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Sterilization, disinfection and antisepsis Two very original methods for disinfection or For lecture only BC Yang In 1866 J Lister suggested antiseptic surgery. His rational was:    Putrefaction is caused by microbes Wound sepsis is a form of putrefaction Wound sepsis is caused by microbes Carbolic acid, phenol For lecture only BC Yang Carbolic acid, phenol: a toxic white soluble crystalline acidic derivative of benzene  various antiseptics  Acute poisoning by  various disinfectants ingestion, inhalation or skin contact may lead to death.  Phenol is readily absorbed through the skin. Highly toxic by inhalation.  Causes burns.  various germicides  adhesive dyes  perfumes  textiles  lubricating oils  In the previous year Lister had heard that 'carbolic acid' was being used to treat sewage in Carlise, and that fields treated with the affluent were freed of a parasite causing disease in cattle.  Lister then began to clean wounds and dress them using a solution of carbolic acid. He was able to announce at a British Medical Association meeting, in 1867, that his wards at the Glasgow Royal Infirmary had remained clear of sepsis for nine months.  Opposition was great In England and the United States mainly against Lister's germ theory rather than against his "carbolic treatment." Phenols and phenolics  Carbolic acid  Low level disinfectant  O-phenylphenol (Lysol)  Hexachlorophene (Phisohex)  High level for Staphylococcus sp. and Streptococcus sp.   Surgical scrubs Damage membrane, inactive enzymes, denature proteins For lecture only BC Yang The day after SARS 蚊子少了; 人離的遠了; 官員被糾正; 化學兵正當紅 • Ethylene oxide: denatures proteins • Highly penetrating • Most used in hospitals for plastic ware, textiles, etc….. For lecture only BC Yang Mechanism of antimicrobial action  Damage to DNA: radiation, UV, DNAreactive agents  Protein denaturation: Heat, pH, metals  Disruption of cell membrane or cell wall: detergents, enzymes  Chemical antagonism: analogs  Removal of free sulfhydryl groups: oxidizing agents For lecture only BC Yang To die or not to die, that is a question       For lecture only Sepsis: microbes contamination Asepsis: absence of microbes contamination Sterilization: 100% killing Disinfection: loss the ability to cause disease -cide or cidal: killing of microorganism -static or stasis: inhibit growth or multiplication of microbes BC Yang Types of antimicrobial agents • Physical – Heat – radiation • Chemical – Vapors – selectivity Scientific American284 (5):54-61 For lecture only BC Yang Killing is a probability   Die at a constant rate (logarithmically) Depend on exposure time and microbial load  Rare will reach 100% (on purpose and money consuming) For lecture only BC Yang Parameters of sterilization/disinfection  Action process  The rate/kinetics: the death rate of a microbial population follows a logarithmic path.  Resistances: pure empirical, varied from culture condition, nature of the environment  Control/indicators:  Living:  heat : spores, themophilic bacteria  ethylene oxide and radiation: Bacillus subtilits var. nigar.  Chemical: succinic anhydride (120oC), sulphur (115oC); color change; etc.. For lecture only BC Yang Action index  A spoonful work already well?  Why not LD50?  Phenol coefficient (PC)  American official analytical chemist’s use-dilution method  Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella choleraesuis  Filter paper method For lecture only BC Yang The phenol coefficient (PC)     A water-soluble phenol-based disinfectant (amphyl, lysol) is tested for its bactericidal effectiveness as compared with phenol. These disinfectants are serially diluted in a series of salmonella cultures and incubate for a while. Chemicals with lower phenol coefficients have greater effectiveness Restricted to phenolics Greatest dilution of the phenolic that kills Test bacteria in 10 min, but not in 5 min PC= For lecture only Greatest dilution of phenol giving same result BC Yang As a matter of temperature  Heat  Boiling water  Moist heat (steam under pressure, autoclave)  Hot-air sterilization (Oven)  Pasteurization  Tyndallization  Incineration  Low temperature    For lecture only Refrigerator temp (4-7oC) Deep-freeze (-20oC to -40oC); liquid nitrogen (-196oC) Lyophilization (desiccation in low temperature) BC Yang Pasteurization  Suggested by L. Pasteur  It is used to render mild safe (tuberculoses) and extend its storage quality  Keep the flavor of milk, wine  62oC 30 min, 71oC for 15 sec For lecture only BC Yang Pasteurization 別呆了, 不要喝尚青尚新鮮的牛奶! • 1909 John Ross Robertson finances the installation of Toronto's first milk pasteurization plant in the College Street hospital, 30 years before it becomes mandatory. For lecture only BC Yang Tyndallization (Fractional sterilization) For lecture only  John Tyndall was a man of science—draftsman, surveyor, physics professor, mathematician, geologist, atmospheric scientist, public lecturer, and mountaineer.  For killing both vegetative and spore forming bacteria at temperature of 100oC or below for 30 min on the consecutive days BC Yang Filtration For lecture only BC Yang Filtration  Liquid    When subjects are heat-labile 0.22/0.45 mm membrane filter Air  Large space Alternative: electrostatic precipitation  For lecture only Particles passed through a high voltage electric field become charged, and attracted to and held by the plate of opposite potential (remove ~97% of bacteria) BC Yang Wash away: Surfactants: breaks oily film on skin For lecture only do you really clean your hands? BC Yang UV radiation   Ultraviolet is light with very high energy levels and a wavelength of 200-400 nm. One of the most effective wavelengths for disinfection is that of 254 nm. For lecture only BC Yang Alcohols  High level disinfectant  Disrupt protein, disrupt membranes, dissolve lipids  70% ethanol  Used in tinctures For lecture only BC Yang 碘酒 Halogens (Iodine)  Iodine combines with tyrosine & oxidized SH groups on other amino acids  Tincture: 1-2% I2 + 2% Na2I in 70% ethanol (for surgical site disinfection).  Povidone-iodines: Betadine  Skin disinfection  Surgical scrub For lecture only BC Yang The choices? It always depends!  The materials  The purpose  The nature of microbes For lecture only BC Yang