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The following lecture is complied from different textbooks and is for teaching learning use only This lecture is not a substitute for classroom lecture but an adjunct for the same This lecture may be useful for BSc Nursing, BMLT & DMLT students too
DEFINITION
The process of freeing an article or a surface from all living microorganisms including viruses & bacterial spores Various methods
Heat Filtration Radiation Sterilant gases
HEAT
Factors affecting
Nature of heat dry or moist Temperature & time No of organisms present Characteristics of the organism Type of material
Two methods
Dry heat Moist heat
DRY HEAT
Kills by oxidation, protein denaturation & toxic effect of elevated levels of electrolyte Types of processes
Flaming Incineration Hot air oven
Flaming
Incineration
Dont over load the oven Allow free circulation of air between the material
MOIST HEAT
Lethal effect due to denaturation & coagulation of proteins
Temp below 1000C Temp at 1000C Temp above 1000C
Pasteurization
630C 30 min (Holder method) 720C 15-20 sec (Flash method) 1320C 1 sec (Ultra high temp)
Inspissator
Water bath
Sterilization control
Thermocouples Brownes tube (red-green), Bowie & Dick tape (white-brown) 106 spore of B stearothermophilus. Incubate at 550C for 5 days
FILTRATION
Aqueous liquids may be sterilized by forced passage through a filter of porosity small enough to retain any microorganisms present in them Used to sterilize serum, carbohydrates soln, filtrates of toxins & bacteriophages, in water bacteriology, in examination of Schistosoma eggs
FILTRATION
Types of filters
Earthenware candles
Unglazed ceramic & diatomaceous earth filters Eg. Chamberland filters, Doulton filters
Asbestos filter Seitz, Carlson, Sterimat Sintered glass filter Membrane filters cellulose nitrate, cellulose acetate, polycarbonate, polyester filters
Pore size: 0.015 12 m HEPA filters for large volumes of air
Membrane filters
RADIATION
2 types
Non ionising
Infra Red radiation ( rapid mass sterilization of syringes, etc) Ultra Violet radiation (enclosed areas)
Ionising Gamma, X ray, cathode ray (plastics, syringes, oil, metal foils) Sterilization controls
Dosimeter measures radiation dose Colored discs M radiodurans, B pumilus
STERILANT GASES
Ethylene oxide Formaldehyde Betapropiolactone
More efficient than HCHO
DISINFECTION
The process of freeing an article or a surface from all or some of the living microorganisms but not necessarily bacterial spores Strong disinfectants for inanimate object Mild disinfectant (antiseptic) superficial application on living tissue
Categories of disinfectants
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Alcohol Aldehyde Ethylene oxide Dyes Halogens Phenolics Surface active agents Metallic salts Diguanides Amides
ALCOHOL
Ethanol, isopropyl alcohol
Skin antiseptics at 70% Less sporicidal & virucidal activity Denature bacterial proteins Isopropyl alcohol better fat solvent, more bactericidal and less volatile
Methyl alcohol to treat cabinets / incubators affected by fungal spores Others benzyl alcohol, chlorbutol, phenylethanol
ALDEHYDE
Formaldehyde - 10% used
In aq. soln is virucidal, bactericidal, sporicidal Used to fumigate wards, sick rooms, labs Expose to ammonia to remove residual formaldehyde Has pungent smell, irritant to skin, eyes, mucus memb & toxic when inhaled
ETHYLENE OXIDE
Highly inflammable, mixed with inert gases CO2, N Especially for heart lung machines, respirators, sutures, syringes, dental equipments
DYES
Combine with nucleic acids Aniline dyes
Brilliant green, malachite green, crystal violet
Acridine dyes
Proflavine, acriflavine, euflavine, aminacrine
HALOGENS
Kills by oxidation Iodine 2.5% in 70% alcohol, Skin antiseptic Iodophores (iodine + non-ionic surface active agent) betadine non staining, less irritant, less toxic Chlorine disinfect water supplies, swimming pools Sodium hypochlorite 1% for HIV Organic chloramines antiseptic for wound dressings
PHENOLICS
Carbolic acid 2-5%
Powerful microbicidal, very corrosive General purpose disinfectant in hospital
Cresol, lysol Chloroxylenol, chlorophenol, hexachlorophane less toxic, less irritant, less active, more readily inactivated by organic matter
METTALIC SALTS
Mercuric salts ointments Silver salts AgNO3 to prevent infection of burns, ophthalmia neonatorum Copper salts antifungal, antialgae water reservoirs, swimming pools
DIGUANIDES
Chlorhexidine burns, skin disinfection Picloxydine hospital equipment, floors
AMIDES
Propamide Dibromopropamide Antiseptic cream, eye ointments
PRIONS BACTERIAL SPORES Bacillus subtilis Clostridium sporogenes MYCOBACTERIA M. tuberculosis var bovis NON LIPID OR SMALL VIRUSES Polio virus, Rhino virus FUNGI Trichophyton, Candida, Cryptococcus VEGETATIVE BACTERIA Pseudomonas, Staphylococcus, VRE LIPID OR MEDIUM SIZED VIRUSES HBV, HIV, HSV, HCV, EBOLA, CMV
Categories
Sterilisation High level disinfection (HLD) kills all microorganisms except high number of bacterial spores - aldehydes, hydrogen peroxide, ortho-phthaldehyde Intermediate level disinfection (ILD) kills all vegetative alcohols
bacteria including M. tuberculosis var bovis, all fungi and most viruses - phenolics, iodophores, chlorine compounds,
Low level disinfection (LLD) kills most vegetative bacteria but not M. tuberculosis var bovis, some fungi and some viruses Hospital type germicides- quaternary ammonium compounds
Plasma technology
Glow discharge or low temperature plasmas Plasma has sufficient energy to disrupt molecular bonds Direct current, radiofrequency, microwave power is used to produce the plasma Used in disinfection of OTs
A known HIV positive patient is admitted in an isolation ward after an abdominal surgery following an accident. The resident doctor who changed his dressing the next day found it to be soaked in blood. Which of the following would be the right method of choice of discarding the dressings :
a) Pour 1% hypochlorite on the dressing material and send it for incineration in a appropriate bag b) Pour 5% hypochlorite on the dressing material and send it for incineration in a appropriate bag c) Put the dressing material directly in an appropriate bag and send for incineration d) Pour 2% Lysol on the dressing material and send it for incineration in a appropriate bag
Heat labile instruments for use in surgical procedures can be best sterilized by
Absolute alcohol Ultra violet rays Cholorine releasing compound Ethylene oxide gas