Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping...

Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

Instrument Decontamination Methods for Prevention of infection

Dr. Aidah Abu Elsoud AlkaissiAn Najah National University


Instrument Decontamination Methods for Prevention of infection

Instrument should be immediately submersed in water or a germicidal solution at the close of the procedure to prevent blood and other substances from drying on the surface or in the cervicesThe cleaning method should be economic and must be provide protection fromcross-contamination damage to the instrument and injury to the workerWashed and sterilized instruments are inspected, reassembled(To fit together the parts or pieces of) into sets, placed in containers or wrapped and sterilized & stored for future used


Mechanical WashingDuring surgical procedure instrument should be kept as free of body substances (bioburden) as possible by wiping off the gross material with a moistened sponge Sterile water is selected because saline causes corrosion and deterioration of the instrument surfacesAll instruments that can be immersed are placed in a basin, disassembled or box locks opened

and covered with water or a detergent/germicidal solution


Mechanical WashingMathods may be selected for decontamination of instruments and equipment

To cover and transport all items used during the surgery to a centralized location for processing. The cover should be watertight and remain intact during transport to the central decontamination area. Examples of covers include case carts (A small wheeled vehicle typically pushed by hand), plastic bags & impervious (Incapable of being penetrated) surgical drapes (To cover, dress, or hang with or as if with cloth in loose folds)Soiled instruments should be handled by gloved personnel


Mechanical WashingAppropriate apparel for personnel in the central decontamination area includes scrub attire, cap and mask, protective eye wear, a waterproof apron or coverall suit and long, cuffed, heavy-duty rubber glovesUpon arrival the instruments are uncovered, arranged loosely in an open mesh tray with the lightest instruments on the top and placed directly into a washer sterilizer


Mechanical Washing

If gross debris is present a hand prewash in a detergent/germicide solution is recommendedWhen decontaminated instruments are removed from the washer-sterilizer they transported to the ultrasonic cleaner


Instrument decontamination

When a centralized area is not available, autoclave in the substerilizing room, the other involves a thorough hand washingThe later is time consuming, less efficient and higher in labor expense


Ultrasonic CleaningOnce the terminal strilization is complete the second phase of instrument processing with an ultrasonic cleaner may beginThis process removes tenacious soil that remains on instruments after they have been mechanically or manually washedBy cavitation process debris and material are removed from all surfacesof the instrumantation Most manufactures instructions warn against placing instruments to dissimilar metals (as stainless steel, coppar & titanium) in the ultrasonic cleaner at the same time


Ultrasonic Cleaning

Ultrasonic cleaning is not recommended for some delicate instruments, chrome-plated instrumentsThen instrument are inspected and all movable parts are lubricated with an antimicrobial, water souble lubricant to protect against rusting, staining (To discolor, soil, or spot), or corrosionInstruments then rearranged into sets, placed in containers or wrapped and sterilized or stored for future used


Sterilization Methods for Prevention of Infection

Methods of sterilization of surgical items must result in complete destruction of microbial life, including spores, and the absence of toxic residue on the objects as well as little or no deterioration or damage to treat and moisture sensitive instruments


Sterilization Methods for Prevention of Infection

Steam sterilizationSaturated steam under pressure is recognized as the safest most practical means of sterilizing surgical supplies, fluids , the majority of instruments and other inanimate (Not having the qualities associated with active, living organisms. See Synonyms at dead) objects


Theory of microbial destruction

Microorganisms destroyed by moist heat through a process of denaturation (To change the nature or natural qualities of) and coagulation of the enzyme-protein system within the bacterial cellMicroorganisms are killed at a lower temperature when moist heat is used than when dry heat is used


Theory of microbial destruction

When steam comes in contact with a cold object, condensation takesplace immediatelyAs the steam condenses it gives off latent heats and wets the object


Principles and mechanismof steam sterilization

In conventional steam sterilizer, the sterilization process may be divided into 5 phases

Loading phase, in which the objects are packaged and loaded in the sterilizerHeating phase, in which the steam is brought to the proper temperature and allowed to penetrate around and through the objects in the chamberDestroying phase, or the time-temperature cycle, in which all microbial life is exposed to the killing effects of the steamDrying and cooling phase, in which the objects are dried and cooled, filtered air is introduced into the chamber, the door is opened and the objects are removed and storedTesting phase in which the efficiency of the sterilization process is checked


High speed (flash) sterilization

Referred to a flash sterilizer, adjusted to operate at 132 degreeIt can be used for sterilizing packs and solutionsMost frequently used in the operating room for urgently neededunwrapped instrumentPlease read figure 5.10


Prevacuum, high-temperature sterilization

Accomplished by mean of an air-blasted (destructive force ), oil-sealed rotary pump, protected by a condenser and coupled with an automatic control mechanismPlease read Figure 5.11


Boiling water (nonpressure)

Boiling does not sterilize instrumentsHeat resistant microorganism, bacterial spores and certain viruses can withstand (resist or confront with resistance)

boiling water at 100 degree for many hours


Dry Heat Sterilizatin

Rarely used in hospitals todayAs the proteins become dry during exposure to dry heat, their resistace to denaturation increases, for this reason, at a given temperature,, dry heat sterilization is much less effective than moist heat


Chemical SterilizationNew material that cannot be heat sterilized are continually being introduced for use in hospitals, they require the use of other methods of sterilizationRestricted to ethylene oxide ( a gaseous chemosterilizer) and aqueous glutaraldehyde ( a liquid chemosterilizer)Refered to as cold sterilizationThis term refers to the maximum temperature of 54 °C to 60 of gaseous sterilization as compared with 121 °C to 132 °C temperature of steam sterilization


Gaseous chemical sterilization

to sterilize of heat-labile and moisture sensitive items as intricate (having many complexly arranged elements), delicate surgical instruments, large pieces of equipment used in the hospital, plastic and porous (able to absorb fluids) materials, all of which are difficult to steam sterilize without deterioration and damage


Gaseous chemical sterilization

Ethylene oxide is the most frequently used gas, odor similar to etherHas inhalation toxicity similar of ammonia gas, kept as a liquidItem that can be steam sterilized should never be gas sterilized


Liquid chemical sterilization

Destroy all forms of microbial life, including bacterial and fungal spores, tuercle bacilli and virusesAqueous glutaraldehyde and aqueous formaldehydeaqueous formaldehyde rarely used because it takes 12-24hto be effectiveAqueous glutaraldehyde 2% useful in the disinfection of lensed instruments such as cystoscope and bronchoscopes because it has minimal deleteriuos (Harmfu) effects on the lens cement and noncorrosiveInstruments must be free of bioburden and completely immersed an activated Aqueous glutaraldehyde solution for 10 hto acheive sterilizationFollowing immersion instruments must be rinsed thoroughly with sterile distilled water before being used

Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping...

Documents

Transcript of Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping...