1. Types of sterilization To DR\ Mohamed Eldsoky. Eng\ Ahmed Mustafa. By\ Eman Sayed. Doaa Usama. Riham Amin.

2. The meaning of sterilization Sterilization methods remove or destroy all forms of microbial life including bacterial spores by either physical or chemical processes. Sterilization is accomplished principally by steam under pressure, by dry heat, and by chemical sterilants. Sterilization is a process which achieves the complete destruction or killing of all microorganisms, including bacterial spores.

3. The meaning of sterilization The choice of the method for sterilization depends on a number of factors including the type of material that the object to be sterilized is made of, the number and type of microorganisms involved, the classification of the item, and availability of sterilization methods. Sterilization is accomplished principally by steam under pressure, by dry heat, and by chemical sterilants.

4. Types of sterilization Steam under pressure (Autoclaving) Dry heat (Hot Air Oven) The use of chemicals such as ethylene oxide gas (which is mainly used in industry) or other low temperature methods (e.g. hydrogen peroxide gas plasma). Ozone Gas Microwaves

5. The Instrument Processing ( Decontamination Steps)

6. Risks of Infection from Equipment Low risk (noncritical items) Non critical items are items that come into contact with normal and intact skin as stethoscopes or with the inanimate environment (e.g. walls, floors, ceilings, furniture, sinks, etc.). Intermediate risk (semi-critical items) Semi-critical items are items that do not penetrate the skin or enter sterile areas of the body but that are in close contact with mucous membranes or with non-intact skin. Examples include respiratory equipment, thermometers.

7. Risks of Infection from Equipment High risk (critical items) High risk items are items that penetrate sterile tissues such as body cavities and the vascular system. Examples of high-risk items include surgical instruments, intra- uterine devices.

8. Risks of Infection from Equipment

9. Cleaning Cleaning is the removal of all foreign material (dirt and organic matter) from the object being reprocessed. Two key components of cleaning are friction to remove foreign matter and fluids to remove contamination. Cleaning may be manual or mechanical.

10. Cleaning Mechanical cleaning includes ultrasonic cleaners or washer/disinfectors that may facilitate cleaning and decontamination of some items and may reduce the need for handling. Manual Cleaning by using cold water and brush.

11. Steps of manual cleaning

12. Wrapping instruments and other items for steam sterilization:

13. Steps for wrapping instruments and other items

16. Dry-heat Sterilization

17. Dry heat sterilization temperatures & times

18. Advantages and disadvantages of dry-heat sterilization Advantages Can be used for powders, anhydrous oils, and glass. Reaches surfaces of instruments that cannot be disassembled. No corrosive or rusting effect on instruments. Low cost.

19. Advantages and disadvantages of dry-heat sterilization Disadvantages Penetrates materials slowly and unevenly. Long exposure time’s necessary. High temperatures damage rubber goods and some fabrics. Limited package materials.

20. Chemical Sterilization: Chemical sterilants are primarily used for heat- labile equipment where single use is not cost effective. If an item is sterilized chemically, it should be used immediately after sterilization, to be sure that it is sterile. Types of chemical sterilants: Glutaraldehyde: Glutaraldehyde is a commonly available solution that can be used for sterilization. Disadvantageous: Glutaraldehyde solution is irritating to the skin, to the eyes, and to the respiratory tract. Peracetic acid: Uses: In dental instruments

21. Types of sterilization Pressure Steam Sterilization (Autoclaving) Steam sterilization is the most common and most preferred method employed for sterilization. Steam sterilization is dependable, non toxic, inexpensive, sporicidal, and has rapid heating and good penetration of fabrics.

22. Types of steam sterilizers 1. Small table-top sterilizers. 2. Portable steam sterilizer. 3. Gravity downward-displacement sterilizers. 4. Emergency (flash) sterilizers (these are a form of gravity-displacement sterilizer. 5. High-speed prevacuum vacuum sterilizers (Porous load autoclaves).

23. Types of steam sterilizers

24. Curve of steam sterilization (for solid)

25. Curve of steam sterilization (for liquid )

26. Temperature of liquid 134 ------  10 min. 121------  20 min. 107-----  30-40 min.

27. Block diagram of steam sterilization machine.

28. Block diagram of steam sterilization machine

29. Amsco Century sterilization

34. Advantages and disadvantages of steam sterilization Advantages : Highly effective. Rapid heating and rapid penetration of instruments. Nontoxic. Inexpensive. Can be used to sterilize liquids.

35. To make sure the sterilization machines are perfect calibrationvalidation

36. Advantages and disadvantages of steam sterilization Disadvantages: Items must be heat and moisture resistant. Will not sterilize powders, ointments or oils. Needs good maintenance.

37. Hydrogen Peroxide Plasma Free radicals of the hydrogen peroxide in the cloud interact with the cell membranes, enzymes, or nucleic acids to disrupt life functions of microorganisms. The plasma and vapor phases of hydrogen peroxide are highly sporicidal even at low concentrations and temperature.

38. Ethyl Oxide Ethylene oxide is used to sterilize items that are heat or moisture sensitive. (EO) kills microorganisms, including spores, by interfering with the normal metabolism of protein resulting in death of cells. EO is a reliable and safe agent for sterilization, but toxic emissions. It takes longer than steam sterilization, typically, 16-18 hrs for a complete cycle.

39. Ozone Gas Ozone, a form of oxygen, sterilizes by oxidation, a process that destroys organic and inorganic matter. It penetrates membrane of cells causing them to explode. Penetration of ozone may be controlled by vacuum in the chamber, or enhanced by adding humidity. Cycle time may be up to 60 minutes depending on the size of the chamber or load. Ozone is an unstable gas. A generator converts oxygen, from a source within the hospital, to ozone.

40. Microwaves The nonionizing radiation of microwaves produces hyperthermic conditions. This heating action affects water molecules and interferes with cell membranes. Microwave sterilization uses low- pressure steam with the nonionizing radiation to produce localized heat that kills microorganisms. The temperature is lower than conventional steam, and the cycle faster, as short as 30 seconds.

41. Sterile Services Department (SSD) The sterile services department (SSD) is vital for an effective Infection Control and Prevention program. Not all hospitals can afford to have an SSD and a separate surgical services unit to deal with the operating theatres and associated departments.

42. Sterile Services Department (SSD) It is ideal to have separate rooms: –one for receiving and cleaning instruments and other items –another room for sterilization and storage. However, in many settings in Egypt this is not possible.

43. Clean &Wash Rooms

44. Sterilization Room When only one room is available, it should be arranged so that activities and objects flow in an organized way.

45. The layout of the SSD The air moves from the clean area to the dirty area. Soiled objects never cross paths with sterilized instruments. The doors are kept closed to minimize dust contamination. The staff works in either area– never in both. Single room for processing instruments and other items

46. Establishing an SSD Recyclable equipment should be collected from the wards and then should be transferred to the SSD where it is sterilized, and dispatched back to the wards.

47. In the SSD Wash all instruments in water and detergent. Inspect all equipment for cleanliness and damage. Send damaged instruments for repair after appropriate decontamination. Pack cleaned instruments on a tray. Autoclave trays at recommended temperature. Ensure that the packaged trays are dry. Sort the packaged trays for ward collection.

48. SSD staff facilities All SSD staff should be provided with adequate protective clothing (e.g. heavy duty gloves, plastic aprons, and eye protection if manual cleaning is undertaken). Overshoes are not necessary. SSD staff should be immunized against hepatitis.

49. Storage in the SSD After items have been reprocessed, the sterile packs should be stored in well ventilated, clean stores ready for dispatch to the wards. Do not store instruments or other items such as scalpel blades and suture needles in solutions-always store them in a dry container. –As microorganisms can live and multiply in both antiseptic and disinfectant solutions.