Decontamination Decontamination

By By Dr.Amina Dr.Amina Nour Nour El El Deen Deen

Professor of Microbiology Professor of Microbiology
*CIeaning *CIeaning = mechanicaI removaI of organic = mechanicaI removaI of organic
matter which is accompanied by chemicaI matter which is accompanied by chemicaI
kiIIing of kiIIing of some some organisms ( organisms ( x x T.B. T.B. x x spores) spores)
*Disinfection *Disinfection = freeing of an articIe from = freeing of an articIe from
many many of its contaminating organisms of its contaminating organisms
( (]]T.B. T.B. ]] some some spores) spores)
* SteriIization * SteriIization = freeing of an articIe from = freeing of an articIe from aII aII
Iiving organisms incIuding bacteriaI spores Iiving organisms incIuding bacteriaI spores
*Decontamination *Decontamination= rendering an equipment = rendering an equipment
safe safe to handIe to handIe
CIeaning
SteriIization Disinfection
Use or Storage
Decontamination
or non criticaI items, Iow risk ; Items
that come into contact with normaI and
intact skin as stethoscopes or with the
inanimate environment (e.g. waIIs,
fIoors, ceiIings, furniture, sinks, etc.)
we use CIeaning
PracticaI AppIications
or Semi criticaI items, Intermediate risk;
those in contact with intact skin or mucous
membrane e.g. suction tubes, endoscopes,
Iaryngoscopes, specuIa, endotracheaI
tubes, ) we use Disinfection
or criticaI items, High risk; those in contact with
a break in skin or mucous membrane or entering
a steriIe body area e.g. surgicaI instruments,
needIes,intra-uterine devices, vascuIar catheters,
impIants, parenteraI fIuids ) we use SteriIization
CIeaning CIeaning
* Achieved * Achieved by mechanicaI removaI of by mechanicaI removaI of
dust, grease, organic matter and debris dust, grease, organic matter and debris
dried on instruments. This is done by dried on instruments. This is done by
the use of water ,detergents & friction the use of water ,detergents & friction
which may be manuaI or mechanicaI. which may be manuaI or mechanicaI.
An enzymatic presoak (protease formuIa
that dissoIves protein can aIso be used)
* Organisms * Organisms that are kiIIed during that are kiIIed during
cIeaning process incIude; cIeaning process incIude;
AII vegetative bacteria AII vegetative bacteria except T.B. except T.B.
EnveIoped & Some non EnveIoped & Some non- -enveIoped enveIoped
viruses & Some fungi . viruses & Some fungi .
Never bacteriaI spores Never bacteriaI spores
Uses of cIeaning Uses of cIeaning
Preliminary step before Preliminary step before
disinfection or sterilization. disinfection or sterilization.
Environmental sanitation. Environmental sanitation.
AppIied for non-criticaI items
Types of cIeaning soIutions Types of cIeaning soIutions
1 1- - Detergents (Surfactants): Detergents (Surfactants):
Anionic Anionic $oaps (effective cleanser with $oaps (effective cleanser with
little antibacterial effect). little antibacterial effect).
Cationic Cationic QAC QAC e.g.Cetrimide e.g.Cetrimide (bactericidal (bactericidal
on gram + on gram +ve ve bacteria in absence of bacteria in absence of
organic matter, can support growth of organic matter, can support growth of
gram gram - -ve ve bacilli ) bacilli )
- - ChIorine & Hypo chIorites : ChIorine & Hypo chIorites :
* * Cheap, effective , wide spectrum(1%) & Cheap, effective , wide spectrum(1%) &
in in high high concentrations can kiII T.B. and concentrations can kiII T.B. and
bacteriaI spores ( 5% hypochIorite is HLD , bacteriaI spores ( 5% hypochIorite is HLD ,
the best house hoId bIeach). the best house hoId bIeach). But But corrosive; corrosive;
avoid contact with metaI & bare hands ). avoid contact with metaI & bare hands ).
* * in in Iow Iow concentrations inactivated by concentrations inactivated by
organic matter. organic matter. Used Used for disinfection of for disinfection of
swimming pooIs & drinking water (after swimming pooIs & drinking water (after
removaI of organic matter). removaI of organic matter).
II II- -Disinfection Disinfection
* * RemovaI of some or aII ( according to RemovaI of some or aII ( according to
IeveI) pathogenic organisms but IeveI) pathogenic organisms but
doesn't incIude spores. doesn't incIude spores.
* * It invoIves many chemicaI as weII as It invoIves many chemicaI as weII as
physicaI processes physicaI processes
Disinfection Disinfection
Moist heat
BeIow or at 100
0
C
U.V.irradiation
iItration of air
ChemicaIs
Low,intermediate &high
AppIied for semi-criticaI items
Disinfection by moist heat Disinfection by moist heat
beIow or at 100 beIow or at 100
0 0
C C
A A- - Pasteurization; Pasteurization; Heating at 60 Heating at 60
0 0
C for 30 C for 30
min ( min (holder process holder process) or 70 ) or 70
0 0
C for 0 sec C for 0 sec
( ( flash process flash process) usuaIIy foIIowed by ) usuaIIy foIIowed by
rapid cooIing at 4 rapid cooIing at 4
0 0
C.Used for preparing C.Used for preparing
safe miIk. safe miIk.
B B- - Washing in water; Washing in water; at at 75 75- -80 80
0 0
C for few C for few
min. usefuI for disinfection of ward min. usefuI for disinfection of ward
Iaundry & eating utensiIs. Iaundry & eating utensiIs.
C C- - BoiIing; BoiIing; 100 100
0 0
C for 0 min couId be used for C for 0 min couId be used for
disinfecting surgicaI instruments, tubing of disinfecting surgicaI instruments, tubing of
anesthetic apparatus & ventiIators & face anesthetic apparatus & ventiIators & face
masks masks (onIy in emergency situations where (onIy in emergency situations where
no other aIternative no other aIternative).Addition of % NaHCO ).Addition of % NaHCO
3 3
increases efficiency increases efficiency
D D- -TyndaIization: TyndaIization: Exposure to steam at 100 Exposure to steam at 100
oo
C C
for 30 min for 3 successive days. Used to for 30 min for 3 successive days. Used to
disinfect cuIture media containing sugar or disinfect cuIture media containing sugar or
geIatin. geIatin.
Disinfection by uItravioIet radiation Disinfection by uItravioIet radiation
Low energy, non Low energy, non- -ionizing rays with Iow ionizing rays with Iow
penetrative power penetrative power
(can't penetrate gIass or Iiquids). (can't penetrate gIass or Iiquids).
* * used for treatment of air and used for treatment of air and cIean surfaces cIean surfaces
e.g. Iaboratory safety cabinets, operating e.g. Iaboratory safety cabinets, operating
room and water pipes room and water pipes
Disinfection by fiItration Disinfection by fiItration
* Achieved by; * Achieved by; high efficiency particuIate air high efficiency particuIate air
(HEPA) fiIters. (HEPA) fiIters.
* Used * Used for removaI of microorganisms from for removaI of microorganisms from
air suppIied to criticaI sites e.g. air suppIied to criticaI sites e.g.
operating theaters operating theaters
pharmaceuticaI cIean rooms pharmaceuticaI cIean rooms
Laboratory Iaminar fIow systems Laboratory Iaminar fIow systems
Chemical
disinfection
Low level ntermediate High level
eneraI ruIes for use of disinfectants eneraI ruIes for use of disinfectants
1 1- - eneraIIy toxic eneraIIy toxic
- - Narrow spectrum. Narrow spectrum.
3 3- - Correct concentration. Correct concentration.
4 4- - Proper time. Proper time.
5 5- - BacteriaI Ioad. BacteriaI Ioad.
6 6- - PH changes. PH changes.
7 7- - SheIf Iife. SheIf Iife.
Low LeveI ChemicaI Disinfection Low LeveI ChemicaI Disinfection

CIeaning CIeaning
Intermediate LeveI ChemicaI Intermediate LeveI ChemicaI
Disinfection Disinfection
nvolves all organisms killed by nvolves all organisms killed by
cleaning cleaning ++ T.B. T.B.
Disinfectants Disinfectants are usually toxic & used are usually toxic & used
for inanimate objects (floors, walls for inanimate objects (floors, walls
,tables etc..) ,tables etc..)
Antiseptics Antiseptics are non are non- -toxic & used for toxic & used for
skin and living tissues (surgeon hand skin and living tissues (surgeon hand
& patient's skin). & patient's skin).
CommonIy used Antiseptics CommonIy used Antiseptics
1 1- - AIcohoI (60 AIcohoI (60- -90% ethyI or isopropyI) 90% ethyI or isopropyI)Skin Skin
- - Iodine (tincture in 70% aIcohoI) & Iodine (tincture in 70% aIcohoI) &
iodophors (povidon iodine) iodophors (povidon iodine)Skin & mm Skin & mm
3 3- - Biguanides (ChIorhexidine gIuconate4%& Biguanides (ChIorhexidine gIuconate4%&
hexachIorophane hexachIorophanehand hand
1 1- -3 affected by organic matter 3 affected by organic matter
Important Disinfectants Important Disinfectants
* PhenoIics e.g. 5%LysoI * PhenoIics e.g. 5%LysoI inanimate inanimate
PhenoIics are not affected by organic matter PhenoIics are not affected by organic matter
& have IittIe activity on viruses & have IittIe activity on viruses
* Activated chIorines * Activated chIorines
High LeveI ChemicaI Disinfection High LeveI ChemicaI Disinfection
InvoIves aII organisms kiIIed by InvoIves aII organisms kiIIed by
intermediate IeveI intermediate IeveI + + some spores. some spores.
* * % % IutaraIdehyde IutaraIdehyde ( (Cidex Cidex) ) 0 0 min min
Used for heat IabiIe Equipments e.g. Used for heat IabiIe Equipments e.g.
Endoscopes Endoscopes
* * 6 6% Hydrogen peroxide % Hydrogen peroxide 0 0 min min
SuitabIe for Wounds SuitabIe for Wounds
III SteriIization III SteriIization
Complete killing of all microorganisms Complete killing of all microorganisms
including bacterial spores including bacterial spores
SteriIization SteriIization
Moist heat above 100
0
C
Dry heat
y-irradiation
aseous process
iItration
AppIied for criticaI items
SteriIization by moist heat SteriIization by moist heat
KiIIs KiIIs by denaturation of aII proteins by denaturation of aII proteins
Achieved Achieved by steam under pressure by steam under pressure
n the autocIave ( n the autocIave (11 11
oo
C for C for 0 0 min) min)
ravity dispIacement (un ravity dispIacement (un- -wrapped wrapped
items )Pre items )Pre- -vacuum (wrapped items) vacuum (wrapped items)
Most preferred method Most preferred method appIied appIied for for
high risk items ( surgicaI high risk items ( surgicaI
instruments, dressings and surgicaI instruments, dressings and surgicaI
sheets ) , Iaboratory media& sheets ) , Iaboratory media&
gIassware with rubber stoppers gIassware with rubber stoppers
SteriIization by dry heat SteriIization by dry heat
* * KiIIs KiIIs by oxidation of ceII constituents by oxidation of ceII constituents
* Methods: * Methods:
A A- - Hot air oven Hot air oven (160 (160
oo
C for hours) C for hours)
for oiIs , powders , carbon steeI for oiIs , powders , carbon steeI
surgicaI instruments, and surgicaI instruments, and
Iaboratory gIassware. Iaboratory gIassware.
B B- - Incineration Incineration (more than 160 (more than 160
oo
C) for C) for
disposaI of contaminated materiaIs disposaI of contaminated materiaIs
e.g. surgicaI dressings, sharp e.g. surgicaI dressings, sharp
needIes, cIinicaI waste needIes, cIinicaI waste
C C- - SpeciaI methods SpeciaI methods of using dry heat of using dry heat
in microbioIogy Iab in microbioIogy Iab (red heat & (red heat &
fIaming) fIaming)
SteriIization by SteriIization by y-irradiation irradiation
Achieved Achieved by high speed eIectron beam by high speed eIectron beam
(highIy penetrative (highIy penetrative ionizing radiation)..
AppIications: AppIications:
A A- - Large amounts of Large amounts of pre pre- -packed singIe use items packed singIe use items
e.g. pIastic syringes and catheters. e.g. pIastic syringes and catheters.
B B- - CommerciaI steriIization of pharmaceuticaI CommerciaI steriIization of pharmaceuticaI
preparations and food stuffs. preparations and food stuffs.
SteriIization by gaseous process SteriIization by gaseous process
Achieved Achieved by ethyIene oxide gas . by ethyIene oxide gas .
(highIy penetrative, toxic, expIosive, (highIy penetrative, toxic, expIosive,
fIammabIe and microbicidaI gas) fIammabIe and microbicidaI gas)
AppIications: AppIications: for heat sensitive medicaI for heat sensitive medicaI
devices as prosthetic heart & joint vaIves devices as prosthetic heart & joint vaIves
and cardiac catheters and cardiac catheters
SteriIization by fiItration SteriIization by fiItration
Achieved Achieved by bacteriaI fiIters e.g. membrane by bacteriaI fiIters e.g. membrane
fiIters with pore size Iess than bacteriaI size. fiIters with pore size Iess than bacteriaI size.
AppIications: AppIications: for heat sensitive fIuids e.g. for heat sensitive fIuids e.g.
bacteriaI toxins, antibiotics and bIood bacteriaI toxins, antibiotics and bIood
products products
Monitoring efficiency of
steriIization
Monitoring efficiency of
steriIization
Mechanical
indicators
Chemical
indicators
Biological
indicators