TOPIC 3

MICROBIAL CONTROL AND STERILIZATION

Instruction: Answer the question briefly and concisely. In answering,

demonstrate the necessary concepts applied in the question.
1. Why is it better to use a 10% sodium hypochlorite solution than a
50% sodium hypochlorite solution? Justify your answer objectively.
2. Why is it important to sterilize medical equipment?
3. What are the common medical equipment used in the ward and in an
operating room? How should they be sterilized?

Answers:

1.

2. Medical devices that have contact with sterile body tissues or fluids are
considered critical items. These items should be sterile when used
because any microbial contamination could result in disease transmission.
Such items include surgical instruments, biopsy forceps, and implanted
medical devices. The failure to adequately reprocess contaminated
instruments—that is, not cleaning and disinfecting or sterilizing them—
before using them on subsequent patients can lead to the spread of deadly
pathogens

Failure to properly disinfect or sterilize equipment carries not only the risk
associated with breach of the host barriers but also the additional risk for
person-to-person transmission (e.g., hepatitis B virus) and transmission of
environmental pathogens (e.g., Clostridium difficile).

The risk of spread of infection should be assessed to determine the choice

between using sterilization or disinfection accordingly. Sterilization is
required for all critical medical devices that are intended for being in
contact with sterile tissues, and "semi-critical" devices that come in contact
with mucous tissues or non intact skin (respiratory therapy equipment,
anesthesia equipment, endoscopes, parts of laryngoscope, etc).
1. Needles

There are three different types of needles available; the 1/2 circle
needle, the 3/8 circle needle and the straight needle. Needles are used
for different purposes in a surgical operation. Some of which are:

 A needle is inserted into a vein in order to draw blood.

 A needle is inserted into an artery in order to measure
blood pressure.
 A needle is inserted into a tumor in order to remove a
sample of tissue for examination.
 A needle is inserted into the spinal cord in order to give
an injection of medication

2. Blades

There is a 10-blade with a curved cutting edge, an 11-blade that

is triangularly pin-pointed, a 12-blade (stitch cutter) and a 15-blade.
The blade is used to make an incision in the skin.

3. Gauze

Gauze is used as a surgical dressing to keep a wound clean and

protected. It can also be used to absorb blood and other fluids from the
wound.

4. Diathermy

Diathermy is used to cut through tissue.

5. Retractors

Retractors are sharp and round retractors. The sharp retractors

have six prongs. They are commonly used for retracting and
simultaneously lifting the skin and subcutaneous tissue.
6. Scissors

Different scissors are used, either straight or curved. Scissors are

basically used for cutting. To cut sutures, bandages, gauze, tape, cotton
or cloth.

7. Forceps

There are anatomical forceps and surgical forceps. The surgical

forceps have teeth at the tip. Surgical forceps are used for grasping and
holding various objects during surgical procedures. These tools include
hand forceps, needle holders, clamping forceps, and others.

8. Clamps

There are many types of clamps with their common denominator

being the cremaillere that allows permanent closure. There are many
uses of clamps in surgical operations. They can be used to hold tissues
together, to stop bleeding, and to secure instruments or other materials
in place. Plastic clamps are available for the insertion of blood vessels in
order to feed blood from the site of surgery. Other plastic surgical
clamps are used for the placement of implants, to tie ligaments, or for
other various procedures.

9. Scalpel

This is one of the most basic instruments used during surgery. It

is a knife with a short blade (about 1 to 3 cm) that makes cuts in the
skin or other tissues. The blade is very small and this helps make clean
cuts.

10. Needle driver/holder

There are different types of needle holders. They include straight,

curved-left, curved-right, and self-righting needle holders. They are
used to hold suturing needles during surgical procedures.

11. Curette
 The curette is used to scrape away tissue.

Surgical instruments must be kept clean and sterile by all members

of the surgical team to prevent the spread of infection and to avoid
contamination. This is ensured by proper preparation/handling of sterile
items and sterilization of surgical instruments.
The setting up of table setting and preparation of instruments should
be done in a sterile preparation room that has a laminar down-flow
ventilation system that directs ambient air away from the site, carrying
contaminant dust particles along. A back table and Mayo stand are used to
set up the sterile field upon which the sterile instruments and materials
can be placed. Table setting furniture and equipment should be placed, at
least 1m from the walls and the person passing materials from the
unsterile area to the sterile field should stand 50cm away from it.
To ensure that the instruments are clean, used tools must be
cleaned and disinfected. The use of disposable instruments like gauze
swabs and sutures is very effective in preventing the spread of infection.
Some surgical instruments have a built-in sterilisation feature or may be
purchased with a sterilisation system.
A very important item to note is that metal instruments should never
be immersed in ethylene oxide (ETO) as they are made from stainless
steel, which can cause pitting or rusting of the metal. Another method of
sterilisation is by using autoclaving. The items are placed in a water bath
and subject to steam for 5 minutes at around 121°C. The autoclave is then
turned off, and the water bath is removed. The items are then left for a
further 5 minutes at room temperature in an environment which will not
induce condensation on the surface of the items.