Sterilization and Disinfection in Healthcare Facilities

Sterilization and disinfection processes are crucial in healthcare facilities to prevent the transmission of infectious pathogens. The failure to comply with established guidelines for disinfection and sterilization can lead to numerous outbreaks and patient exposures. This article provides a comprehensive overview of sterilization and disinfection, their importance, and the principles behind their execution.

The Importance of Sterilization and Disinfection

Sterilization and disinfection are essential components of infection control in healthcare facilities. Sterilization involves the destruction or elimination of all forms of microbial life, including bacterial spores. On the other hand, disinfection aims to eliminate most pathogenic microorganisms, excluding bacterial spores. Both processes are carried out in health-care facilities using physical or chemical methods.

Classification of Sterilization and Disinfection

Earle H. Spaulding devised a rational approach to disinfection and sterilization of patient-care items or equipment. This classification scheme is based on the nature of the items and includes three categories: critical, semicritical, and noncritical.

• Critical items require sterilization because they come into direct contact with sterile tissues or the vascular system. Examples include surgical instruments and implantable devices.
• Semicritical items require high-level disinfection because they only come in contact with mucous membranes or non-intact skin. Examples include endoscopes and laryngoscopes.
• Noncritical items require low-level disinfection because they come into contact with intact skin or non-mucous membranes. Examples include clothing and bedding.

Methods of Sterilization and Disinfection

Several methods are used to achieve sterilization and disinfection in healthcare facilities, including steam under pressure, dry heat, EtO gas, hydrogen peroxide gas plasma, and liquid chemicals.

• Steam under pressure is a common method used to sterilize items in an autoclave. The high pressure and temperature kill all forms of microbial life, including bacterial spores.
• Dry heat involves the use of dry air to heat items to a high temperature, typically around 160°C (320°F). This process is effective in killing most microorganisms, but not bacterial spores.
• EtO gas is a sterilizing agent that reacts with the proteins in microbial cells, destroying their ability to function. This process is particularly useful for items that cannot withstand heat or moisture.
• Hydrogen peroxide gas plasma is a non-thermal sterilization method that uses a low-temperature plasma containing reactive oxygen species (ROS) to inactivate microorganisms.
• Liquid chemicals such as quaternary ammonia compounds, alcohols, and chlorine compounds are used for low-level disinfection. These chemicals are effective against most microorganisms, but not bacterial spores.

Rational Approach to Sterilization and Disinfection

A rational approach to disinfection and sterilization is essential to ensure the safety of patients and healthcare workers. This approach involves identifying the intended use of the item, considering the manufacturer's recommendations, and following established guidelines. This systematic method helps to reduce the risk of contamination and infection transmission.

Disinfection and Sterilization Failures

Breaches of disinfection and sterilization guidelines are not uncommon, leading to potential patient notifications due to improper reprocessing of semicritical and critical medical instruments. To assess the risk to patients from such failures, a 14-step algorithm has been developed to guide institutions in managing potential disinfection and sterilization failures.

Future Perspectives: Plasma Technology

Plasma technology is a promising area of research for disinfection and sterilization. Plasma can efficiently inactivate microbial pathogens and degrade toxins. This technology has potential applications in medical devices, agriculture, and food preservation.

In conclusion, sterilization and disinfection are critical aspects of infection control in healthcare facilities. Proper implementation of these processes is essential to prevent the transmission of infectious pathogens and ensure patient safety.