Instrument Decontamination Methods for Prevention of infection

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Instrument Decontamination Methods for Prevention
of infection

• Dr. Aidah Abu Elsoud Alkaissi
• An Najah National University

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Instrument Decontamination Methods for Prevention
of infection

• Instrument should be immediately submersed in
  water or a germicidal solution at the close of
  the procedure to prevent blood and other
  substances from drying on the surface or in the
  cervices
• The cleaning method should be economic and must
  be provide protection fromcross-contamination
  damage to the instrument and injury to the worker
• Washed and sterilized instruments are inspected,
  reassembled(To fit together the parts or pieces
  of) into sets, placed in containers or wrapped
  and sterilized stored for future used

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Mechanical Washing

• During surgical procedure instrument should be
  kept as free of body substances (bioburden) as
  possible by wiping off the gross material with a
  moistened sponge
• Sterile water is selected because saline causes
  corrosion and deterioration of the instrument
  surfaces
• All instruments that can be immersed are placed
  in a basin, disassembled or box locks opened
• and covered with water or a detergent/germicidal
  solution

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Mechanical Washing

• Mathods may be selected for decontamination of
  instruments and equipment
• To cover and transport all items used during the
  surgery to a centralized location for processing.
  
• The cover should be watertight and remain intact
  during transport to the central decontamination
  area.
• Examples of covers include case carts (A small
  wheeled vehicle typically pushed by hand),
  plastic bags impervious (Incapable of being
  penetrated) surgical drapes (To cover, dress, or
  hang with or as if with cloth in loose folds)
• Soiled instruments should be handled by gloved
  personnel

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Mechanical Washing

• Appropriate apparel for personnel in the central
  decontamination area includes scrub attire, cap
  and mask, protective eye wear, a waterproof apron
  or coverall suit and long, cuffed, heavy-duty
  rubber gloves
• Upon arrival the instruments are uncovered,
  arranged loosely in an open mesh tray with the
  lightest instruments on the top and placed
  directly into a washer sterilizer

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Mechanical Washing

• If gross debris is present a hand prewash in a
  detergent/germicide solution is recommended
• When decontaminated instruments are removed from
  the washer-sterilizer they transported to the
  ultrasonic cleaner

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Instrument decontamination

• When a centralized area is not available,
  autoclave in the substerilizing room, the other
  involves a thorough hand washing
• The later is time consuming, less efficient and
  higher in labor expense

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Ultrasonic Cleaning

• Once the terminal strilization is complete the
  second phase of instrument processing with an
  ultrasonic cleaner may begin
• This process removes tenacious soil that remains
  on instruments after they have been mechanically
  or manually washed
• By cavitation process debris and material are
  removed from all surfacesof the instrumantation
• Most manufactures instructions warn against
  placing instruments to dissimilar metals (as
  stainless steel, coppar titanium) in the
  ultrasonic cleaner at the same time

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Ultrasonic Cleaning

• Ultrasonic cleaning is not recommended for some
  delicate instruments, chrome-plated instruments
• Then instrument are inspected and all movable
  parts are lubricated with an antimicrobial, water
  souble lubricant to protect against rusting,
  staining (To discolor, soil, or spot), or
  corrosion
• Instruments then rearranged into sets, placed in
  containers or wrapped and sterilized or stored
  for future used

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Sterilization Methods for Prevention of Infection

• Methods of sterilization of surgical items must
  result in complete destruction of microbial life,
  including spores, and the absence of toxic
  residue on the objects as well as little or no
  deterioration or damage to treat and moisture
  sensitive instruments

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Sterilization Methods for Prevention of Infection

• Steam sterilization
• Saturated steam under pressure is recognized as
  the safest most practical means of sterilizing
  surgical supplies, fluids , the majority of
  instruments and other inanimate (Not having the
  qualities associated with active, living
  organisms. See Synonyms at dead) objects

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Theory of microbial destruction

• Microorganisms destroyed by moist heat through a
  process of denaturation (To change the nature or
  natural qualities of) and coagulation of the
  enzyme-protein system within the bacterial cell
• Microorganisms are killed at a lower temperature
  when moist heat is used than when dry heat is used

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Theory of microbial destruction

• When steam comes in contact with a cold object,
  condensation takesplace immediately
• As the steam condenses it gives off latent heats
  and wets the object

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Principles and mechanismof steam sterilization

• In conventional steam sterilizer, the
  sterilization process may be divided into 5
  phases
• Loading phase, in which the objects are packaged
  and loaded in the sterilizer
• Heating phase, in which the steam is brought to
  the proper temperature and allowed to penetrate
  around and through the objects in the chamber
• Destroying phase, or the time-temperature cycle,
  in which all microbial life is exposed to the
  killing effects of the steam
• Drying and cooling phase, in which the objects
  are dried and cooled, filtered air is introduced
  into the chamber, the door is opened and the
  objects are removed and stored
• Testing phase in which the efficiency of the
  sterilization process is checked

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High speed (flash) sterilization

• Referred to a flash sterilizer, adjusted to
  operate at 132 degree
• It can be used for sterilizing packs and
  solutions
• Most frequently used in the operating room for
  urgently neededunwrapped instrument
• Please read figure 5.10

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Prevacuum, high-temperature sterilization

• Accomplished by mean of an air-blasted
  (destructive force ), oil-sealed rotary pump,
  protected by a condenser and coupled with an
  automatic control mechanism
• Please read Figure 5.11

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Boiling water (nonpressure)

• Boiling does not sterilize instruments
• Heat resistant microorganism, bacterial spores
  and certain viruses can withstand (resist or
  confront with resistance)
• boiling water at 100 degree for many hours

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Dry Heat Sterilizatin

• Rarely used in hospitals today
• As the proteins become dry during exposure to dry
  heat, their resistace to denaturation increases,
  for this reason, at a given temperature,, dry
  heat sterilization is much less effective than
  moist heat

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Chemical Sterilization

• New material that cannot be heat sterilized are
  continually being introduced for use in
  hospitals, they require the use of other methods
  of sterilization
• Restricted to ethylene oxide ( a gaseous
  chemosterilizer) and aqueous glutaraldehyde ( a
  liquid chemosterilizer)
• Refered to as cold sterilization
• This term refers to the maximum temperature of 54
  C to 60 of gaseous sterilization as compared
  with 121 C to 132 C temperature of steam
  sterilization

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Gaseous chemical sterilization

• to sterilize of heat-labile and moisture
  sensitive items as intricate (having many
  complexly arranged elements), delicate surgical
  instruments, large pieces of equipment used in
  the hospital, plastic and porous (able to absorb
  fluids) materials, all of which are difficult to
  steam sterilize without deterioration and damage

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Gaseous chemical sterilization

• Ethylene oxide is the most frequently used gas,
  odor similar to ether
• Has inhalation toxicity similar of ammonia gas,
  kept as a liquid
• Item that can be steam sterilized should never be
  gas sterilized

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Liquid chemical sterilization

• Destroy all forms of microbial life, including
  bacterial and fungal spores, tuercle bacilli and
  viruses
• Aqueous glutaraldehyde and aqueous formaldehyde
• aqueous formaldehyde rarely used because it takes
  12-24hto be effective
• Aqueous glutaraldehyde 2 useful in the
  disinfection of lensed instruments such as
  cystoscope and bronchoscopes because it has
  minimal deleteriuos (Harmfu) effects on the lens
  cement and noncorrosive
• Instruments must be free of bioburden and
  completely immersed an activated Aqueous
  glutaraldehyde solution for 10 hto acheive
  sterilization
• Following immersion instruments must be rinsed
  thoroughly with sterile distilled water before
  being used