Microorganism Absence & Sterilization

Absence of Microorganisms

• This refers to the absence of microorganisms that cause illness or disease
• It is also defined as being free from disease

Sepsis Prevention

• Achieved through the exclusion, destruction, or inhibition of growth and multiplication of microorganisms

Procedures for Minimizing Microbial Contamination

• An overall set of procedures aimed at minimizing the chances of microbial contamination
• These procedures are crucial during specific patient care

Sterilization

• It involves the elimination of all microorganisms, including spores
• It refers to a process capable of destroying all forms of life

Dirty or infected

• Indicates contamination by microorganisms

Sterilization

• Involves a cleaning, disinfection, or sterilization process
• It is carried out to make contaminated utensils safe and appropriate for their intended use

Mechanical Removal

• A physical removal of all foreign matter in the environment, on surfaces, and on objects

Reducing Microorganisms

• The number of microorganisms is diminished using mechanical drag
• Water and detergent are commonly used

Chemical Agent

• A chemical or pharmacological agent that destroys or inhibits the growth of microorganisms
• Includes antiseptics, disinfectants, antibiotics, and antivirals

Inorganic Chemical Compounds

• Combat sepsis by inhibiting microorganism growth without necessarily destroying them
• Used on skin and tissues to stop the growth of endogenous microorganisms (resident flora)
• Should not destroy tissues

Physical or Chemical Process

• Destroys most pathogenic microorganisms except bacterial spores
• Applied to inanimate objects, not living tissues
• Disinfection effectiveness depends on the resistance of the agent, nature of contamination, and process objective

Disinfectants

• Agents that destroy vegetative or growing forms of microorganisms
• Eliminate microorganisms entirely from inanimate objects

Contamination Risks

• Solutions are frequently susceptible to contamination
• Solutions should be prepared in the hospital pharmacy
• Solutions must be sterile and handled using aseptic techniques

Aseptic Requirements

• Bottles must be small with non-refluxing caps, and always sealed
• All containers must be sterilized pre-solution insertion

Solution Labels

• Solutions must have a label indicating solution type, expiration date, and concentration

Additional Safety Considerations

• Disinfectants should not be mixed
• Clean and dry surface before disinfecting
• Avoid exposure to high temperatures and light
• Avoid decanting or refilling containers
• Allow sufficient contact time to the target area

Types of Disinfectants

• Ethyl alcohol (70-92%)
• Chlorhexidine (4 - 2 - 0.5%)
• Hexachlorophene (3%)
• Iodine tincture (0.5-1-5%)
• Iodophors
• Triclosan

Types of Disinfectants

• Alcohols
• Chlorine and chlorinated compounds
• Formaldehyde
• Glutaraldehyde
• Stabilized hydrogen peroxide
• Iodophors
• Phenols
• Quaternary ammonium compounds
• Peracetic acid

Germicidal Potency Criteria

• High germicidal power
• Effective at low concentrations
• High-speed action
• Inactivation absence when in organic matter

Germicidal Environmental Characteristics

• Low sensitivity to temperature
• Broad spectrum of action
• Low toxicity to tissues
• High penetrating power
• Absence of unpleasant odor
• Compatibility with other locally applied substances
• Cost effective

Levels of Disinfection

• High-level
• Intermediate-level
• Low-level

High-Level Disinfection

• Absence of organic matter
• Use 2% glutaraldehyde
• Handle solution with protection
• Disinfection time of no less than 20 minutes
• Complete immersion of items
• Covered containers
• Dry and rinse items
• Use chemical controls

Spaulding Classification of risk

• Critical items
• Semi-critical items
• Non-critical

Sterilization Methods - Physical

• Wet heat (Autoclaving with saturated steam: Method Option)
• Dry heat (Pupinization: Method Option)

Sterilization Methods - Chemical

• Liquid (2% Glutaraldehyde: Method Option)
• Liquid (6% Hydrogen Peroxide: Method Option)
• Liquid (0.2 to 30% Peracetic Acid: Method Option)
• Gas (100% Ethylene Oxide: Method Option)
• Gas (Formaldehyde: Method Option)
• Plasma (Hydrogen Peroxide: Method Option)
• Plasma (Peracetic Acid: Method Option)

Saturated Steam Under Pressure

• It involves saturated steam under pressure
• This method is the most effective, economical, and rapid method available today
• Rapid temperature increase with short sterilization periods
• Organic matter interferes with the method
• Microorganisms are eliminated by protein denaturation

Dry Heat Sterilization

• Sterilization by dry heat
• Should be limited to materials that cannot be sterilized in an autoclave
• Penetrates items slowly, requiring a long sterilization time
• Used for items resistant to high temperatures
• Microbicidal action is conditioned by the presence of organic matter

Diffusion of Heat Consideration

• Effectiveness depends on heat diffusion and quantity
• Suitable for sterilizing oils, petroleum jelly, and powders
• Not suitable for liquids, gums, fabrics, glass, and steel instruments
• Microorganisms are eliminated through protein coagulation

High-Power Disinfectant

• A high-power chemical disinfectant
• Exists in liquid form and volatilizes forming a gaseous compound
• Eliminates microorganisms through cellular wall alkylation
• It is flammable and explosive
• Sterilizes at low temperatures

Ethylene Oxide Concerns

• Can be absorbed by porous materials
• Aeration should not occur at room temperature
• Toxic to skin, mucous membranes, and the respiratory system
• Exposure must be controlled under international standards

Alternative to Heat

• An alternative for materials and equipment that cannot withstand high temperatures
• Sterilizes at temperatures equal to or greater than 65°C
• Sterilization occurs through the action of formaldehyde gas in the presence of saturated steam
• It is toxic, potentially carcinogenic, and mutagenic

Chemical Agent High-Level Disinfectant

• A chemical agent used as a high-level disinfectant and chemical sterilant through immersion
• Sterilizes at low temperatures using plasma equipment
• Diffusion of P.H. can be difficult in narrow channels
• Current method in use

High-Level Disinfectant Agent

• A high-level disinfectant agent
• Sporicidal, thus sterilizes in less time than glutaraldehyde
• Objects with lumens and hinges cannot be sterilized in plasma equipment using peracetic acid

Microbicidal Qualities

• Has excellent microbicidal properties
• Effective in the presence of organic matter
• Not corrosive to endoscopes, rubber, or plastics
• Acts through protein alkylation, altering protein synthesis
• Must be used in well-ventilated rooms and closed containers

Contact Time

• Product exposure time should not be less than 20 minutes
• The most used agent for high-level disinfection of medical equipment, such as endoscopes, laparoscopes, respiratory therapy equipment, transducers, and anesthesia equipment
• The product is toxic upon contact with skin and mucous membranes

Material Preparation

• Subjected to a predetermined dose of radiation (gamma or cobalt rays)
• Limited to industrial plants for new and unused items
• Requires specialized infrastructure
• Manufacturing and packaging must meet certain requirements
• Sterility confirmation relies on protocols
• Re-sterilization of material is not recommended

Material Stages

• Reception of material
• Washing and decontamination
• Material revision
• Preparation
• Packaging
• Processing

Distribution Stages

• Process certification
• Adequate storage
• Efficient distribution
• Replenishment of obsolete material

Indicators

• Thermometers
• Valves
• Manometers
• Special paper indicator
• Adhesive tape indicator
• Liquid Tubes indicator
• Spores of a microorganisms indicator

Preservation of Sterility

• Prevent microorganism entry
• Permit method of sterilization
• Remain completely sealed
• Withstand traction and usual handling without damage
• Remain unaffected by sterilization process

Sterility Properties

• Remain unaffected by the sterilization process
• Prevent passage of dust and microorganisms
• Remain unaffected by environmental humidity and temperature
• Be repellent to water (desirable property)
• Easily enable compliance with the aseptic technique
• Possess manufacturer-guaranteed quality
• Affordable Cost

Storage

• Arrange in order of expiration date, using shorter expiration date items first
• Conduct a periodic stock review
• Perform routine daily cleaning
• Store in closed, easy-to-clean shelves, 40cm from the floor, and 20cm from the ceiling

Ideal Storage

• Each sterile item stored should have:
• Clear identification
• Expiration date
• Verified chemical control
• Package integrity

Packaging Assessment

• Sealed and undamaged packaging
• Clean when inspected
• Processed via appropriate method
• Verify proper sterilization control
• Within expiration date