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Dr. Alaa gad MD,CIC
process of freeing an article
or a surface from all or some of
the living microorganisms but not
necessarily bacterial spores
Sterilization The process of freeing an article or a surface from all living microorganisms including viruses & bacterial spores .
some of which are intrinsic qualities of the organism.The activity of germicides against microorganisms depends on a number of factors. others of which are the chemical and external physical environment. .
Factors affecting DISINFECTION Conc of disinfectant Time of action pH of the medium Temperature Nature & number of organisms Presence of extraneous material Others – hardness of water. relative humidity .
000 Bacillus atrophaeusspores.Number of Microorganisms The larger the number of microbes. the more time a germicide needs to destroy all of them. . increases the margin of safety when the germicide is used according to the labeling and shortens the exposure time required to kill the entire microbial load. Spaulding illustrated this relation when he employed identical test conditions and demonstrated that it took 30 minutes to kill 10 B. atrophaeus (formerly Bacillus subtilis) spores but 3 hours to kill 100. Reducing the number of microorganisms that must be inactivated through meticulous cleaning.
Location of Microorganisms Medical instruments with multiple pieces must be disassembled and equipment such as endoscopes that have crevices. . and channels are more difficult to disinfect because penetration of the disinfectant of all parts of the equipment is difficult. Must be no air pockets and the equipment must be completely immersed for the entire exposure period. joints.
. the greater its efficacy and the shorter the time necessary to achieve microbial kill. and with one exception (iodophors).Concentration and Potency of Disinfectants With other variables constant. the more concentrated the disinfectant.
Temperature / PH The activity of most disinfectants increases as the temperature increases. The pH influences the antimicrobial activity by altering the disinfectant molecule or the cell surface . and iodine).. too great an increase in temperature causes the disinfectant to degrade and weakens its germicidal activity and produce a potential health hazard.. An increase in pH improves the antimicrobial activity of some disinfectants (e. glutaraldehyde. hypochlorites. . phenols.g. quaternary ammonium compounds) but decreases the antimicrobial activity of others (e.g.
g. Water hardness reduces the rate of kill of certain disinfectants because divalent cations (e. magnesium. calcium) in the hard water interact with the disinfectant to form insoluble precipitates.. .Humidity / water hardness Relative humidity is the single most important factor influencing the activity of gaseous disinfectants/sterilants.
Factors Affecting The Sterilization Efficacy .
protein load. . and salt concentration. Cleaning Failure to adequately clean instrument results in higher bioburden.1. These will decrease sterilization efficacy.
2. . Bioburden The natural bioburden of used surgical devices is 100 to 103 organisms(primarily vegetative bacteria). which is substantially below the 105-106 spores used with biological indicators.
.Pathogen type Spore-forming organisms are most resistant to sterilization and are the test organisms required for FDA clearance.3. However. the contaminating microflora on used surgical instruments consists mainly of vegetative bacteria.
4. cleaning appears to rapidly remove protein load. However. . Protein Residual protein decreases efficacy of sterilization.
cleaning appears to rapidly remove salt load. .5.Salt Residual salt decreases efficacy of sterilization more than does protein load. However.
endoscopes) Some enzymes and detergents can degrade biofilms or reduce numbers of viable bacteria within a biofilm. contact lenses. central venous catheters.g. Chlorine and monochloramines can effectively inactivate biofilm bacteria . urinary catheters. . but no products are EPA-registered or FDAcleared for this purpose. Biofilm accumulation Biofilms are microbial communities that are tightly attached to surfaces and cannot be easily removed.. pacemakers. and numerous medical devices (e.000 times more resistant to antimicrobials than are the same bacteria in suspension . Bacteria within biofilms are up to 1. hemodialysis systems. dental unit waterlines.6. Biofilms have been found in whirlpools.
.7. May require forced flow through lumen to achieve sterilization. Lumen length Increasing lumen length impairs sterilant penetration.
8. May require forced flow through lumen to achieve sterilization. . Lumen diameter Decreasing lumen diameter impairs sterilant penetration.
blind lumens) will decrease sterilization efficacy.9. sharp bends.. . Restricted flow Sterilant must come into contact with microorganisms.g. Device designs that prevent or inhibit this contact (e.
g. hinges) will also affect sterilization efficacy.10. Design issues (e.. Device design and construction Materials used in construction may affect compatibility with different sterilization processes and affect sterilization efficacy. . screws.
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