Instrument Decontamination Methods for Prevention of infection

1. Instrument Decontamination Methods for Prevention of infection Dr. Aidah Abu Elsoud Alkaissi An Najah National University Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

2. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

3. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

4. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

5. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

6. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

7. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

8. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

9. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

10. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

11. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

12. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

13. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

14. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

15. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

16. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

17. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

18. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

19. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

20. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

21. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden

22. 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 Dr. Aidah Abu Elsoud Alkaisi devision of Intensive Care & Anaesthesiology University of Linköping Sweden