Sterilization and Disinfection

Seshkant Poudyal
M.Sc. M.L.T. (Gold medalist)
I. Sterilization
It is one of the basic steps in surface asepsis.
Definition: Sterilization refers to the use of different
procedures to destroy all forms of microorganisms
including bacterial spores.
 What to sterilize?
It is mandatory to sterilize :
all instruments that penetrate soft tissues
and bone.
 Instruments that are not intended to
penetrate the tissues, but that may come into
contact with oral tissues.
If the sterilization procedure may damage the
instruments, then, sterilization can be replaced
by Disinfection procedure
II. Disinfection
It a is less lethal process than sterilization.
Definition: It is a procedure intended to
reduce microorganisms as far as possible
(but not bacterial spores).
Thus, disinfection can never replace
sterilization
Which procedure to use?
Category Items in each category Procedure

Items that: (1) enter the tissue; (2)

Critical Enter vascular system; (3) through Sterilization
which blood flows
Items that: (1) touch mucous
membranes; (2) touch non-intact High level
Semi-critical skin (e.g. endoscopes, respiratory disinfection
therapy equipment, and diaphragms)

Items such as bedpans, blood Low level

Non-critical pressure cuffs, and bedside tables disinfection
Sterilization – Instrument Packing
Often instruments are packed for sterilization
Packing depend on the intended shelf life after
sterilization.
The available packing options are:
Textile has shelf life of 1 month
Paper has shelf life of 1-6 months
Nylon, glass, and metal have shelf life of 1 year
if tightly closed
Sterilization Principles
 There are 3 different sterilization principles:
1. Heat sterilization
2. Chemical sterilization
3. Radiation sterilization
 Each principles is discussed in the following
sections.
1. Heat Sterilization
 Advantages:
It is the simplest, most effective and
inexpensive method.
 There are 2 procedures depending on the
tolerance of the material used:

a) Steam sterilization (Autoclaving)

b) Dry heat sterilization
1.a. Heat – Steam Sterilization
Use saturated steam above 100º C on packed items.
Objects occupy 4/5 of autoclave volume to facilitate
circulation.
Process is divided into 3 periods as follows:

– Pre-vacuum period:
– air is withdrawn from device
– Sterilizing period: steam is introduced under
pressure t specific temperatures & times.
– Post-vacuum: steam is withdrawn to dry
autoclave
Steam Sterilization
Advantages & Disadvantages
Advantages:
good penetration
maintains integrity of liquids (e.g. Lubricants) due to the
100% humidity within the chamber.

Disadvantages:
Non stainless steel metal items corrode
may damage plastic and rubber items
sharp instruments get dulled.
1.b. Dry-Heat Sterilization
Involves heating at atmospheric pressure and often
use a fan to obtain uniform temperature by circulation.
Heat at
 180º for half hour ,
170º for 1 hr.,
or 160º C for 2 hrs.
Times are the periods during which object is
maintained at the respective temperature
Dry-Heat Sterilization
Disadvantages
Disadvantages:
Less reliable than autoclaving
sharp instruments get dulled
Many materials do not tolerate dry heat
2. Chemical Sterilization - Types
 The chemical compounds used can be:
a) Gas Sterilization
b) Liquid Sterilization

 Generally, chemical sterilization procedures have the

disadvantages of presenting health hazards to users
(e.g. poisonous, flammable )
2.a) Gas Sterilization
The gas used in this procedure is ethylene oxide.
Procedure:
Keep objects in constant atmospheric humidity.
Heat to temperatures between 30º and 60º C.
 maintain for a period of 10 hrs.
Residual ethylene oxide must be ventilated

Formalin gas autoclaves have been developed for

sterilizing endoscopes and anaesthetic apparatus.
Gas Sterilization – Disadvantages
Ethylene oxide (& formalin) autoclaves have the
following disadvantages:

 Difficult to operate
 Unsuitable for hospitals but used in industry
(e.g. for sterilizing disposable materials that can
not tolerate high temperatures).
 2.b) Liquid Sterilization
Can be performed with buffered glutaric
aldehyde.

Procedure:
Immerse object in liquid for several hours.
Rinse with sterile water after end of procedure.
3. Radiation Sterilization
Provides effective way of sterilization when used in high
doses.
Gamma radiation
Procedure:
Expose objects for about 24 hrs.
Radiation Sterilization
Advantages and Disadvantages
Advantages:
Clean process
Dry process
Ensures full exposure of object from all directions
Disadvantages:
Posses threat to humans (radiation)
Lengthy process
Requires very qualified personnel
Disinfection - Types
 Disinfection can not kill all microorganisms but only
reduce its number.
 Disinfection can be accomplished with:
1. Heat disinfection
2. Chemical disinfection
 Object that can be disinfected are bedpans, patient skin
before operation and surgeon hands before putting
gloves.
1. Heat Disinfection
It is accomplished by boiling water at atmospheric
pressure for at least 20 min’s
 2. Chemical disinfection
Number of different agents are used according to tolerance
of objects and infectious agents.

Using phenol with cleaning component destroy the membrane

of microorganisms.
Using 70% alcohol for skin which denatures proteins of
microorganisms.
Use soap containing hexachlorophene for hands.
In case of hepatitis use 5% solution of chloramines or heat
disinfection
Asepsis – Summary Asepsis

Sterilization Disinfection

Heat Chemical Radiation Heat Chemical

Steam Gas Gamma Boiling water Phenol

Dry heat Ethylene oxide Alcohol 70%

Formalin Hexachlorophene

Heat or
Liquid chloramines solution

Glutaric
Aldehyde
Disinfection and Sterilization -
New methods
These include sterilants based on compounds
such as hydrogen peroxide, peracetic acid,
peroxysulphates, chlorine dioxide, and ozone.
For the most part, the microbicidal action of
these chemicals has been recognized for many
years.
Peracetic Acid. Peracetic acid is currently
used in a number of sterilization processes.
Agent Mechanisms of Action Comments
Surfactants Membrane Disruption; Soaps; detergents
increased penetration
Quats (cationic Denature proteins; Antiseptic - benzalconium
detergent) Disrupts lipids chloride, Cepacol; Disinfectant
Organic acids and High/low pH Mold and Fungi inhibitors; e.g.,
bases benzoate of soda
Heavy Metals Denature protein Antiseptic & Disinfectant; Silver
Nitrate
Halogens Oxidizing agent Antiseptic - Iodine (Betadine)
Disrupts cell membrane Disinfectant - Chlorine (Chlorox)
Alcohols Denatures proteins; Antiseptic & Disinfectant
Disrupts lipids Ethanol and isopropyl
Phenolics Disrupts cell membrane Disinfectant
Irritating odor
Aldehydes Denature proteins Gluteraldehyde - disinfectant
(Cidex); Formaldehyde -
disinfectant
Oxidizing agents Denature proteins Hydrogen peroxide – antiseptic;
Hydrogen peroxide – disinfectan;
Benzoyl peroxide – antiseptic
 Soaps are sodium or potassium salts of
fatty acids, a natural product
 Detergents, instead, are artificial
surfactants
 While soaps are always negatively
charged, some detergents are negatively
charged while others are positively
charged
 One example of a positively charged
detergent are quaternary ammonium
compounds (a.k.a., quats)
 Halogens are the seventh (VII) column of the
periodic table of elements
 Two halogens are regularly employed as
antimicrobials: Iodine and Chloride
 Iodine: commonly used as an antiseptic
against all microbes, fungi, and viruses
 Iodine: It inhibits protein synthesis and
oxidizes –SH groups of amino acids
 Chlorine: Used as a disinfectant (10% bleach)
 Chlorine: Hypochlorous acid (HOCl) is a
product, formed in water, that is the active
form of the disinfectant
 Chlorine: Applied in treatment of drinking
water, swimming pool, and sewage
 Glutaraldehyde is
capable of effectiving
sterilization—at room
temperature, even
against endospores,
and even in the
presence of organics,
but achieving
sterilization requries
many hours of
exposure… and it is
nasty stuff to work
with!
Conclusion
In summary:
Sterilization and disinfection are costly and time consuming
process
However, it is an essential in all health care facilities to
avoid spread of diseases.
It depends on the ehtics of the instrument users.
Users should keep in mind that contaminated instrument
present risk to patient as well as the user himself.