Download High-level disinfection

Prevention of Nosocomial Infection
PharMed Parto Co.,Ltd.
Atrineh Saziba Co., Ltd
Dr. Farzan Ravanasa
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Our Ultimate Aim / Take Home Message

To inform you that staff safety and patient safety are
no longer mutually exclusive
Yesterday’s thinking
Today’s thinking
Tomorrow’s thinking
(congruent thinking)
STAFF
SAFETY
PATIENT
SAFETY
PATIENT
SAFETY
STAFF
SAFETY
SAFETY
FOR
ALL
STAFF
SAFETY
PATIENT
SAFETY
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Methods of Decontamination depends mainly on the type of material,
the level of decontamination and the microorganisms involved
Cleaning:
◦ allows the physical removal of microorganisms
◦ allows prevents inactivation of the disinfectant by organic matter
◦ complete surface contact during further decontamination procedure
 Through cleaning of items is a prerequisite before disinfection
and sterilization is commenced
 Disinfection:
◦ by heat or chemicals will destroy microorganism but not bacterial
spores
◦ chemical disinfection does not necessarily kill all microorganisms
present but reduces them to a level not harmful to health
 Antiseptics:
◦ the agents must have effective antimicrobial activity
◦ must not be toxic to living tissues
◦ chemicals used to kill microorganisms on skin or living tissue
 Sterilization:
◦ a process which achieves the complete destruction or removal of all
microorganisms , including bacterial spores

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Spaulding classification of chemical disinfectants
Fungi
Nonlipid
& small
viruses
Lipid &
mediumsize
viruses
Level of
disinfection
Spores
TB
Vegetati
ve
bacteria
High
+*
+
+
+
+
+
Intermediate
-
+
+
+
+/-
+
Low
-
-
+
+/-
+/-
+
* high-level disinfectants may not be able to kill large numbers of spores
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Spaulding classification of medical devices
Class of
item
Use of item
Example
Decont.
level needed
Critical
Enter vascular
system or sterile
body tissues
Hypodermic
needle,
Scalpels and
other surgical
instruments,
Biopsy forceps
Sterilization
Semicritical
Comes in contact
with intact
mucous
membranes
Vaginal spec.,
Anaesthetic
equipment, flex.
Endoscopes
High-level
disinfection
(by heat or
chemicals)
Touches only
intact skin
Blood pressure
cuff, Baby
weigh scale,
Examining table
top
Intermediatelevel or lowlevel
disinfection
Noncritical
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Instrument Cycle
Using
Sterilizing
Decontaminating
Sorting /
Packing
Cleaning
Disinfecting
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Disinfectant Classes :
-Aldehydes or Aldehyde releasing agents :
Glutaraldehyde(Cidex),Formaldehyde
- Alcohols : ethanol,n-propanol,isopropanol
- Alkylamines or Alkylamine derivatives
-Chloramides or Chlorine releasing agents :
Hypochlorite sodium(Vitex) , Halamid
- Guanidine or Guanidine derivatives
- Heavy metal compounds Silver compounds
- Organic acids : Peracetic acid,Salicilic acid,Acetic acids
- Inorganic acids : HCl
- Peroxide compounds : Hydrogen peroxide
- Phenols and phenol derivatives :
Chlorhexidine,Chloroxylenol(Dettol) ,Triclosan
-Quternary ammonium compounds :
Benzalkanium Chloride,deconex® and micro 10 ,…
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Cleaning and Disinfection

-
Automated procedure (chemical and thermal)
instrument washer – disinfector
Washer – disinfector for anesthetic and respiratory equipment
Bed pan and urinal washer – disinfector
 Manual procedure
- precleaning
- soaking
- brushing
- rinsing
- drying
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Method of Sterilization






Dry heat sterilization: Oven 170°C for 2h
Moist heat sterilization:
 Autoclaving at 134-138°C for 3 min
 Autoclaving at 121-124°C for 15 min
 Autoclaving at 115°C for 30 min
Chemical sterilization :Aldehide compound, Peracetic acid
Ethylene oxide
Gamma or UV way
Prion sterilization:
 Autoclaving at 134°C for ≥ 18 min
 Soaking in 1 N NAOH for 1 h
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Standard Precautions
1- Hand Hygiene
- Hand Washing (plain soap)
- Antiseptic hand rub
Alcohol-based hand rub
1- Liquid 2- Gel
- Surgical hand antisepsis
1- Betadin or Chlorhexidine 4%
2- Alcohol-based hand rub
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2- Gloves
- Anti bacterial gloves(Nano silver)
- Preventive needle stick gloves
- Latex or Latex-free gloves
3- Masks
- Anti bacterial Masks(Nano silver)
- N95
4- Shields or Eye protectors
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5- Devives for prevention of Needle
Sticks & Sharps Injuries

$1.8 billion is spent annually in the US to treat worker who have
actually contracted viruses from needle-sticks. Between US$600
and US$4000 per incident (not including cost of microsurgery,
rehabilitation and litigation)

Healthcare workers in the United States report between 600,000 and
1 million sharps injuries per year

70% of sharps injuries go unreported

41% of sharp injuries occur after use and prior to disposal of a sharp
device

Real chance of acquiring HIV through occupational exposures but the
risk of acquiring and dying from Hepatitis B is much greater.

Scalpel blade injuries are in the top five common type of sharps
injury and second only to needle-stick

7-11% of sharps injuries are caused by scalpel blades
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Infection Rates

The chances of infection rates from a single contaminated
needlestick or sharp instrument injury are as follows:
◦ HIV at 0.2% to 0.5%
 Currently there is no vaccine or treatment available to
either prevent or cure HIV
◦ HBV at 30% (Hepatitis B)
 Post-exposure prophylaxis with hepatitis B
immunoglobulin and initiation of hepatitis B vaccine is
highly effective in preventing infection
◦ HCV at 3% to 10% (Hepatitis C)
 Currently no vaccines or cures for HCV and neither
immunoglobulin nor antiviral therapy is recommended as
post-exposure prophylaxis
 Of those infected with HCV, 85% develop an infection,
70% of whom develop liver disease which often leads to
cirrhosis and liver transplants
Culver, J. (1997). "Preventing transmission of blood-borne pathogens: a compelling argument for
effective device-selection strategies." Am J Infect Control 25(5): 430-3.
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Standards for scalpel blade removal

Hand

Resheathing

Forceps

Singlehanded
Device
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Extracted from the AS/NZ Standards 3825-1998 pages 6 & 7.
New Product Range
Non Sterile
Sterile
FLASK
CASSETTE 3in1
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Snapit
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