thoroughly wet cleaning of hospital rooms and
the maintenance of clean equipment, medical equipment,
care items, furniture - a prerequisite for compliance with
the rules of the sanitary-hygienic regime in a medical
institution (tab. 3-10).
 Table 3-10. General rules for sanitary-hygienic cleaning of hospital premises
Activities for Basic requirements for Multiplicity of
sanitary sanitary cleaning cleaning
tidying up
Wet cleaning Floor washing, wiping doors 2 times a day
and doorknobs, window sills and more often
Coves, furniture,
equipment;
necessarily use detergents
and
disinfectant solutions

Wipe the inside Using liquid detergents At least 1 time

window panes per month
 Wipe the window Using liquid At least 1 time in 4
panes outside detergents months
Clear-out of Washing walls, At least 1 time per
chambers and floors, doors and month
offices doorknobs, window
sills, furniture,
equipment, lamps,
safety shutters, botka
ceilings, etc .; the use
of washing and
disinfecting solutions
is mandatory
General cleaning of Wet cleaning with the Once a week
procedural and release of premises
dressing rooms from equipment and
furniture
 Airing of chambers, Ventilation with opening window leaves and At least 4 times a day
cabinets window sashes
Food Unit Cleaning Wall washing, lighting; disinfection of premises Daily
using 1% bleach solution (1% chloramine B
solution ")
Pantry cleaning Washing dishes with hot water and a disinfectant After each meal
solution and sterilizing it (in an air sterilizer) for 1
hat a temperature of 180 ° C; cleaning with
disinfectant solutions
Hygiene activities Basic requirements for sanitary cleaning Multiplicity of
tidying up cleaning
Change of linen in the Dirty laundry is collected in special oilcloth bags or At least 1 time in 7
wards linen trolleys days and as pollution
Bathroom cleaning Washing the baths after each patient with warm Several times a day
water with a washing (soap) solution, then and as pollution
treatment with a 0.5% solution of bleach or 1-2%
solution of chloramine B; washing the toilet with
0.5% bleach solution
Liner handling and Soaking ships (urinals) in a disinfectant solution Constantly (as used)
urinals (exposure time depends on the applied creature, for
example in a 0.5% solution of bleach should hold
for 60 minutes) and rinse under hot spray water
with brushes
 Cleaning is carried out with a brush, a mop, rags moistened
with a disinfectant solution.
House cleaning. In the ward, cleaning should begin with
bedside tables: they dust off, remove all excess, leave soap,
toothpaste, cookies, preserves, sweets, books.
Fruits and perishable foods should be refrigerated. Then
dust is wiped off the surface of beds, radiators, pipes, from
window sills, shades, furniture. It should be quiet during
cleaning. Nursing movements should not bother patients.
Clean should be clean, not missing corners and inaccessible
places. You need to sweep the chamber towards the door,
pick up the trash with a dustpan and take it out to the
garbage chute or burn it.
Cleaning the corridors. In the corridors they wipe the doors,
panels, furniture, handles with a damp cloth, complete the
cleaning by washing the floor with a solution of bleach.
Equipment and cleaning of toilet rooms. Toilet rooms
should be well insulated from other rooms, have an
intermediate gateway, a reliable exhaust hood
ventilation, adequate lighting. Here you should place
closed cabinets for ships, urinals, utensils for collecting
feces and urine. Cleaning equipment should be separate
for chambers and toilets, used strictly for their intended
purpose. It must be properly labeled and kept clean.
Brushes, rags, basins are regularly washed hot water, and
the rags are dried. Ruffs for washing ships and urinals
("ducks") also washed with water and disinfected. Baths,
bedpan, urinals are washed and disinfected after each use
with 0.5% bleach solution. The vessel, "ducks" are
thoroughly washed with hot water and disinfected with a
2% solution of chloramine B.
If the patient has an infectious intestinal disease, the
feces are poured with a 20% solution of bleach for 2
hours, and then the vessel is emptied. Clean vessels,
"ducks" are stored in toilet rooms in special nests. Some
hospitals have a washing machine for ships.
Toilets are cleaned as needed and well ventilated so that
there is no smell. Washbasins, toilet bowls, urinals, water
storage tanks, spittoon bowls are washed daily with hot
water and soap, 2% soda solution and a disinfectant
solution; brown spots are wiped with acetic acid. The
younger nurse must carry out cleaning of the toilet
rooms with rubber gloves. After cleaning, she should
wash her hands with soap and with a 2% solution
Chloramine B, which should be in every toilet room.
THANK YOU FOR ATTENTION!