1. PROBLEMS OF STERILISATION

2. OBJECTIVES IDENTIFY STANDARD TECHNIQUES AND CURRENT GUIDELINES
WHAT ARE THE PRACTICAL DIFFICULTIES FACED IN RURAL & SEMI URBAN SETUPS
SUGGESTIONS TO IMPROVE THE EFFICIENCY

4. DEFINITIONS
CLEANING
Removal of soil & redn in no of microorganisms from surface by washing in detergents
DISINFECTION
Inactivation of non-sporing organisms using either heat & water (thermal ) or by chemical means

5. STERILISATION
A validated physical or chemical process that is used to render a product free of all forms of viable micro organisms

6. CLEANING CLEANING SINK
RINSE IN LUKEWARM WATER / REMOVE VISIBLE BLOOD & BODY SUBSTANCES
DISMANTLE THE ITEMS IF ABLE
FULLY IMMERSE IN WARM WATER & USE DETERGENT / SCRUB WITH BRUSH

7. CLEANING RINSE THE INSTRUMENT IN RUNNING HOT WATER DRY THE INSTRUMENTS
Air dry / Sterile Disposable Paper towel /
Clean nonlined cloth
WEAR GLOVES / WASH HANDS BEFORE & AFTER CLEANING
BETTER WIPE BLOOD & TISSUE WHEN WET, DURING SURGERY

8. ENZYMATIC CLEANERS HAZARDOUS NOT FOR ROUTINE USE
CONCEALED DEBRIS – DIFFICULT TO CLEAN
ULTRACISION SCISSORS
ENDOSCOPES

9. ULTRASONIC CLEANERS HIGH FREQUENCY HIGH ENERGY WAVES
JOINTED AND SERRATED STEEL INSTRUMENTS
LOOSENS AND DISLODGES SOIL
FOLLOW BY RINSING IN WATER
DOES NOT STERILISE INSTRUMENTS

10. Cleaning- ultrasonic cleaners
objects are cleaned by ultrasonic cavitations
Microprocessor based ultrasonic cleaning system used in hospitals is a two chamber or three chamber cleaning machine consisting of
Ultrasonic tank,
Rinsing tank, 
Drying tank.

11. DISINFECTION
CRITICAL - OBJECTS WHICH ENTER NORMALLY STERILE TISSUE OR THE VASCULAR SYSTEM OR THROUGH WHICH BLOOD FLOWS
SHOULD BE STERILE.
SEMICRITICAL - OBJECTS THAT TOUCH MUCOUS MEMBRANES OR SKIN THAT IS NOT INTACT REQUIRE A DISINFECTION PROCESS (HIGH-LEVEL DISINFECTION[HLD]) THAT KILLS ALL MICROORGANISMS BUT HIGH NUMBERS OF BACTERIAL SPORES.
NONCRITICAL -OBJECTS THAT TOUCH ONLY INTACT SKIN
REQUIRE LOW-LEVEL DISINFECTION.

12. CHEMICAL STERILISATION
MANY CHEMICALS ARE AVAILABLE TO STERILIZE, DISINFECT OR SANITIZE
NONE IS THE “IDEAL” AGENT
CHEMICALS PENETRATE CELL WALLS AND REACT WITH CELL COMPONENTS IN VARIOUS WAYS TO DESTROY OR INHIBIT GROWTH
MANY CHEMICALS ARE DISINFECTANTS WITH VARYING LEVELS OF EFFICACY
SOME ARE STERILANTS

13. CHEMICAL STERILISATION
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%)

14. ETHYLENE OXIDE ALDEHYDES VAPOR PHASE H2O2 HALOGENS PHENOLS
High-cidal
Activity
ETHYLENE OXIDE
ALDEHYDES
VAPOR PHASE H2O2
HALOGENS
PHENOLS
7TH GENERATION QUATERNARY
ALCOHOLS
CHLORHEXIDINE
OLD GENERATION QUATERNARY
Low-cidal
Activity

15. CIDEX GLUTARALDEHYDE - INEXPENSIVE ADVANTAGES DISDVANTAGES
GOOD ACTIVITY AGAINST SPORES, VIRUSES, FUNGI
DISDVANTAGES
GLUTARALDEHYDE ONLY MODERATELY ACTIVE AGAINST TB
NEED LONG EXPOSURE TIME FOR FULL EFFECT (>3 HOURS)
FRESHNESS & PH CRITICAL
TOXIC!

16. CIDEX NEEDS ACTIVATOR 14 DAY USE LIFE 2 YEAR SHELF LIFE
( sodium bicarbonate)
14 DAY USE LIFE
2 YEAR SHELF LIFE
NONCORROSIVE
GOOD FOR PLASTICS, RUBBER, LENSES
IN “COLD STERILIZATION”
NOT INACTIVATED BY ORGANIC MATERIAL OR HARD WATER
IRRITATING TO RESPIRATORY TRACT AND SKIN

17. PERASAFE EXTREMELY RAPID ACTION A TOTAL BIOCIDAL SPECTRUM
SAFE AND NON-TOXIC TO USERS
NON-CORROSIVE
DOES NOT 'FIX' PROTEINS
ENVIRONMENTALLY FRIENDLY
STERILISES IN 10 MINUTES
DISINFECTS IN 5 MINUTES
100% BIO-DEGRADABLE,
NO SPECIAL DISPOSAL PROCEDURES.

18. IS DISINFECTANT STERILE?
MANY REPORTED CASES OF GRAM-NEGATIVE ORGANISMS LIVING IN DISINFECTANTS!

19. TIPS DO NOT TOP UP OLD SOLUTION DO NOT DILUTE THE SOLUTION
INSTRUMENTS SHOULD SUBMERGE
DO NOT OVERLOAD
USE STERILE METALLIC TRAY
DISCARD AFTER EXPIRY
RINSE FOR STIPULATED TIME

21. FORMALIN CHAMBER
CLEAN THE INSTRUMENT THOROUGHLY BEFORE ARRANGING THEM IN THE TRAY.
FORMALIN TABLETS SHOULD BE KEPT EXPOSED IN THE CABINET FOR OVERNIGHT VAPOR SATURATION.
THEREAFTER ONLY TWENTY TO SIXTY MINUTES OF EXPOSURE WILL BE REQUIRED TO ENSURE SATISFACTORY STERILIZATION.
TIME PERIOD DEPENDS ON THE CONCENTRATION OF FORMALIN AND INSTRUMENT SOILING

22. AUTOCLAVES

23. AUTOCLAVE ADVANTAGES CONSISTENTLY ACHIEVES COMPLETE STERILITY
INEXPENSIVE AND EASY TO OPERATE
SAFE FOR MOST SURGICAL INSTRUMENTS AND EQUIPMENT, DRAPES AND GOWNS, SUTURE MATERIALS, SPONGES AND SOME PLASTICS AND RUBBERS
SAFE FOR PATIENTS AND PERSONNEL
ESTABLISHED PROTOCOLS AND QUALITY CONTROL INDICATORS ARE EASY TO ACCESS

24. FUNCTION
COMPLETE STERILIZATION OF MOST ITEMS IS ACHIEVED AFTER 9 TO 15 MINUTES EXPOSURE TO 121° C (250° F)
STEAM AT SEA LEVEL IS 100° C (212° F) AS PRESSURE IS INCREASED THE TEMPERATURE OF THE STEAM INCREASES
THE MINIMUM EFFECTIVE PRESSURE OF THE AUTOCLAVE IS 15 POUNDS PER SQUARE INCH WHICH PROVIDES STEAM AT 121° C (250° F)
MANY AUTOCLAVES ATTAIN 35 PSI WHICH CREATES STEAM TEMPERATURE OF 135° C (275° F)

25. ACTION OF MOIST HEAT
STEAM CONTACTS A COOLER SURFACE, CONDENSES, CAUSING A HUGE DECREASE IN VOLUME AND SETTING UP A NEGATIVE PRESSURE THAT DRAWS MORE STEAM.
CONDENSATION OCCURS AS LONG AS THERE IS A TEMPERATURE DIFFERENTIAL .
ACTION OF STEAM : SURFACE HEATING, PENETRATION, AND PROTEIN COAGULATION

26. AUTOCLAVE
TYPES
GRAVITY DISPLACEMENT AUTOCLAVE
PREVACUUM AUTOCLAVE

27. AUTOCLAVE Types Gravity displacement Water is heated in a chamber
Continued heating creates pressure
Steam displaces air within the chamber forcing it out through a vent
Cycle timing begins when the temperature reaches at least 121°C

28. Gravity displacement
After sufficient exposure time, steam is exhausted through a vent back into a reservoir
Air that has been sterilized within the jacket and then filtered is admitted back into the chamber to replace the exhausting steam
If the chamber is loaded improperly or there is insufficient steam, there will be air pockets remaining in the chamber that will interfere with steam penetration and result in non-sterile areas
THE LOAD MUST BE DRIED WITHIN THE AUTOCLAVE

29. AUTOCLAVE Types Prevacuum
Usually a much larger and more costly machine
Equipped with a boiler to generate steam and a vacuum system
Air is taken out of the loaded chamber by means of the vacuum system
Steam at 121°C or more is introduced into the chamber
The steam immediately fills the chamber to eliminate the vacuum
Exposure time begins immediately
At completion of the cycle steam is vacuumed and replaced by hot, dry sterile air
Air pockets are eliminated and processing times are reduced due to the vacuum

30. FLASH AUTOCLAVE 132OC FOR 3 MIN AT 27-28 LBS PRESSURE IN GRAVITY
USED FOR UNWRAPPED ITEMS THAT MUST BE USED IMMEDIATELY
ITEMS THAT CANNOT BE PACKAGED, STERILIZED AND STORED BEFORE USE
IMPLANTED SURGICAL DEVICES SHOULD NOT BE FLASH STERILIZED

31. FLASH AUTOCLAVE
ITEM DECONTAMINATED; STERILIZER FUNCTION MONITORED BY MECHANICAL, AND BIOLOGICAL MONITORS
NOT FOR REASONS OF CONVENIENCE, AS AN ALTERNATIVE TO PURCHASING ADDITIONAL INSTRUMENT SETS, OR TO SAVE TIME

32. FLASH STERILISER

33. Et O STERILISER

34. Et O STERILISATION ADVANTAGES VERY EFFECTIVE AT KILLING MICROORGANISMS
PENETRATES MEDICAL PACKAGING AND MANY PLASTICS
COMPATIBLE WITH MOST MEDICAL MATERIALS
CYCLE EASY TO CONTROL AND MONITOR
DISADVANTAGES
TOXIC, CARCINOGENIC, EXPLOSIVE
POTENTIAL HAZARD TO PATIENTS AND STAFF
LENGTHY CYCLE/AERATION TIME

35. GAS PLASMA STERILISER The Vacuum Phase The Injection Phase
The Diffusion Phase
The Plasma Phase

36. H2 O2 GAS PLASMA ADVANTAGES
SAFE FOR THE ENVIRONMENT AND HEALTH CARE WORKER; IT LEAVES NO TOXIC RESIDUALS
FAST - CYCLE TIME IS MIN AND NO AERATION NECESSARY
USED FOR HEAT AND MOISTURE SENSITIVE ITEMS SINCE PROCESS TEMPERATURE 50OC
SIMPLE TO OPERATE, INSTALL, AND MONITOR
COMPATIBLE WITH MOST MEDICAL DEVICES

37. DISADVANTAGES
CELLULOSE (PAPER), LINENS AND LIQUIDS CANNOT BE PROCESSED
STERILIZATION CHAMBER IS SMALL, ABOUT 3.5FT3 TO 7.3FT3
REQUIRES SYNTHETIC PACKAGING (POLYPROPYLENE) AND SPECIAL CONTAINER TRAY

38. NEWER H2 O2 GAS PLASMA

39. STERIS ADVANTAGES RAPID CYCLE TIME (30-45 MIN)
LOW TEMPERATURE (50-55OC) LIQUID IMMERSION STERILIZATION
ENVIRONMENTAL FRIENDLY BY-PRODUCTS (ACETIC ACID, O2, H2O)
FULLY AUTOMATED
NO ADVERSE HEALTH EFFECTS
COMPATIBLE WITH WIDE VARIETY OF MATERIALS
EXCELLENT MICROBIAL KILLING

40. DISADVANTAGES POTENTIAL MATERIAL INCOMPATIBILITY
USED FOR IMMERSIBLE INSTRUMENTS ONLY
BIOLOGICAL INDICATOR NOT SUITABLE
SMALL NUMBER OF INSTRUMENTS CAN BE PROCESSED IN A CYCLE
MORE EXPENSIVE
POINT-OF-USE SYSTEM, NO LONG-TERM STORAGE

41. STERIS

42. REUSE OF DISPOSIBLES DANGEROUS FOR BOTH THE PATIENT AND THE RE-USER.
PLASTIC MATERIALS MAY BECOME BRITTLE, LOSE FLEXIBILITY, CRACK OR DARKEN;
INFECTION ARISING FROM INADEQUATE CLEANING, DISINFECTION OR STERILISATION
REUSER BEGETS LEGAL LIABILITY OF MANUFACTURER

43. PROBLEMS
FACILITIES DO NOT MEET STANDARDS
EQUIPMENT NEEDS UPGRADING
NO PROPER DOCUMENTATION
NO SURVEILLANCE STAFF
POOR PRACTICES OF CLEANING
NONUSAGE OF BIOLOGICAL INDICATORS
LACK OF TRAINING AND PROTECTION FOR STAFF

44. FACILITIES DO NOT MEET STANDARDS GOV’T SECTOR PRIVATE
PROBLEMS
FACILITIES DO NOT MEET STANDARDS
GOV’T SECTOR PRIVATE
LACK OF FUNDS ECON VIABILITY
IMPROPER MAINTAINENCE
APATHY IGNORANCE

45. EQUIPMENT NEEDS UPGRADING
PROBLEMS
EQUIPMENT NEEDS UPGRADING
FINANCIAL REASONS
NO ENFORCEMENT
“WE DON’T HAVE ANY INFECTION IN OUR HOSPITAL”

46. NO PROPER DOCUMENTATION GOVT SECTOR PRIVATE NO STAFF IGNORANCE
PROBLEMS
NO PROPER DOCUMENTATION
GOVT SECTOR PRIVATE
NO STAFF IGNORANCE
NO GUIDELINES

47. PROBLEMS
NO SURVEILLANCE STAFF

48. POOR PRACTICES OF CLEANING NO GUIDELINES NO TRAINING
PROBLEMS
POOR PRACTICES OF CLEANING
NO GUIDELINES
NO TRAINING
INSUFFICIENT INSTRUMENTS
INCREASED WORKLOAD

49. NONUSAGE OF BIOLOGICAL INDICATORS IGNORANCE OVERCONFIDENCE
PROBLEMS
NONUSAGE OF BIOLOGICAL INDICATORS
IGNORANCE
OVERCONFIDENCE

50. LACK OF TRAINING AND PROTECTION FOR STAFF
PROBLEMS
LACK OF TRAINING AND PROTECTION FOR STAFF
ASSOCIATIONS SHOULD TAKEUP PROGRAMS
NEED FOR WORKSHOPS
LITERATURE

51. Nitrogen dioxide
 The unique physical properties of NO2 gas allow for sterilant dispersion in an enclosed environment at room temperature and ambient pressure.
Mechanism : degradation of DNA in the spore core through nitration of the phosphate backbone, which kills the exposed organism as it absorbs NO2 
NO2 is also less corrosive than other sterilant gases
compatible with most medical materials and adhesives
rapid lethality and easy removal of the gas allows for shorter overall cycle times during the sterilization
lower level of sterilant residuals
Patented : Not commercially available worldwide outside of the USA

52. Ozone cycler
For processing reusable medical devices. The sterilizer creates its own sterilant internally from USP grade oxygen, steam-quality water and electricity; the sterilant is converted back to oxygen and water vapor at the end of the cycle 
ozone process is compatible with a wide range of commonly used materials including stainless steel, titanium, anodized aluminum, ceramic, glass, silica, PVC, Teflon, silicone, polypropylene, polyethylene and acrylic.
The process should be safe for use by the operator because there is no handling of the sterilant, no toxic emissions, no residue to aerate, and low operating temperature means there is no danger of an accidental burn. 

53. Ultraviolet Radiation (UV)
The application of UV radiation in the health-care environment (i.e., operating rooms, isolation rooms, and biologic safety cabinets) is limited to destruction of airborne organisms or inactivation of microorganisms on surfaces
UV radiation has been employed in the disinfection of drinking water, air , titanium implants, and contact lenses

54. Gamma rays
Gamma rays pass readily through plastics and kill bacteria by breaking the covalent bonds of bacterial DNA
Gamma radiation is ideal for:
Sterilization of single-use medical supplies such as syringes, implants, catheters, IV sets, surgical gloves, gauze and more
Elimination of organisms from pharmaceuticals such as ointments and solutions

55. THANK YOU ALL