1. SVCC Respiratory Care Programs

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

3. 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

4. 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,

5. 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

6. 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

7. Resistance of organism to killing agents

8. 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

9. 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) ·

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

12. 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

13. 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.

14. 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

15. 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

16. 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

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

18. 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

19. 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

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

22. 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

23. 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

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

25. SVCC Respiratory Care Programs

26. 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

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

28. 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)

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

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

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

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

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

34. فنلیک ها
ارتو فنیل فنل
ارتو-بنزیل-کلروفنل

35. 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

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