APPLICATION OF

STERILIZATION AND
DISINFECTION IN
HOSPITAL SETTING
INFECTION CONTROL 2021
INTRODUCTION

Sterilization and disinfection in hospital setting:

• Are methods used for eliminating microorganisms or reducing their numbers on medical
equipment and healthcare environment.
APPROACHES FOR PREVENTION OF INFECTION IN A
HEALTHCARE SETTING

• There are two main approaches:

1. Removal of microorganism from healthcare environment (require cleaning or a
disinfection process)
2. Removal of organism from patient care equipment (require cleaning, disinfection or
sterilization process)
MODE OF TRANSMISSION IN HEALTHCARE
FACILITIES
• In healthcare facilities an important mode of transmission of pathogenic microorganisms
to a susceptible person via equipment which include medical and surgical instruments
and patient care items and furnishing.
PRIORITIZATION FOR STERLIZATION
• Prioritization done according to the risk’s level:

Level of risk Use of item Process Example

Equipment that penetrates sterile

Critical tissue, body cavity or Sterilization Surgical instrument
bloodstream

Equipment contact with patient Single use or sterilization or high Endoscopes, cystoscopes,
Semi critical
not intact skin level chemical disinfection respiratory equipment

X-ray machine, bedpans,

Cleaning, low level of
Non- critical Contact with intact skin thermometers, blood
disinfection
pressure cuffs.
FACTORS IMPACTING THE EFFECTIVENESS
OF METHODS
Factors impacting the effectiveness of methods are:
• Risk level associated with use of particular item.
• Nature of the object to be sterilized.
• Susceptibility of the microorganisms present to the procedure.
IS CLEAN, SANITIZE AND DISINFECT SUFFICIENT TO
PREVENT INFECTION?
• Often, practices that clean (remove dirt and other impurities), sanitize (reduce the
number of microorganisms to safe levels), or disinfect (remove most microorganisms but
not highly resistant ones) aren't sufficient to prevent infection
CLEANING

• Cleaning is:
• One of most important procedure for the removal of microorganisms from inanimate objects
(get rid of visible dirt).
• Reduce the pathogen load while removing organic and inorganic residues, essential before a
disinfecting or sterilizing procedure.
• The item must be freed of organic material, grease and dirt as these can provide a protective
barrier for the microorganism and markedly reduce the effectiveness of the procedure.
• For example, organic matter reacts with some chemical’s disinfectant, making the disinfectant
less effective.
REQUIREMENT AND METHODS OF CLEANING

Requirement and methods of cleaning:

• Effective cleaning of devices often requires chemicals, combined with mechanical action and heat. It
can be performed manually and/or with machines.
• Reusable items must be disassembled safely and cleaned as soon as possible
after use to prevent any contaminants from drying.
• Manual cleaning requires detergents or enzymes with friction (rubbing,
brushing, flushing) to remove soil from the outside and inside of the items being reprocessed. After
cleaning, items must be rinsed and flushed thoroughly to remove any chemical residues and then dried.
All reprocessed items must be stored properly to prevent damage or recontamination.
ENVIRONMENTAL CLEANING

• Microorganisms can be transfer from the hospital environment to patient by direct contact
with contaminated items or indirectly via the hands of healthcare workers.
• There for cleaning of wards, bathrooms, floor and furnishings is important part of infection
control.
• According risk assessment the surface divide into:
1. Minimally touched surfaces Such as walls, floors should be cleaned with detergent solution
when they are visibly dusty or soiled.
2. Frequently touched / high risk surfaces: Such as bedrails, over bed table and light switch
should be cleaned with detergent solution combined with or followed by disinfectant.
STERILIZATION

• In hospital setting, patients are protected from infection by the use of sterile equipment,
instrument, dressings and IV solution
• Moist heat sterilization by autoclave:
- The most commonly used method,
- The process is reliable,
- Has known killing action
- Used in way that provides a wide safety margin.
PASTEURIZATION AND BOILING

• Pasteurization and boiling: used for semi-critical items, such as respiratory therapy and
anesthesia equipment, can be pasteurized by heating in water. All their parts must remain well
immersed throughout; holding the heat at about 65-77°C for 30 minutes is sufficient. Locations at
higher elevations require a longer time because the boiling point of water gets lower the higher
one gets from sea-level.10 Immersion of heat-resistant items in boiling water for about 10 minutes
can substantially reduce the pathogen load, but must never be regarded as ‘sterilization’.
• Pasteurization and boiling are thus low-tech and chemical free methods (as long as the water is
pure); treated items must be retrieved carefully for safe transport and storage.
DRY HEAT STERILIZER, INCINERATION AND
IONIZING RADIATION
• Dry heat sterilizer: is only suitable for sterilizing equipment that is not harmed by long
exposure to high temperatures.
• Incineration: is used for the complete destruction of contaminated articles.
Ionizing radiation: is useful method for heat sensitive organic material such
pharmaceutical product for injection, and for disposable equipment.
DISINFECTION

• Most disinfection procedures have little activity against bacterial spores; any reduction in
the spore load is mainly achieved by mechanical action and flushing.
• Chemical disinfection: chemicals can be used alone or in combination. They must be
used in accordance with the manufacturer’s instructions and only on surfaces with which
they are compatible.
DISINFECTANTS CATEGORIES

• Disinfectants are placed into three categories depending on microbicidal

activity:
1. High-level disinfectants (HLD)
2. Intermediate-level disinfectants
3. Low-level disinfectants
HIGH-LEVEL DISINFECTANTS (HLD)

• High-level disinfectants (HLD):

• Are active against vegetative bacteria, viruses (including the non-enveloped ones), fungi,
and mycobacteria.
• They may also have some activity against bacterial spores with extended contact times.
HLDs are used to disinfect heat-sensitive and semi-critical devices such as flexible
fiberoptic endoscopes .
• Examples for HLDs: Aldehydes (glutaraldehyde and ortho-phthalaldehyde) and oxidizers
(e.g., hydrogen peroxide and peracetic acid).
HIGH-LEVEL DISINFECTANTS (HLD) ….
CONTINUE
• The aldehydes are noncorrosive and safe for use on most devices. However, they can fix
organic materials, therefore it is particularly important to remove any embedded
microbes prior to disinfection. Unless properly formulated and carefully used, oxidizers
can be corrosive. However, they can be faster-acting and safer for the environment than
aldehydes .
HIGH-LEVEL DISINFECTANTS (HLD) ….
CONTINUE
• HLDs typically require 10-45 minutes contact time for disinfection, depending on the
temperature. After disinfection, items require thorough rinsing with sterile or filtered
water to remove any chemical residues; they must then be dried with an alcohol rinse or
by blowing clean and filtered air through the device’s channels prior to safe storage .
INTERMEDIATE-LEVEL DISINFECTANTS

Intermediate-level disinfectants:
• Are active against vegetative bacteria, mycobacteria, fungi and most viruses.
• They may fail to kill spores, even after prolonged exposure .
LOW-LEVEL DISINFECTANTS

Low-level disinfectants (LLD):

• Are active against vegetative bacteria (except mycobacteria), some fungi, and only
enveloped viruses.
• In many cases, washing with unmedicated soap and water would be sufficient in place of
LLD .