SVCC Respiratory Care Programs

Dr.Hossein Fazeli Isfahan University of Medical Science Disinfection Dr.Hossein Fazeli Isfahan University of Medical Science

Outline History Definitions Factors that influence the degree of disinfectants How an object should be disinfected depended on its intended use General Disinfectant Guidelines New Disinfectants Test Methods for Disinfectants

History of Antiseptics Antiseptics were used for the first time by Doctor Joseph Lister, a surgeon at the Royal Infirmary in Glasgow, Scotland. In 1867,

Definitions Disinfection is using an agent that destroys microbes or inactivates them, usually referred to chemicals that kill vegetative forms but not the resistant spores of bacteria Sterilization is any process, physical or chemical, that will destroy all forms of life, including bacterial, mold, spores, and viruses

Definitions (cont’d) Antisepsis is destruction of pathogenic microorganisms existing in their vegetative state on living tissue Sanitize is to reduce the population of microbes on inanimate objects to a safe level as judged by public health authorities

Resistance of organism to killing agents

Hierarchy of Microbes MICROBE REQUIRES PRIONS Extended sterilization times SPORES Routine sterilization Mycobacteria (TB) high level disinfection Non-lipid/sm viruses intermediate level disinfection Fungi intermediate level disinfection Vegetative bacteria low level disinfection Lipid/med. Size viruses (HBV,HIV) low level disinfection

FACTORS THAT INFLUENCE THE DEGREE OF DISINFECTANTS Types of organisms · Number of organisms · Concentration of disinfecting agent · Presence of organic material (e.g., serum, blood) ·

Nature (composition) of surface to be disinfected Contact time, Temperature, pH Biofilms Compatibility of disinfectants

How an object should be disinfected depended on its intended use Spaulding system (1972) The three categories he described : critical objects Semicritical objects noncritical objects

Processing “Critical” Patient Care Objects Classification: Critical objects enter normally sterile tissue or vascular system, or through which blood flows. Object: Sterility. Level germicidal action: Kill all microorganisms, including bacterial spores. Examples: Surgical instruments and devices; cardiac catheters; implants; etc. Method: Steam, gas, hydrogen peroxide plasma or chemical sterilization.

Chemical Sterilization of “Critical Objects” Glutaraldehyde (> 2.0%) Hydrogen peroxide-HP (7.5%) Peracetic acid-PA (0.2%) HP (1.0%) and PA (0.08%) HP (7.5%) and PA (0.23%) Glut (1.12%) and Phenol/phenate (1.93%) _______________________________________________ Exposure time per manufacturers’ recommendations

Chemical Sterilization of “Critical Objects” Glutaraldehyde (> 2.0%) Hydrogen peroxide-HP (7.5%) Peracetic acid-PA (0.2%) HP (1.0%) and PA (0.08%) HP (7.5%) and PA (0.23%) Glut (1.12%) and Phenol/phenate (1.93%) _______________________________________________ Exposure time per manufacturers’ recommendations

Processing “Semicritical” Patient Care Objects Classification: Semicritical objects come in contact with mucous membranes or skin that is not intact. Object: Free of all microorganisms except high numbers of bacterial spores. Level germicidal action: Kills all microorganisms except high numbers of bacterial spores. Examples: Respiratory therapy and anesthesia equipment, GI endoscopes, thermometer, etc. Method: High-level disinfection

High Level Disinfection of “Semicritical Objects” Exposure Time > 12 m-30m, 20oC Germicide Concentration_____ Glutaraldehyde > 2.0% Ortho-phthalaldehyde (12 m) 0.55% Hydrogen peroxide* 7.5% Hydrogen peroxide and peracetic acid* 1.0%/0.08% Hydrogen peroxide and peracetic acid* 7.5%/0.23% Hypochorite (free chlorine)* 650-675 ppm Glut and phenol/phenate** 1.21%/1.93%___ *May cause cosmetic and functional damage; **efficacy not verified

Processing “Noncritical” Patient Care Objects Classification: Noncritical objects will not come in contact with mucous membranes or skin that is not intact. Object: Can be expected to be contaminated with some microorganisms. Level germicidal action: Kill vegetative bacteria, fungi and lipid viruses. Examples: Bedpans; crutches; bed rails; EKG leads; bedside tables; walls, floors and furniture. Method: Low-level disinfection

Low-Level Disinfection for “Noncritical” Objects Exposure time > 1 min Germicide Use Concentration Ethyl or isopropyl alcohol 70-90% Chlorine 100ppm (1:500 dilution) Phenolic UD Iodophor UD Quaternary ammonium UD _____________________________________ UD=Manufacturer’s recommended use dilution

General Disinfectant Guidelines . water quality and its impact on the disinfection process The temperature can also affect the process;

General Disinfectant Guidelines All surfaces must make direct contact with the disinfectant for a specified period of time. read all safety information before you use the chemical

General Disinfectant Guidelines Before using a disinfectant, make sure it has been approved by your Infection Control Department/Committee for use. make sure the product has a valid EPA registration number

What are the Differences Between Disinfectants and Disinfectant Cleaners? Disinfectant cleaners combine the cleaner (detergent) and disinfectant into a “one-step” process.

SVCC Respiratory Care Programs

New Disinfectants New disinfection methods include a persistent antimicrobial-drug coating that can be applied to inanimate and animate objects, a high-level disinfectant with reduced exposure time

New Disinfectants ortho-phthalaldehyde (Cidex) superoxidized water New generation of Quaternary ammonium Flushing and Washer Disinfectors Surfacine (breakthrough silver technology)

Test Methods for Disinfectants FDA (Food and Drug Administration) EPA (Environmental protection Agency) ASTM (American Society for testing and Material) ECS (European committee for Standardization)

Test Methods for Disinfectants Basic suspension tests Quantitative suspension tests Surface test and hand wash/rub methods Field tests under practical conditions

کلرین و ترکیبات کلر دار هیپوکلریت ها دی اکسید کلرین کلرآمین T سدیم دی کلروایزوسیانات

SVCC Respiratory Care Programs فرمالدئید فرمالین فرمالدئید-الکل پارافرمالدئید SVCC Respiratory Care Programs

گلوتارالئید محلول های آبی گلوتارالدئید اسیدی و قلیایی فرمولاسیون های جدید: گلوتارالدئید-فنل سدیم فتات، گلوتارالدئید قلیایی پایدار شده، گلوتارالدئید-فنل امید

پراکسید هیدروژن یدوفورها ارتو-فتال آلدئید(سایدکس) اسید پراستیک الکل ها

فنلیک ها ارتو فنیل فنل ارتو-بنزیل-کلروفنل

ترکیبات چهار گانه آمونیوم الکیل دی متیل بنزیل آمونیوم کلرید الکیل دی دسیل دی متیل امونیوم کلرید دی الکیل دی متیل آمونیوم کلرید آمونیوم های نسل چهارم

آب سوپر اکسید شده فلزات فلاشر ها ( ضد عفونی کننده های با فشار آب)