Infection Control - Disinfectants PDF

Infection Control DISINFECTANTS Terminology Terminology Terminology Difference between an antiseptic and a disinfectant Antiseptic – used on living tissue Disinfectant – used on surfaces Ideal properties of a disinfectant Š Rapid activity ŠStable when in contact with organic matter,...

Infection Control DISINFECTANTS Terminology Terminology Terminology Difference between an antiseptic and a disinfectant Antiseptic – used on living tissue Disinfectant – used on surfaces Ideal properties of a disinfectant Š Rapid activity ŠStable when in contact with organic matter, soaps, detergents, hard water, plastic, etc. Š Non-toxic Non-corrosive Š Not damaging to equipment/substances treated Š Cost-effective and Good availability. Broad spectrum of activity  Categories of  disinfectants High level: Must be Tuberculocidal, kills most but not all bacterial spores, fungi and viruses. If it destroys spores- it is also labeled as sporicidal. Intermediate level: Is tuberculocidal. Inactivates all forms of micro-organisms, but do not destroy bacterial spores. Low level: Inactivate vegetative bacteria, certain lipid type viruses but do not destroy Bacterial spores TB Bacteria Non-lipid viruses Disinfectants used in the dental practice Jik Hibitane Betadine  Application of Disinfectants in the dental environment  Dental equipment:  Always use disinfectants on pre-cleaned surfaces  Reason: Bio-burden reduce the working action of disinfectants therefore ALWAYS Wash all dental surfaces with soap and water before disinfecting Take a disposable paper towel, dampen with water and use a soap detergent to wash down all high touch surfaces Dispose of previous used paper towel  Take new paper towel, dampen with water and wipe away soap. Method of disinfection After cleaning of surfaces follows disinfection of surfaces by applying the SPRAY-WIPE –SPRAY technique  Spray surface with disinfectant  Wipe vigorously paper towels/ dispose paper  Spray and leave disinfectant on surface 10 min Spray-wipe spray technique TYPES OF DISINFECTANTS Chlorine  For example Sodium hypochlorite Brand name :Jik  Which is House hold bleach – 5.25% Mix with distilled water for dental practice A 1:10–1:100 dilution of 5.25%– 6.15%  Bleach could be  Corrosive  Bleaches surfaces, make colors fade  Has a pungent odor  Extremely unstable only active for 24 hours (new solution every 24 hours)  Economical  Kills most mo  Works rapidly – 10 minutes Sodium Hypochlorite (continue) Need good ventilation when used (open windows etc) Stored in a closed container Never mix with any other products such as ammonium – results in toxic fumes Never spray sodium hypochlorite on: Overhead lights of dental chairs- dulls the light cover Vinyl chairs (discolors) over a period of time  DISINFECTANTS Glutaraldehide – High level Brand name: Cidex  Corrosive to metal instruments  Toxic gasses if in contact with surfaces  Irritates eyes, oral mucosa, causes breathing problems  Disinfection of instruments submerged – 10- 90 minutes  Sterilization? Expose instrument 10-12 hours  Cold sterilization not approved by CDC or OHSA  Replace 10-14 days How to use Glutaraldehyde solutions When using a glutaraldehyde solution: Prepare the solution according to the manufacturer’s instructions. READ the instructions on the container  Ideally, an indicator strip should be used each time the solution is used to determine if the solution is still effective. After preparing the solution, place in a clean container with a lid. Mark the container with the date the solution was prepared and the date it expires. Usually OHSA(Occupational Health and Safety Administration) report November 2016 Because of glutaraldehyde’s toxic nature and corrosive properties, the U.S. Environmental Protection Agency (EPA) prohibits the use of glutaraldehyde as an environmental surface disinfectant. Additionally, OSHA regulates glutaraldehyde as a hazardous airborne chemical contaminant. Exposure to glutaraldehyde can cause severe irritation to the skin, mucous membranes, and respiratory system. Its vapors have been associated with cases of occupational asthma, and the FDA requires the all glutaraldehyde labels warn that the product should not be used outside a closed container.  DISINFECTANTS  IODOPHORS – Intermediate  Iodine based  Brand name: Betadine (dark brown fluid if undiluted  Available as Betadine soap scrub, Betadine disinfectant fluid, Betadine mouth rinse.  Diluted with distilled water : light brown to dark yellow in color)  Stains environmental surfaces and equipment, instruments  Prepare daily  Becomes deactivated after 24 hours- fluid may become translucent in color  Expensive Diluted Betadine  Disinfectants Chlorexidene gluconate High level Hibitane/ Hibiscrub soap Disinfectant/antiseptic Residual working for up to 6 hours  Alcohol based disinfectants Ethyl alcohol, at concentrations of 60%–80%, is a potent virucidal agent inactivating all of the lipophilic viruses Isopropyl alcohol is not active against the nonlipid enteroviruses but is fully active against the lipid viruses. Studies also have demonstrated the ability of ethyl and isopropyl alcohol to inactivate the hepatitis B virus(HBV) and the herpes virus. Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP) Alcohol based disinfectants However they are: Inferior in presence of bio-burden Blood & saliva inactivate Rapid evaporation from surfaces Corrosive on metals, brittles plastics First cleaning with soap & water Then apply alcohol  Alcohol based disinfectants Alcohols are not recommended for sterilizing medical and surgical materials principally because they lack sporicidal action and they cannot penetrate protein-rich materials.  Quaternary Ammonium Compounds Quaternary ammonium compounds are widely used as disinfectants in health settings Health-care–associated infections have been reported from contaminated quaternary ammonium compounds  The quaternaries are good cleaning agents, but high water hardness and materials such as cotton and gauze can make them less microbicidal because of insoluble precipitates or cotton and gauze absorb the active ingredients, respectively. Quaternary Ammonium Compounds Used in ordinary environmental sanitation of noncritical surfaces in the dental environment such as floors, furniture, and walls. EPA-registered quaternary ammonium compounds are appropriate to use for disinfecting medical equipment that contacts intact skin (e.g., blood pressure cuffs). Ortho-phthalaldehyde (OPA)  Ortho-phthalaldehyde is a high-level disinfectant that received FDA clearance in October 1999.  It contains 0.55% 1,2-benzenedicarboxaldehyde (OPA).  OPA solution is a clear, pale-blue liquid with a pH of 7.5.  Excellent mycobactericidal activity excellent stability over a wide pH range (pH 3–9)  Does not irritate the eyes or nasal passages  Does not require exposure monitoring,  Almost no odor,  Requires no activation.  Excellent compatibility with surfaces  The End