STERILIZATION

AND
DISINFECTION
BY-CAPT T DIVYA
NQAS
 WHY NEEDED?
 Microorganisms are
omnipresent.

 Since they cause

contamination, infection
and decay, it becomes
necessary to remove or
destroy them from
materials or from areas.
 DEFINITIONS
 Sterilization – Process by which an article,
surface or medium is freed of all living
microorganisms in the vegetative and spore
state.

 Disinfection – Process of destroying all

pathogenic microorganisms capable of
producing infections but not necessarily
spores.
HOW CAN MICROORGANISMS
BE KILLED ??
 RESISTANCE OF
MICROORGANISMS
CLASSIFICATION OF MEDICAL
DEVICES FOR REPROCESSING
 Proposed by Earle H. Spaulding in 1968

 Categorized into 3 categories

 Critical devices

 Semi critical devices

 Non critical devices

 REQUISITES FOR
STERILIZATION
 Decontamination
 Pre sterilization cleaning
 Sterilization process
 Aseptic storage
DECONTAMINATION
 The instruments are dipped in 0.5% sodium hypochoride
solution for 10minutes.
 PREPARATION OF VARIOUS
CONCENTRATION OF
HYPOCHLORITE SOLUTION
Desired concentration x Quantity to be prepared= Dose
Available strength

For eg to make 0.5% 100ml hypochlorite solution from 10%

hypochlorite solution

0.5 X 100ml =5ml

10
That is 5ml of 10% hypochorite should be added to 95ml of
water to make 100ml of 0.5% hypochlorite solution.
 PRESTERILIZATION
CLEANING
 Objective-
Removal of the organic matters, blood
and saliva.

 There are three methods for cleaning

-Manual
-Ultrasonic
-Mechanical washing
 MANUAL CLEANING

 Simplest and the cheapest method.

 Heavy duty gloves and glasses must be
worn to protect needle stick injury and to
protect eye.
 Material used for manual cleaning
-Soaps
-Detergents
ULTRASONIC
CLEANING
Principle- conversion of
electrical energy into vibratory
sound waves which pass
through a soap solution
containing the instrument.

Used mainly for burs, bone

files, bone cutter, artery
forceps, saw etc.
MECHANICAL
WASHING
Principle- High-pressure
jets of water with or
without a detergent which
removes debris from
instrument.
Small instrument like
burs, blade are not
suitable for this type of
cleaning.
PHYSICAL S CHEMICAL
METHODS T METHODS
E Alcohols
Heat R Aldehydes
Dry heat I
Moist heat Dyes
L
I Halogens
Radiation
S Phenols
A
Surface-active agents
T
I Metallic salts
O
Gases
N
 HEAT
❖ Most reliable method.

❖ Can be used either in the form of

MOIST
DRY HEAT
HEAT
 INCINERATION

❖ Excellent method.

❖ Materials are reduced to ashes by burning.

❖ For contaminated and pathological materials

at a high temperature.
HOT AIR OVEN
 Kills by oxidation effects
 Utilizes dry heat to sterilize
 Used to sterilise culture
media, petri dish, specimen
bottle,culture bottle and test
tubes,liquid paraffin
MOIST HEAT STERILISATION
TEMPERATURE ABOVE 100O C
(AUTOCLAVE)
❖ Most reliable method of sterilisation.

❖ Works on the principle of Steam

under pressure.
❖ Invented by Charles
Chamberland in 1879.
AUTOCLAVE
AUTOCLAVE
 TIME ,TEMPERATURE
PRESSURE RELATION
TIME TEMPERATUR PRESSURE
E
15Minutes 121 15 Psi

4 Minutes 132 27 Psi

 AUTOCLAVE
AUTOCLAVABLE NON SHELF LIFE
ARTICLES AUTOCLAVABLE
ARTICLES

Surgical instruments Heat sensitive 06 months/180 days

Gauze articles 24 hours(Opened
Abdominal Plastic tubes drums)
swab,linen Acids,organic 72 hours(unused
Drapes solvents packs)
Customised packs Radioactive materials
Glasswares Polyurethane
Paraffin
 ETHYLENE OXIDE
STERILIZATION(EO)

 Used to sterilize medical

products that cannot be steam
sterilized or sensitive to
radiation.

 Provides an effective method of

sterilization for items that steam
may erode
 ETHYLENE OXIDE
STERILIZATION
Aticles which can be Articles which Shelf life
EO sterilised cannot be EO
sterilised

Metals Oils 2 years

Glasses Liquids
Rubber materials Powder
Pvc materials Lensed equipments
Cameras
 PLASMA
STERILIZATION
 Hydrogen peroxide is activated to
create a reactive plasma.
 Used for metal and nonmetal
surgical devices at low temperature.
 Processing time ranges between 35-
75 minutes.
PLASMA MACHINE
 PLASMA STERILIZATION

Articles which can be Articles which Shelf life

plama sterilised cannot be plasma
sterilised

Heat sensitive articles Endoscopes 09 months

Metallic intruments Bronchoscopes
Rubber articles Woven textiles with
PVC tubes cotton ffibres
Light weight Metal trays
instruments Liquids
PACKAGING FOR
STERILIZATION
 STERILISATION
VALIDATION
❖ Biological indicators – Bacillus
stearothermophilus

❖ Mechanical indicators

❖ Chemical indicators
STERILISATION
VALIDATION
STERILISATION
VALIDATION
 ASEPTIC STORAGE
• Instruments are kept wrapped until ready for use .
• Minimal handling to be done
• Sterilized packs should be allowed to cool before storage;
otherwise condensation will occur inside the packs.
• The store must be subjected to adequate pest control .
• Materials should be stored at least 8” off the floor and 18”
from the ceiling
• Sterile packs must be stored and issued in correct date
order.
ASEPTIC STORAGE
 CHEMICAL AGENTS

 Alcohols – Ethyl, Isopropyl,

 Aldehydes – Formaldehyde,
Glutaraldehyde
 Halogens
 Phenols
 Surface Active Agents
 Gases – Ethylene Oxide,
Formaldehyde,
LEVEL OF DISINFECTANTS
 High-level disinfectants
 Intermediate-level disinfectants
 Low-level disinfectants
MODES OF DISINFECTION

 Manual wiping with a chemical impregnated

cloth or sponge
 Soaking or total immersion
 Processing by flush through
machinery
 ALCOHOLS
 Ethanol (80% v/v ethyl alcohol) or 2-propanol
(60-70% v/v iso- propyl alcohol) solutions

 Are used to disinfect

• Skin
• Semicritical instruments
• Eg stethoscopes,ventilators.

 It kills 70%-95%,microorganisms,by coagulation

of cell proteins.
ALCOHOLS
ALCOHOLS
 ALDEHYDES
 Formaldehyde
 Glutaraldehyde
 Ortho-phthaladehyde
 FORMALDEHYDE

 Formalin is 37% formaldehyde in

water
 8% formaldehyde in 70%
isopropylalcohol
 High level disinfectant for
instruments
 Notused for housekeeping
purposes as a surface disinfectant.
 GLUTARALDEHYDE
 Concentration: Glutaraldehyde is commercially available
as 2% w/v aqueous solution which must be made alkaline
to "activate" (e.g. by addition of 0.3% sodium
bicarbonate).
 High level disinfectant of critical and semicritical items

 A 2% glutaraldehyde solution, for at least 10 hours, can

be used to sterilize heat labile items.
 It can be high level disinfectant if articles are dipped for
at least 30 minutes.
 USES OF
GLUTARALDEHYDE
 Endoscopes
 Plasticand
rubber items
 Broncoscopes
 Corrugated
anesthetic
tubes
 ORTHO-
PHTHALDEHYDE
 Composition-0.55% OPA
 Does not requires activation
 Highlevel disinfection-12 min
contact time
 Used for-disinfection of semicritical
articles
 HYPOCHLORITE
 These are inexpensive, broad spectrum
chlorine releasing disinfectants of choice
against viruses, including hepatitis B virus.

 Aqueous solution of sodium

hypochlorite (5.25%) is called
household bleach.
 PHENOLS
 Effective against bacteria (especially gram +ve
bacteria) and enveloped viruses.

 Used for decontamination of the hospital

environment, including laboratory surfaces.

 Ex Cresol, Chlorhexidine,
Chlorxylenol, Hexachlorophines
 DETTOL

 Composition- Chloroxylenol 4.8%

-Terpineol 9.0%
-Absolute alcohol
13.1%
 Action – it disrupts the cell
wall membrane leading to cell death
 Itis a non corrosive, non skin irritant,
low level disinfectant
DETTOL
 IODINE COMPOUNDS
 Iodine is used in aqueous or alcoholic
solution.

 Rapidly effective against most

microorganisms.
IODINE COMPOUNDS
 CUTASEPT

 Composition – isoprapanolol
-benzalkonium chloride
 Action – rapid broad spectrum bactericidal,
fungicidal, tuberculocidal, virucidal(enveloped
viruses)
 Contact- skin antisepsis-2min
-viruses-30 sec
-fungi and bacteria-15 sec
 It is a rapid acting low level disinfectant with
good skin tolerability
CUTASEPT
 OXIDISING AGENTS

 Hydrogen peroxide

 Peracetic acid
 PERASAFE
TRADE NAME HOW TO SHELF LIFE CONTACT
PREPARE TIME
PERASAFE Add 16.2 gm 24 HOURS 10 MINUTES
of perasafe
powder to
1000ml of
luke water
mix until
fully
dissolved
 STERIGEN

 High level disinfectant

 Itis produced by sterisol-
c,water ,and electricity.
 Itis a mixture of oxidants and
hypochlorous acid.
 Used for surface disinfection,aerial
fumigation,floor mopping,plastic
medical devices.
STERIGEN
STERIGEN PLANT
 CONCLUSION
 Sterilization and Disinfection are costly and
time consuming process.

 However it is essential in all health care

facilities to avoid spread of disease.

 Users should keep in mind that contaminated

instrument present risk to patient as well as
the user himself.
 BIBLIOGRAPHY

 Nancy Marie Philips,Berry & Kohns operative room

techniques,Elsevier Publications.
 AORN:Guidelines for perioperative practice,Denver,2015.
 Seavey R:Immediate use sterilization:Moving beyond current
policy,American Journal of Infection Control 41(5)
 Morton PJ ,Conner R:Implementing AORN recommended
practices for selection and use of packing systems for
sterilization
 Kennedy L:Implementing AORN recommended practices for
sale
environment of care ,Part 2,AORN Journal.
 Graybill –D Ercole P:Implementing AORN recommended
practices for sterilization,AORN Journal.
THANK YOU