Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
1
1/24/2017
DJH©2017
PHC 6517: “Cleaning, Disinfection, & Sterilization, Part 1”
https://commons.wikimedia.org/wiki/File:Joint_Rea
diness_Training_Center_140117-F-XL333-824.jpg
DJH©2017
Part I Outline
• Definitions
• Levels of decontamination
• Levels of disinfection
https://en.wikipedia.org/wiki/Black%27s_Law_Dictionary
DJH©2017
Definitions
• Often interchanged
• Often used to apply inappropriately to inanimate objects or living tissue
• Alphabet soup of terms
DJH©2017
Hospital Environment
• Cleaning, disinfecting & sterilizing refer to inanimate objects, instruments
• Antisepsis refers to agents or practices affecting living tissue
• Asepsis refers to patient care practices
• Difference between what FDA & EPA regulate
DJH©2017
• Process of removing pathogenic (disease-producing) microorganisms from objects, thus rendering them safe to handle (think of it in levels)
• For bioterrorism, refers to process of removing agents from persons or environments
Decontamination
https://commons.wikimedia.org/wiki/File:Alabama_Guardsmen_perform_Chemi
cal_Training_with_Marine_Expeditionary_Unit_DVIDS202099.jpg
DJH©2017
Levels of Decontamination
• Cleaning
• Sanitizing
• Low-level disinfection
• Intermediate-level disinfection
• High-level disinfection
• Sterilization
2
1/24/2017
DJH©2017
Cleaning
DJH©2017
Cleaning
• Physical removal of soil or organic material (blood, secretions) from objects
• using water & mechanical action
• with or without detergent, enzymatic products
• removes rather than kills microorganisms
DJH©2017
Hospital Cleaning
www.dallasdustbusters.com/index.php http://www.fotosearch.com/OJO227/pe0068563/
https://en.wikipedia.org/wiki/Terminal_cleaning
http://www.public-domain-image.com/free-
images/people/female-women/when-cleaning-windows-
personal-protective-equipment-should-be-worn
https://c1.staticflickr.com/7/6203/6103128464_c99324d98a_b.jpg
DJH©2017
Cleaning
• Single, most important stepin making medical device ready for reuse
• Without it, disinfection & sterilization are ineffective
• Debris on devices can interfere with function or lead to foreign-body/pyrogen reaction in patient if introduced into the body
https://en.wikipedia.org/wiki/Ultraviolet_germicidal_irradiation
DJH©2017
Types of Cleaning
• Manual
• Machine-driven
• Surface
• Object
• Instrument
http://www.mnn.com/sites/default/files/GreenCleaningHospital_mai
n.jpg
http://www.smsclean.com/images/photo_floor.jpg
http://www.freestockphotos.biz/stockphoto/16323
https://www.flickr.com/photos/tracywoolery/5438982335
DJH©2017
Wiping with Detergent-Dampened Cloth
• Can be used on mattresses, walkers, wheelchairs, intravenous fluid pumps, blood pressure cuffs (sphygmomanometers)
• Usually not contaminated with blood or body fluids
• If they are, require higher level of decontamination
3
1/24/2017
DJH©2017
Wiping with Detergent-Dampened Cloth
http://www.rehabmart.com/imag
esfromrd/IN-TracerWCTop.jpg
https://en.wikipedia.org/wiki/Wheelchair
http://www.clipartbest.com/cliparts/dT6/M5k/dT6M5knT9.jpe
g
http://www.public-domain-image.com/free-images/science/medical-science/measure-a-patients-blood-
pressure-a-sphygmomanometer/attachment/measure-a-patients-blood-pressure-a-sphygmomanometer
http://www.public-domain-image.com/free-images/science/medical-science/measure-a-patients-blood-
pressure-a-sphygmomanometer/attachment/measure-a-patients-blood-pressure-a-sphygmomanometer
DJH©2017
Manual Cleaning• Requires manipulation of device
• Possibility of glove & skin punctures
• Possibility of disease transmission
• Some devices cannot tolerate cleaning in automated machines or some hospitals don’t have them
https://commons.wikimedia.org/wiki/File:Surgical_instruments_15.jpg
DJH©2017
• Ultrasonic Cleaners
Cleaning with Machines
• Washer-Disinfectors
https://pixabay.com/en/ultrasonic-cleaner-devices-609651/ https://en.wikipedia.org/wiki/Miele
DJH©2017
Ultrasonic Cleaners
• Use energy from high frequency sound waves, to remove fine debris from surgical instruments
• Can use detergent & heat
• Can have rinse cycle
• Instruments must be free of gross debris
DJH©2017
Ultrasonic Cleaners
http://gotopac.files.wordpress.com/2010/10/mixed-units-4-21.jpg
https://commons.wikimedia.org/wiki/File:UZ%C4%8Disti%C4%8Dky.jpg
https://pixabay.com/en/ultrasonic-cleaner-devices-609651/
https://upload.wikimedia.org/wikipedia/commons/0/09/ATO
MO_Dental_premium_quality_ultrasonic_cleaner_GT-
1860QTS_with_accessories_for_dental_clinics.png
DJH©2017
Washer-Disinfectors
• Single or multi-chamber
• Fully automated (hands off)
• Devices are clean & at least intermediate level of disinfection
• Making them safe for handling but maybe not reuse
https://en.wikipedia.org/wiki/Miele
4
1/24/2017
DJH©2017
Sanitation/Sanitizer• Process capable of reducing #’s of microbial
contaminants to relatively safe level (?)
• Does not require/ produce complete destruction of any particular microorganisms
• Agent that reduces # of bacterial contaminants to safe levels as judged by public health requirements
• Use: e.g., dishwashing machines
• No universal test method or standard
DJH©2017
Disinfection
• Falls between processes of physical cleaning & sterilization:
• the elimination of disease-producing organisms, but NOT spores
• from inanimate objects
• via wet pasteurization or liquid chemicals
DJH©2017
Disinfectant
A germicide that inactivates virtually all recognized pathogenic microorganismsbut not necessarily all microbial forms (e.g., spores) on inanimate objects
https://c1.staticflickr.com/2/1663/25045773816_cd2c04a79e_b.jpg
DJH©2017
3 Levels of DisinfectionHigh level: lethal process using a sterilant under less
than sterilizing conditions. The process kills all forms of microbial life except for large numbers of bacterial spores
Intermediate level: lethal process using an agent that kills viruses, mycobacteria, fungi & vegetative bacteria, but not spores
Low-level: kills vegetative forms of bacteria, some fungi & lipid viruses
Vegetative = active growth state
DJH©2017
Germicide
• An agent that destroys microorganisms, particularly pathogenic ones
• Agent that can be used on living tissue as well as on inanimate objects
https://pixabay.com/en/germ-bacteria-medical-virus-41366/
DJH©2017
Other “cides”
Cide- means to “kill”:
• Virucide• Fungicide• Bactericide• Sporicide• Tuberculocide
https://pixabay.com/static/uploads/photo/2012/04/11/16/50/germ-28874_960_720.png
5
1/24/2017
DJH©2017
“-static”
• Means “to inhibit”
• Thus, bactericidal = kills & bacteriostatic = inhibits bacteria
“Static”- inhibits bacteria
“Cidal”-kills bacteria
https://pixabay.com/static/uploads/photo/2014/04/03/10/00/bacteria-309587_960_720.png
https://pixabay.com/static/uploads/photo/2012/04/11/16/50/germ-28874_960_720.png
DJH©2017
Bacteriostatic vs. Bactericidal
http://www.leeds.ac.uk/
http://tmedweb.tulane.edu/pharmwiki/doku.php/bacteriostatic_vs_bactericidal?do=
DJH©2017
Bacteriostatic Waterfor injections
https://upload.wikimedia.org/wikipedia/commons/d/d0/Heparin_Sodium_sample.jpg
DJH©2017
Sterilization
• Process of complete destruction of all forms of microbial life
• Bacteria, fungi, viruses & spores
• Accomplished by physical or chemical processes
• Absolute term
Gold
Standard
DJH©2017
Antiseptic
• Chemical germicide that prevents or arrests growth/action of organisms on living tissue either by inhibiting their activity or destroying them
• Should NOT be used on inanimate objects
• Registered & regulated as drugs (FDA)https://i.ytimg.com/vi/55Eldh9oj5c/hqdefault.jpg
DJH©2017
Reprocessing Medical Devices
• Evolution towards more complex reusable medical devices; advances in knowledge & technology
• Definition of reprocessing
• FDA’s 3 steps for healthcare facilities: – 1) point of use processing– 2) thorough cleaning, & – 3) disinfection or sterilization
• FDA’s 6 Criteria for Reprocessing Instructions
https://upload.wikimedia.org/wikipedia/commons/8/81/Food_and_Drug_Administration_(United_States)_(logo).jpg
6
1/24/2017
DJH©2017
Flexible Endoscopes• Outbreaks of gram (-) organisms from inadequately
cleaned scopes, including CRE
• Cleaning, disinfection/sterilization important issue (AERs)
• HICPACs 7 essential steps for endoscope reprocessing:– 1. pre-cleaning– 2. leak testing– 3. manual cleaning– 4. visual inspection– 5. disinfection or sterilization– 6. storage– 7. documentation
• Recommendations apply to all settings using/ reprocessing endoscopes
https://en.wikipedia.org/wiki/Endoscopy
DJH©2017
Figure 1. Decreasing order of resistance of
microorganisms to disinfection sterilization & the level of disinfection or sterilization.
Resistant Level
| Prions (Creutzfeldt-Jakob Disease) Prion reprocessing
| Bacterial spores (Bacillus atrophaeus) Sterilization
| Coccidia (Cryptosporidium)
| Mycobacteria (M. tuberculosis, M. terrae) High
| Nonlipid or small viruses (polio, coxsackie) Intermediate
| Fungi (Aspergillus, Candida)
| Vegetative bacteria (S. aureus, P. aeruginosa) Low
↓ Lipid or medium-sized viruses (HIV, herpes, HBV) Susceptible
Source: Required Reading #1, page 108
https://upload.wikimedia.org/wikipedia/commons/thumb/7/71/US_CDC_logo.svg/1280px-US_CDC_logo.svg.png
DJH©2017
Prions
• Creutzfeldt-Jakob Disease (CJD)
• Bovine spongiform encephalopathy (BSE) in cattle aka “Mad cow disease”
• Neurodegenerative diseases in sheep & goats
http://pathology.mc.duke.edu/neuropath/CNSlecture2/cjd.jpg
DJH©2017
Special Reprocessing for Prions
• Option 1- autoclave at 134°C for 18 minutes in a prevacuum sterilizer
• Option 2- autoclave at 132°C for 1 hour in a gravity displacement sterilizer
• Option 3- immerse in NaOH & transfer to autoclave
• Option 4- immersion, gravity displacement, cleaning, & sterilization
See details in slide transcript
https://upload.wikimedia.org/wikipedia/commons/3/3a/BOVINE_PRION_PROTEIN_1dx0_asym_r_500.jpg
bovine prion protein
DJH©2017
W.H.O. Guidelines
• WHO 2003 infection control guidelines for transmissible spongiform encephalopathies– Available at:
http://www.who.int/bloodproducts/publications/en/WHO_TSE_2003.pdf?ua=1
• Follow-up paper in 2006 entitled “WHO Guidelines on Tissue Infectivity Distribution in Transmissible Spongiform Encephalopathies”– Available at:
http://www.who.int/bloodproducts/TSEPUBLISHEDREPORT.pdf?ua=1
who.int
DJH©2017
Summary of Part I
• Definitions
• Levels of Decontamination
• Levels of Disinfection
• Reprocessing of medical devices
– endoscopes
– prions