Download to read offline
More Related Content
Similar to STERILIZATION AND DISINFECTION - ADVANCES
STERILIZATION AND DISINFECTION - ADVANCES
- 1. Sterilization & Disinfection r Made by :Dr . Utsav Gandhi Guided by : Dr . Bhavin Patel
- 2. Agenda • Introduction • History •Terminologies • Classification • Details of individual agents • Sterilization in dentistry • Sterilization in periodontics • Sterilization failure • Indicator strips • Waste management • Recent advances • Conclusion • References
- 3. INTRODUCTION • Pathogenic organismscause contamination, infection , decay , So it becomes necessary to remove and destroy them from materials and areas. • Disinfection and sterilization are essential for ensuring that medical and surgical instruments do not transmit infectious pathogens to patients and staff.
- 4. History - LOUIS PASTEURof France was among the first to use sterilization techniques, he developed the steam sterilization, hot air oven and the autoclave. Pasteurization was a method developed by him to rid milk of tubercle bacilli. - JOSEPH LISTER, applied Pasteur work and introduced antiseptic technique in surgery (1867). He is the father of antiseptic surgery.
- 5. STERILIZATION • A termthat referring to any process that eliminates or kills all forms of life and other biological agents including transmissible agents ( such as fungi, bacteria ,virus, spore forms, unicellular eukaryotic organisms such as plasmodium etc. ) present in a specified region such as a surface , a volume of fluid , medication or in a compound such as biological culture media. ( WHO Glossary )
- 6. DISINFECTION • Destruction ofpathogenic and other kinds of microorganisms by physical or chemical means. Disinfection is less lethal than sterilization because it destroys the majority of recognized pathogenic microorganisms, but not necessarily all microbial forms ( e.g. bacterial spores ). ( CDC guidelines )
- 8. Classification of instrumentsto be sterilized / disinfected SPAULDING CLASSIFICATION SPAULDING CLASSIFICATION CRITICAL NON CRITICAL SEMI CRITICAL
- 9. CRITICAL • Surgical andother instruments that touches bone or penetrate soft tissues are known as critical instruments . • Should be sterile after each use.
- 10. SEMI CRITICAL • Instrumentsthat touches mucous membranes , but do not touch bone or penetrate soft tissue. • If the sterilization is not feasible because the instruments will be damaged by heat , use high-level disinfection (HLD).
- 11. NON CRITICAL Instruments that contactintact skin and use intermediate-level or low- level disinfection for them.
- 12. THREE LEVELS OFDISINFECTION
- 14. METHODS PHYSICAL CHEMICAL PHYSIO- CHEMICAL Sunlight Alcohol Dryheat Aldehydes Moist heat Dyes Filtration Halogens Radiation Phenols Ultrasonic and sonic Surface active agents vibrations Metallic salts GASES : Formaldehyde Ethylene oxide Plasma
- 15. PHYSICAL AGENTS SUNLIGHT Active germicidaleffect due to heat and UV rays Seen in tanks , rivers , lake . HEAT DRY HEAT MOIST HEAT Thermal death time- Minimum time required to kill a suspension of organisms at a predetermined temperature in a specified environment
- 16. DRY HEAT Flaming: e.g. scalpels,mouth oftest tubes, flasks, glass slides and cover.
- 17. • INCINERATION : Methodof destroying contaminated material by burning them in incinerator . e.g. soiled dressings; animal carcasses, pathological material, bedding .
- 18. DRY HEAT • PRINCIPLES: Protein denaturation Oxidative damage Toxic effects of elevated levels of electrolytes .
- 19. HOT AIR OVEN •Most widely used method of sterilization. Uses : - Glassware like glass syringe, Pipettes , flasks , test tubes. - Surgical instruments like scalpels, scissors , forceps . - Chemicals like liquid paraffin , fats , sulphonamides , dusting powder etc.
- 20. MOIST HEAT STERILIZATION Temperature below100o C C Temperature at 100o C C Temperature above 100o C C Pasteurization of milk Inspissation Vaccine bath Serum bath Boiling Tyndallisation Steam sterilizer Autoclave
- 21. Vaccine bath : -Serum or body fluid is sterilized in water bath At 56o C for 1 hour. -Vaccines are sterilized at 60o C for 1 hour . Serum bath : -The contaminating bacteria in a serum preparation can be inactivated by heating in a water bath at 56o C for 1 hour .
- 22. Pasteurization of milk: by Louis Pasteur . - Employed in food and dairy industry . - There are 3 methods : 1) Holder method - heated at 63o C for 30 minutes . 2) Flash method - heated at 72o C for 15 seconds followed by quickly cooling to 13o C . 3) Ultra pasteurization – heated at 82o C for 4 sec followed by cooling to 4o C .
- 23. Boiling : Boiling water(100o C) for 10–30 minutes kills most vegetative bacteria and viruses. - Metal articles and glassware disinfected by placing them in boiling water for 10-20 minutes. - The lid of the boiler must not be opened during the period - Syringes, forceps, scissors etc. Tyndallisation : Steaming at 100°C is done in steam sterilizer for 20 minutes followed by incubation at 37°C overnight. Repeated for another 2 successive days.
- 24. AUTOCLAVE It kills allthe vegetative as well as spore forms of bacteria . Three major factors : 1.Temperature : 121o C 2. Pressure : 15 psi 3.Time : 15 min temperature and pressure = time for sterilization
- 25.
- 26. Boiling water aloneis insufficient to kill spores & viruses water boils when its vapor pressure equals to that of surrounding atmosphere so, when pressure increases inside closed vessel temperature increases at which water boils Saturated steam has penetrative power when steam comes in contact with a cooler surface it condenses to water and gives up latent heat to surface The large reduction in volume of steam sucks in more steam to the site & process continues till temperature of article is raised to that of steam.
- 27. Pressure( psi )Temperature (o C ) Time ( min ) 15 121 15 20 126 10 20 134 3
- 28.
- 29. ADVANTAGES DISADVANTAGES - Economical -Good penetration - Short cycle time - Early monitored - No special chemicals required - Moisture retention - Corrosion - Carbon steel gets damaged - Dulling of unprotected edges - Destruction of heat sensitive materials
- 30. FILTRATION • Filtration isthe preferred method of sterilizing heat-sensitive liquid and gases without exposure to denaturing heat. Rather than destroying contaminating microorganisms, it simply removes them. Candle filter
- 31.
- 32.
- 33. Radiation Ionizing radiation Non-ionizing radiation Gamma rays orx-rays Also known as “Cold sterilization” Infrared radiation UV rays
- 34. Non-Ionizing radiation Ionizing radiation - Longer wavelength& lower energy So, low ability to penetrate any substances so used only for sterilizing surfaces. - Shorter wavelength & High energy So, high penetrative power to destroy microorganisms.
- 35. Infrared radiation –Rapid mass sterilization of catheters , syringes . UV rays – For disinfection of operation theatres , laboratories like closed areas. Cold sterilization - No major increase in temperature. - Used for sterilizing plastics , metal foils , swab.
- 36. Gamma radiation • Mostpopular method . • Highly penetrative and can kill contaminating microorganisms. • Low dose rates . • Gamma radiation kills microorganisms by attacking on their DNA molecule- this is known as Substantial decrease in organism survival . • Advantages – Rapid processing , uniform dose distribution, Precise dosing , dosimetric release . Used as penetrating sterilant even with high density products .
- 38. E-beam : electronbeam radiation - High energy electrons capable of inducing biological damage are generated by electron beam accelerators. - Electron energies of ~10 MeV are used in most cases. - The penetration ability of electrons is lower than that of gamma rays, So e-beam sterilization is limited in application to lower density or smaller products. However, e- beam sterilization can use higher dosages and shorter treatment times (seconds vs. min/hours) . X-rays radiation- X-rays are produced when high energy electrons from the accelerator interact with high atomic number nuclei, such as atoms of tungsten or tantalum. In a process known as Bremsstrahlung, the deceleration of the electron when passing the nucleus results in the release of X-rays. Electron energies of 5-7 MeV are commercially used X-rays used for sterilization can be more penetrating than either gamma-rays or electron beams. ( Radiation sterilization from Stanford university , march 2018 )
- 39. Ref. -This datais shared by Stanford university in march,2018
- 40. FUMIGATION – Asepsisof surgical theatre ELECTRIC BOILER METHOD POTASSIUM PERMANGANATE
- 41. 2). POTASSIUM PERMANGANATE : Heatis induced by potassium permanganate . 500 ml of formaldehyde added to it which reacts and generates fumes. 1). ELECTRIC BOILER METHOD : 500 ml of formaldehyde added to distilled water in electric boiler . When the water heats , fumes are generated .
- 43. Asepsis in operatorysurfaces • Operatory surfaces that are touched or soiled repeatedly are best protected with disposable covers that can be discarded after each treatment. • For dental unit , Paper , plastic film or surgical pack wraps should cover the entire tray. • GIGASEPT : Used for disinfection of plastic and rubber materials . e.g. Dental chair . GIGASEPT contains - Succindialdehyde + dimethoxytetrahydrofuran
- 44. CHEMICAL METHODS • ALCOHOL: - 70 % ETHYL ALCOHOL Suitable for skin preparation before venepuncture. - Isopropyl alcohol . Used as a skin disinfectant Active against fungal spores
- 45. ALDEHYDES • Formaldehyde ,Glutaraldehyde . • Bactericidal, sporicidal, and also effective against viruses • They are chemical sterilants . • For surface disinfection and fumigation • 10% formalin with 0.5% tetraborate sterilizes clean metal instruments. 40% formaldehyde
- 46. To disinfect hospitaland laboratory equipment . An exposure of at least 3 hours at alkaline pH is required for action by glutaraldehyde. Especially effective against tubercle bacilli, fungi, and viruses 2% Glutaraldehyde CIDEX ( 2% NaHCO3 / B.GLUTARALDEHYDE)
- 47. PHENOLS • MOA :Act by disruption of membranes, precipitation of proteins and inactivation of enzymes . 5% phenol , 5% Lysol , 1-5% cresol ( Lysol ) chlorhexidine ( Savlon ),chloroxylenol ( Dettol ) • As disinfectants at high concentration and as antiseptics at low concentrations . • Bactericidal, fungicidal, but are inactive against spores and most viruses .
- 48. HALOGENS CHLORINE COMPOUNDS IODINE & IODOPHORES Mostly useddisinfectant for HIV infected materials. Concentration – 0.05% or 0.5% Useful for skin preparation , mouthwash and as a surgical scrub. 7.5% povidone + iodine = Betadine
- 49. SURFACE ACTIVE AGENTS: MOA : Disrupt membrane resulting in leakage of cell constituents Examples: - Soaps or detergents, anionic or cationic - Anionic detergents- soaps and bile salts . - Cationic detergents are known as quaternary ammonium compounds. - Cetrimide and benzalkonium chloride act as cationic detergents . SALTS : -Salts of copper , silver , mercury are used as a disinfectant .
- 50. LOWTEMPERATURE H2O2 PLASMA (Sterrad) •Active medium – H2O2 plasma • Plasma is an ionized gas made up of electrons. • Temp. – 45-50 c • Sterilization time – 45-70 minutes . • 2 stages : Air from sterilization chamber is removed & vacuum is created. after that , H2O2 is injected & vaporized in chamber It diffuses in chamber & come in contact with surface of various items where it kills bacteria.
- 51. Then , radiofrequency energyis applied in chamber that creates electric field Form a low temperature plasma It causes ionization of H2O2 molecules & creates free radicals which kills microorganisms.
- 52.
- 53.
- 55. ETHYLENE OXIDE Highly inflammable •Used as 10% CO2 + 90% EO or Dichlorodifluoromethane. • Used to sterilize heat or moisture sensitive. • Kills microorganisms including spores , but sterilization time is longer than 16-18 hours for complete cycle. • Temperature around 50-60 c because it is highly inflammable , so used in explosion proof sterilizing chamber .
- 57. Steris system 1 •Another low temp. sterilization system that uses a peracetic acid solution (Steris20TM solution ) – to destroy dangerous microorganisms . • Temp. = 50-56 c • Sterilisation cycle completed in 12 min , followed by repetitive sterile rinses . • Total sterilization process is completed in 30 min . • The bactericidal action of peracetic acid is because of presence of extra oxygen atom attached to acetic acid .
- 58. Flash sterilization - Sterilizationof an unwrapped object at 132 C for 3 min at 27-28 lbs of pressure in a gravity displacement sterilizer. ( defined by Underwood & Perkins ) Uses : - For processing cleaned patient cared items that cannot be packaged , sterilized or stored before use. - It is also used when insufficient time to sterilize an item by the preferred method.
- 59. Sterilization in periodontalclinic All diagnostic instruments are sterilized by washing in korsolex and sterilised. Periodontal instruments : SHARP : Knives , scissors , files , tissue holding forceps Sterilised by Conventional hot air oven. BLUNT : Mouth mirrors , tweezers , artery forceps , suture holding forceps , periosteal elevator Sterilised by autoclave .
- 60. Sutures • Sutures arepre-sterilised by gamma radiation. • They are re-sterilised by two methods : 1).Soak for 10 minutes in completely immersed in 10% povidone iodine solution then rinse in sterile saline/water . 2).Ethylene oxide – Gas sterilization
- 61. ULTRASONIC SCALERS Ethylene oxide– best method Soak in a container that contains 70% isopropyl alcohol – for removal of organic debris Rinse clean inserts in warm water to remove all chemicals Then, replace the insert into scaler handpiece & operate for 10 seconds at maximum water flow setting to flush out any retained chemicals Dry insets completely with air syringe Package in proper wrap , bags , pouches , trays .
- 62.
- 63.
- 64. OZONE • A lowtemperature sterilization method. • Used for heat sensitive & moisture sensitive devices. • Cycle time : At temperature of at 85o F - 94o F for 4.5 hours
- 65. • Conclusion : Theresults showed that the ozone may be considered as effective and promising alternative for sterilization of thermosensitive materials and medical devices.
- 66. Sterilization pouch • Alsoknown as “Peel pack” . • A disposable package used in a sterilizer to allow the penetration of the sterilant to the items placed inside . • Three designs Self - seal Heat-seal Rolls or tubing Paper / plastic Two types Tyvek / plastic Ref : Steris healthcare
- 67.
- 69. SAL • Sterilization isthe process of removal or inactivation of all microorganisms present on the surface to achieve an acceptable sterility assurance level (SAL). A SAL of 10−6 is considered the standard for medical devices and defines the probability of 1 in 1000000 that a device is not sterile . The most common sterilant are highly potent agents developed to inactivate all microbiological species.
- 71. Published in GMSKrankenhhyg Interdiszip. 2008
- 72. Sterilization failure • Causes: - Improper cleaning of instruments - Improper packing - Improper temperature in sterilizer - Improper loading of sterilizer - Improper timing of sterilization cycle
- 73. •Steps to betaken after sterilization failure : - Take the sterilizer out of service - Procedures to identify problems - Retest and observe the cycle - Determine the fate of sterilizer - Test the repaired or new sterilizer
- 74. UNIVERSAL PRECAUTIONS • DEFINITION: Measures design to prevent transmission of disease from blood spillage and body fluids . ( CDC guidelines ) • Precautions : Airborne Droplet Contact
- 75. • Transmission ofdisease : A germ A source An exit Method of sterilization Portal of entry A susceptible person The goal is to stop germs from travelling from source to another person .
- 76. Considered Highly infectious Not infectiousunless contaminated Blood Faces Semen Nasal secretion Vaginal secretion Sputum CSF Tears Synovial fluid Urine /Vomit Amniotic fluid Saliva
- 78. When to washhands • Before and after contact with patients. • Before and after gloving • BeforeTaking care of immune suppressed new born • Use Non medicated soap and water • In demanding circumstances , use ethyl or isopropyl alcohol .
- 79. Gloves • Do notreuse the gloves . • Change after the contact with each patient. • Do not touch other environmental surfaces. • Do not touch the face with contaminated gloves. • Discard it properly .
- 80. Masks , Caps, Eyewear • Should wear a mask while operating the patient and if you have a condition that is transmissible cough . • Use caps to protect your hairs • Use eyewear to shield against splashing body fluids .
- 81. • Use protectiveshoes and no open ties . • Use an apron or gown : Prevent exposure to harmful germs and environment. Prevent our clothes from contamination .
- 82. Use of needles •Use properly and wear the gloves. • Dispose in thick puncture resistant container. • Avoid recapping the needles. • Use disposable needle and syringes .
- 83. Instrument processing As perADA guidelines
- 86. Waste Management Options WasteCategory Category 1 Human Anatomical wastes (tissues, organs, body parts) Category 2 Animal wastes Category 3 Microbiology and biotechnology wastes Category 4 Waste sharps ( needles syringe , scalpels ) Category 5 Discarded medicine and cytotoxic drugs
- 87. Options Waste Management Category6 Solid waste ( items contaminated with blood and fluid including cotton dressing …) Category 7 Solid waste ( waste generated from disposable items ) Category 8 Liquid wastes ( waste generated from laboratory and washing cleaning…) Category 9 Incineration ash Category 10 Chemicals used in production of biological, chemical used in disinfection
- 88.
- 90. PPE • Personal protectiveequipment, commonly referred to as "PPE", is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards.
- 91.
- 92. • PPE protectshealthcare workers from two main hazards: Radiation (Enhancing radiation safety in health care) Biological agents (virus, bacteria, etc.) Important transmission pathways to mitigate with PPE include: • Person to person contact • Droplet spread • Airborne transmission • Contaminated objects
- 98. Indicator strips forevery autoclave and sterilizer •Chemical Indicator strips Each CI product visually verifies that items have seen the sterilization process and should be used in conjunction with routine “spore testing" as part of an overall sterility assurance program.
- 99. Dry heat indicatorstrips – DIS - 100 Steam Indicator strips SIS - 100
- 100. Biological Indicators • Astandardized preparation of bacterial spores on or in a carrier serving to demonstrate whether sterilizing conditions have been met . • Each BI contains live Bacillus spores which document their death that sterilization was actually achieved . • An in office BI system for use with steam, EO gas , chemical vapor , dry heat. • After processing in a normal load , the user aseptically transfer BI strip into media & incubates at 56 Celsius ( Steam/ C . vapor ) or 37 Celsius ( EO gas / dry heat ) for 7 days . • A colour change and visible turbidity of a processed BI indicates sterilization failure .
- 101. SporeView Culture Set– CS-100 SporeView Culture Set 56 C ( Stater kit SK056 comes with indicator )
- 102. SporeView Culture Set37 C ( Stater kit SK037 Comes with incubator ) Biological indicator strips DS-100
- 103. Immediate read outsystem • This advanced technology medical device is Scientifically engineered to integrate all 3 critical parameters of sterilization (time, temperature and saturated steam), the SteamPlus Sterilization Integrator is certified to perform equal to a biological indicator plus an added safety factor. SteamPlus integrator – SSI 100
- 104.
- 106. From Indian journal ofcritical care medicine
- 107. Conclusion • Dental healthcare providers have to follow high standards of infection control for safety of patients , dentists & staffs . • An increase in cases of some serious transmissible diseases over last few years became a global concern and we have to take care about it by preventing the transmission of it .
- 109. References • WHO Glossary •Periobasics - A textbook of periodontics & Implantology 2nd edition , Nitin Saroch • Textbook of clinical Periodontology , Newman , Carranza 13th edition • Operative dentistry , Studervant , Chapter – inf control • Textbook of Microbiology , By CP Baveja , 3rd edition • CDC guidelines for sterilization & disinfection • CDC guidelines for health care facilities • Sterilization & disinfection By ADA • Articles on sterilization & disinfection on periodontal instruments by Robert B. Parks & Robert A. Kolstadf
- 110.
Editor's Notes
- #31 It is the method of choice for sterilizing antibiotic solutions, toxic chemicals, radioisotopes, vaccines, and carbohydrates, which are all heat-sensitive. The liquid or gas is passed through a filter, a device with pores too small for the passage of microorganisms, but large enough to allow the passage of the liquid or gas. These filters are made of different materials;