ANES 1502 - M13 PPT - Disinfection
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Transcript of ANES 1502 - M13 PPT - Disinfection
Objectives:As a result of successfully completing this chapter, readers will be able
to:
Define the term, “disinfection,” and explain how disinfection differs from sterilization.
Review factors that impact the effectiveness of a disinfectant.
Discuss the relationship between the risk level (intended use) of the device to be disinfected and the selection of a disinfectant.
Explain disinfectant activity levels as they relate to the resistance of microorganisms to germicidal agents:
high-level disinfection intermediate-level disinfection low-level disinfection
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Objectives: Review factors which affect the chemical action of and other important
selection considerations for disinfections.
Provide basic information about the types of disinfectants commonly used in healthcare facilities: quaternary ammonium compounds, phenolics, alcohol, halogens, glutaraldehyde, ortho-phthalaldehyde, and formaldehyde.
Review safety requirements that should be followed when using chemical disinfectants.
Define the term, “thermal disinfection,” and note key points to ensure that it is occurring.
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Terminology Disinfectant - A
chemical used on inanimate objects such as medical instruments to kill all microorganisms , except spores.
Antiseptic – A chemical used on living tissue such as skin, to slow the growth of microorganisms.
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Terminology
Disinfection – The destruction of nearly all pathogenic microorganisms on an inanimate surface. Disinfection is accomplished using chemical or heat processes.
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Factors Impacting the Effectiveness of Disinfectants:
Excessive Moisture – Excessive moisture can cause disinfectant solutions to become diluted. Lowering the concentration of the chemical disinfectant can reduce its ability to kill microorganisms.
Factors Impacting the Effectiveness of Disinfectants:
Direct Contact with the Item.
In order to be effective, disinfectants must make direct contact with all surfaces being disinfected.
Factors Impacting the Effectiveness of Disinfectants:
Time
Disinfectants must be allowed time to work.
Check manufacturer’s instructions for the correct exposure time required to achieve the desired biocidal effect.
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Other Factors Impacting the Effectiveness of Disinfectants:
Temperature of the Disinfectant
pH
Hardness of the Water
Material Compatibility
Positioning of the Device(s) being disinfected
Selecting a Disinfectant
Should be based on: The intended use of the
device The degree of disinfection
required for the device.
Risk levels are based on the Spaulding Classification System
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Critical Items Items introduced
directly into the bloodstream or other normally sterile areas of the body.
Surgical Instruments, Implants, etc.
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Semi-Critical Items Items which come in
contact with intact mucous membranes.
Fiberoptic Endoscopes, Cystoscopes, etc.
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Non-Critical Items Come in direct contact
with the patient’s unbroken skin.
Crutches, Blood Pressure Cuffs, equipment, etc.
Copyright IAHCSMM 2007Table Modified from Favero and
Bond, 1991
Classification of Patient Care Items
CriticalSterilizationSterile body cavity
Semi-criticalHigh-levelMucous membranes
Non-criticalLow levelIntact skin
Item ClassDestruction Method
Body Contact
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High-Level Disinfection
Process that uses a sterilant for a shorter contact time that needed for sterilization. High-level disinfection kills all microorganisms, except bacterial spores.
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Intermediate-Level Disinfection
Process that utilizes a agent that kills viruses, mycobacteria, fungi, and vegetative bacteria, but not bacterial spores.
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Low-Level Disinfection
Process that utilizes a agent that kills vegetative forms of bacteria some fungi and lipid viruses.
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Terminology Lipid Virus – A virus whose core
is surrounded by a coat of lipoprotein. Viruses included in this structural category are generally easily inactivated by many types of disinfectants, including low-level disinfectants.
Nonlipid Virus – A virus whose core is not surrounded by a lipidenvelope. These viruses are generally more resistant to inactivation by disinfectants.
Copyright IAHCSMM 2007Table Modified from Favero and
Bond, 1991
Hierarchy of Disease Producing Agents
Low-Level DisinfectionLipid or medium sized viruses (Hantavirus, Herpes Simplex Virus)
Low-level DisinfectionGram Positive & Negative Vegetative Bacteria
Intermediate-level DisinfectionFungi
Intermediate-level DisinfectionNonlipid and small viruses (Poliovirus)
High Level DisinfectionMycobacteria
SterilizationBacterial spores
Extended Sterilization TimesPrions
Destruction MethodOrganism Producing Disease
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Factors Influencing Disinfectant Effectiveness:
Types of devices being disinfected.
Whether items can be disassembled.
Manufacturer’s recommendations.
Positioning of the device.
Process Quality Assurance Tests.
Shelf Life and Use Life.
Preparation required (mixing, etc.)
Reuse factors.
Additional inspections required by the manufacturer.
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Common Disinfectant Characteristics
A detailed overview of common chemical disinfectant characteristics can be found on pages 161 – 169 in the text.
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Quaternary Ammonium Compounds (QUATS)
Low-Level Disinfectant
Advantages: Bactericidal, fungicidal and virucidal against
lipophilic viruses Built-in Detergent Properties
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Quats Disadvantages:
Not sporicidal Generally not tuberculocidal or virucidal against hydrophilic
viruses Not Compatible with Soap Absorbed or Neutralized by Cotton or Charcoal Not effective against some gram-negative organisms
commonly found in hospitals
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Phenolics Intermediate to Low LevelAdvantages:
Broad Spectrum of use; bactericidal for gram-negative and gram-positive bacteria, fungi, and tuberculocidal against lipophilic viruses.
Residual Activity* (can also be a disadvantage)
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PhenolicsDisadvantages:
Not sporicidal Inactivated by organic material Corrosive to Rubber and some Plastics
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Alcohol Intermediate-LevelAdvantages:
Rapid bactericidal agent against vegetative microorganisms, tuberculocidal, fungicidal, and virucidal.
Fast-Acting Non-Staining Leaves No Residue
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Alcohol Disadvantages:
Requires a minimum 5 minute wet contact. No residual activity Volatile, flammable Inactivated by Organic Soil. Can dissolve lens mountings on certain
optical instruments Tends to harden and swell plastic tubing Not sporicidal
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Chlorine Intermediate-Level Advantages:
Effective against Gram-Positive and Gram-Negative Microorganisms, Tuberculocidal, Fungicidal, and Virucidal
Rapid-Acting
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Chlorine Disadvantages:
Inactivated by Organic Matter Corrosive to Metals Not Sporicidal Stains fabrics, plastics and other synthetic materials Relatively Unstable
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Iodophors(Buffered Iodine)
Intermediate-Level Advantages:
Bactericidal, Tuberculocidal, and Virucidal Rapid-Action against vegetative bacteria
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Iodophors(Buffered Iodine)
Disadvantages: Corrosive to Metals Detrimental to Rubber and some Plastics May burn tissue Stains fabrics and other materials May require long contact time to kill some fungi
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Glutaraldehyde High-Level Disinfectant/Sterilant
Advantages: Kills vegetative bacteria (within 2 minutes)
Bactericidal (gram-positive and gram-negative), tuberculocidal, fungicidal, virucidal, sporicidal (For sterilization (killing spores) the soak time ranges 6-10 hours).
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Glutaraldehyde Disadvantages:
Noxious odors, good ventilation required Unstable (14-28 product life) Dilution of product reduces activity Vaporizes No cleaning ability Rinsing Required Employee Health Concerns
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Ortho-Phthaldaldehyde(OPA)
High-Level Disinfectant
Advantages: Fast-acting User-friendly Compatible with a wide range of endoscopes and medical
devices Requires no activation or mixing
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OPA Disadvantages:
Does not have sterilant label claim Improper rinsing can cause staining of patient
tissues Patient with a history of bladder cancer should not
be exposed to items processed by OPA
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Formaldehyde Available in different concentrations as a Low,
Intermediate, and High-Level Disinfectant
Advantages: Bactericidal, tuberculocidal, fungicidal, and virucidal
Sporicidal (as 8% Formaldehyde/70% alcohol)
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Formaldehyde Disadvantages:
Inactivated by organic material May stain fabrics, plastics, and other synthetic
materials Not sporicidal Carcinogen (1PPM, 8 hour TWA) Irritating fumes Corrosive
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Using High-Level Disinfectants
Follow manufacturers’ instructions Use appropriate containers Cover the containers Wear gloves Reuse only those products labeled for reuse Watch expiration dates Test as necessary Rinse thoroughly Dispose of according to established guidelines
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Documentation A Log Book should be
maintained for high-level disinfectants.
(See page 171 of the text for a sample log book page.)
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Chemical Disinfectant Safety
Wear PPE Use an exhaust hood when necessary Develop a spill plan Provide an eyewash/shower and other first aid
supplies Provide easy access to a phone and phone
numbers for emergencies
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Chemical Disinfectant Safety
Provide yearly staff training
Monitor disinfectants (including air quality)
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Thermal Disinfection
Thermal Disinfection – Disinfection accomplished by heat.
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Thermal Disinfection
Check spray arms and nozzles of mechanical washer/disinfectors daily to insure they are working correctly.
Medical washers and washer/disinfectors are regulated by the FDA.