Sterilization and Disinfection PDF

STERILIZATION AND DISINFECTION BY: DR/ SHIMAA M. GHANEM Introduction Microbes are ubiquitous and many microorganisms are associated with undesirable consequences, such as food spoilage and disease. Therefore, it is essential to kill a wide variety of microorganisms or inhibit their growth...

STERILIZATION AND DISINFECTION BY: DR/ SHIMAA M. GHANEM Introduction Microbes are ubiquitous and many microorganisms are associated with undesirable consequences, such as food spoilage and disease. Therefore, it is essential to kill a wide variety of microorganisms or inhibit their growth to minimize their destructive effects. The goal is twofold: (a) to destroy pathogens and prevent their transmission (b) to reduce or eliminate microorganisms responsible for the contamination of water, food and other substances.  Definitions of Frequently Used Terms  Sterilization: is defined as a process by which an article, surface, or medium is freed of all living microorganisms either in the vegetative or in the spore state.  Any material that has been subjected to this process is said to be sterile. These terms should be used only in the absolute sense.  An object cannot be slightly sterile or almost sterile; it is either sterile or not sterile.  Although most sterilization is performed with a physical agent, such as heat, a few chemicals called sterilants can be classified as sterilizing agents because of their ability to destroy spores.  A germicide, also called a microbicide, is any chemical agent that kills pathogenic microorganisms. A germicide can be used on inanimate (nonliving) materials or on living tissue, but it ordinarily cannot kill resistant microbial cells.  Any physical or chemical agent that kills “germs” is said to have germicidal properties.  Disinfection: refers to the use of a chemical agent that destroys or removes all pathogenic organisms or organisms capable of giving rise to infection. This process destroys vegetative pathogens but not bacterial endospores.  It is important to note that disinfectants are normally used only on inanimate objects because they can be toxic to human and other animal tissue, when used in higher concentrations.  Disinfection processes also remove the harmful products of microorganisms (toxins) from materials.  Examples of disinfection include o (a) applying a solution of 5% bleach to examining table, o (b) boiling food utensils used by a sick person, and o (c) immersing thermometers in an isopropyl alcohol solution between use.  sepsis is defined as the growth of microorganisms in the body or the presence of microbial toxins in blood and other tissues.  The term asepsis refers to any practice that prevents the entry of infectious agents into sterile tissues and thus prevents infection.  Chemical agents called antiseptics are applied directly to the exposed body surfaces (e.g., skin and mucous membranes), wounds, and surgical incisions to destroy or inhibit vegetative pathogens.  Examples of antisepsis include: o (a) preparing the skin before surgical incisions with iodine compounds, o (b) swabbing an open root canal with hydrogen peroxide, and o (c) ordinary hand washing with a germicidal soap.  Sanitization is any cleansing technique that mechanically removes microorganisms (along with food debris) to reduce the level of contaminants. A sanitizer is a compound (e.g., soap or detergent) that is used to perform this task. Cooking utensils, dishes, bottles, cans, and used clothing that have been washed and dried may not be completely free of microbes, but they are considered safe for normal use.  Air sanitization with ultraviolet lamps reduces airborne microbes in hospital rooms, veterinary clinics, and laboratory installations.  It is often necessary to reduce the numbers of microbes on the human skin through degerming procedures.  This process usually involves scrubbing the skin or immersing it in chemicals, or both. It also emulsifies oils that lie on the outer cutaneous layer and mechanically removes potential pathogens from the outer layers of the skin.  Examples of degerming procedures are: o (a) surgical hand scrub, o (b) application of alcohol wipes to the skin, and o (c) cleansing of a wound with germicidal soap and water.  The concepts of antisepsis and degerming procedures clearly overlap, since a degerming procedure can be simultaneously treated as an antiseptic and vice versa. Sterilization Methods of sterilization can be broadly classified as: 1. Physical methods of sterilization 2. Chemical methods of sterilization. Physical Methods of Sterilization Physical methods of sterilization include the following: 1. Sunlight 2. Heat 3. Filtration 4. Radiation 5. Sound (sonic) waves  Sunlight Direct sunlight is a natural method of sterilization of water in tanks, rivers, and lakes. Direct sunlight has an active germicidal present in natural water sources are rapidly destroyed by exposure to sunlight.  Heat  Heat is the most dependable method of sterilization and is usually the method of choice unless contraindicated.  As a rule, higher temperatures (exceeding the maximum) are microbicidal, whereas lower temperatures (below the minimum) tend to have inhibitory or microbistatic effects.  Two types of physical heat are used in sterilization—moist and dry heat. Sterilization by moist heat  Moist heat occurs in the form of hot water, boiling water, or steam (vaporized water).  In practice, the temperature of moist heat usually ranges from 60 to 135°C.  Adjustment of pressure in a closed container can regulate the temperature of steam.  Moist heat kills microorganisms by denaturation and coagulation of proteins.  Sterilization by moist heat can be classified as follows: 1. Sterilization at a temperature < 100°C 2. Sterilization at a temperature of 100°C 3. Sterilization at a temperature > 100°C 4. Intermittent sterilization  1. Sterilization at a temperature < 100°C:  Pasteurization is an example of sterilization at a temperature < 100°C.  Pasteurization: Fresh beverages (such as milk, fruit juices, beer, and wine) are easily contaminated during collection and processing. Because microbes have potential for spoiling these foods or causing illness, heat is frequently used to reduce the microbial load and to destroy pathogens.  Pasteurization is a technique in which heat is applied to liquids to kill potential agents of infection and spoilage, while at the same time retaining the liquid’s flavor and food value.  This technique is named after Louis Pasteur who devised this method.  This method is extensively used for sterilization of milk and other fresh beverages, such as fruit juices, beer, and wine which are easily contaminated during collection and processing.  Two methods of pasteurization are followed: Flash method and holder method. In the flash method, milk is exposed to heat at 72°C for 15–20 seconds followed by a sudden cooling to 13°C or lower. In the holder method, milk is exposed to a temperature of 63°C for 30 minutes followed by cooling to 13°C or lower, but not less than 6°C. The flash method is preferable for sterilization of milk because: it is less likely to change the flavor and nutrient content, it is more effective against certain resistant pathogens, such as Coxiella and Mycobacterium.  Although pasteurization inactivates most viruses and destroys the vegetative stages of 97–99% of bacteria and fungi, it does not kill endospores or thermoduric species (mostly nonpathogenic lactobacilli, micrococci, and yeasts).  Milk is not sterile after regular pasteurization. In fact, it can contain 20,000 microbes per milliliter or more, which explains why even an unopened carton of milk will eventually spoil on prolonged storage.  Newer techniques have now been used to produce sterile milk that has a storage life of 3 months. In this method, milk is processed with ultrahigh temperature (UHT) of 134°C for 1– 2 seconds.  2. Sterilization at a temperature of 100°C:  Sterilization at a temperature of 100ºC includes: o (a) boiling o (b) steam sterilizer at 100°C.  Boiling: Simple boiling of water for 10–30 minutes kills most of the vegetative forms of bacteria but not bacterial spores.  Exposing materials to boiling water for 30 minutes kills most non-spore forming pathogens including resistant species, such as the tubercle bacillus and staphylococci.  Sterilization by boiling is facilitated by addition of 2% sodium bicarbonate to water.  Since boiling only once at 100° C does not kill all spores, this method cannot be used for sterilization but only for disinfection. Hence, it is not recommended for sterilizing instruments used for surgical procedure.  The greatest disadvantage of this method is that the items sterilized by boiling can be easily recontaminated when removed from water after boiling.  Steam sterilizer at 100°C:  Usually, Koch’s or Arnold’s steam sterilizer is used for heat- labile substances that tend to degrade at higher temperatures and pressure, such as during the process of autoclaving.  These substances are exposed to steam at atmospheric pressure for 90 minutes during which most vegetative forms of the bacteria except for the thermophiles are killed by the moist heat.  3. Sterilization at a temperature > 100°C:  This method is otherwise known as sterilization by steam under pressure.  A temperature of 100°C is the highest that steam can reach under normal atmospheric pressure at sea level.  This pressure is measured at 15 pounds per square inch (psi), or 1 atmosphere.  In order to raise the temperature of steam above this point, it must be pressurized in a closed chamber.  This phenomenon is explained by the physical principle that governs the behavior of gases under pressure.  When a gas is compressed, its temperature rises in direct relation to the amount of pressure.  So, when the pressure is increased to 5 psi above normal atmospheric pressure, the temperature of steam rises to 109°C. When the pressure is increased to 10 psi above normal, its temperature will be 115°C and at 15 psi (a total of 2 atmospheres, it will be 121°C).  It is not the pressure by itself that is killing microbes, but the increased temperature it produces.  This forms the principle of sterilization by steam under pressure.  Such pressure–temperature combinations can be achieved only with a special device that can subject pure steam to pressures greater than 1 atmosphere.  Health and commercial industries use an autoclave for this purpose and a comparable home appliance is the pressure cooker.  Autoclave:  It is a cylindrical metal chamber with an airtight door at one end and racks to hold materials. The lid is fastened by screw clamp and rendered airtight by an asbestos washer. It has a discharge tap for air and steam at the upper side, a pressure gauge and a safety valve that can be set to blow off at any desired pressure.  Heating is usually carried out by electricity. Steam circulates within the jacket and is supplied under pressure to the inner chamber where materials are loaded for sterilization.  The water in the autoclave boils when its vapor pressure equals that of surrounding atmosphere.  Following the increase of pressure inside the closed vessel, the temperature at which the water boils inside the autoclave also increases.  The saturated steam that has a higher penetrative power, on coming in contact with a cooler surface condenses to water and releases its latent heat to that surface.  For example, nearly 1600 mL steam at 100°C and at atmospheric pressure condenses into 1 mL of water at 100°C and releases 518 calories of heat.  The gross reduction in volume of steam sucks in more steam to the area and this process continues till the temperature of that surface is elevated to that of the steam.  Sterilization is achieved when the steam condenses against the objects in the chamber and gradually raises their temperature.  The condensed water facilitates moist conditions that ensures killing of microbes. Sterilization conditions:  Experience has shown that the most efficient pressure–temperature combination for achieving sterilization by autoclave is 15 psi, which yields 121°C.  It is possible to use higher pressure to reach higher temperatures  (for instance, increasing the pressure to 30 psi raises the temperature by 11°C), but doing so will not significantly reduce the exposure time and can harm the items being sterilized.  It is important to avoid over packing or haphazardly loading the chamber, because it prevents steam from circulating freely around the contents and impedes the full contact that is necessary.  The holding time varies from 10 minutes for light loads to 40 minutes for heavy or bulky ones; the average time being 20 minutes.  Uses of autoclave:  The autoclave has many uses: o It is a good method to sterilize heat-resistant materials, such as glassware, cloth (surgical dressings), rubber (gloves), metallic instruments, liquids, paper, some culture media and some heat- resistant plastics. o It is also useful for sterilization of heat-sensitive items, such as plastic Petri plates that need to be discarded. o It is useful for sterilization of materials that cannot withstand the higher temperature of the hot-air oven.  However, the autoclave is ineffective for sterilizing substances that repel moisture (oils, waxes, or powders). Types and uses of various moist heat sterilization methods: Methods Uses Comments Water bath below 100°C For sterilization of serum, Only disinfection possible. body fluids, and vaccines Spores would be spared Water bath at 100°C For sterilization of glass, Some spores will still be metal, and rubber items spared at this temperature Arnold steamer: For sterilization of culture Preserves properties of steaming at 100°C media containing sugar media and gelatin Autoclave: For sterilization of culture Kills all the vegetative as steam under pressure media and operation well as spore forms of theater as well as bacteria laboratory materials Sterilization controls:  Various sterilization controls are used to determine the efficacy of sterilization by moist heat.  These include; o (a) thermocouples, o (b) chemical indicators, o (c) bacteriological spores  (a) Thermocouples are used to record temperatures directly in autoclaves by a potentiometer. (b) Brown’s tube is the most commonly used chemical indicator of moist heat sterilization in the autoclave. It contains red solution that turns green when exposed to temperature of 121°C for 15 minutes in an autoclave. (c) Bacillus stearothermophilus spores are used as the indicators of moist heat sterilization in the autoclave. This is a thermophilic bacterium with an optimum temperature of 55–60°C, and its spores require an exposure of 12 minutes at 121°C to be destroyed.  The efficacy of the autoclave is carried out by placing paper strips impregnated with 106 spores in envelopes and keeping those envelopes in different parts of the load inside the autoclave. These strips after sterilization are inoculated into a suitable recovery medium and incubated at 55°C for 5 days. Spores are destroyed if the sterilizing condition of the autoclave is proper. 4.Intermittent sterilization:  Certain heat-labile substances (e.g., serum, sugar, egg, etc.) that cannot withstand the high temperature of the autoclave can be sterilized by a process of intermittent sterilization, known as tyndallization.  Tyndallization:  It is carried out over a period of 3 days and requires a chamber to hold the materials and a reservoir for boiling water.  Items to be sterilized are kept in the chamber and are exposed to free-flowing steam at 100°C for 20 minutes, for each of the three consecutive days.  On the first day, the temperature is adequate to kill all the vegetative forms of the bacteria, yeasts, and molds but not sufficient to kill spores.  The surviving spores are allowed to germinate to vegetative forms on the second day and are killed on re-exposure to steam.  The third day re-ensures killing of all the spores by their germination to vegetative forms.  Intermittent sterilization is used most often to sterilize heat-sensitive culture media, such as those containing sera (e.g., Loeffler’s serum slope), egg (e.g., Lowenstein–Jensen’s medium), or carbohydrates (e.g., serum sugars) and some canned foods.  Sterilization by dry heat  Sterilization by dry heat makes use of air with a low moisture content that has been heated by a flame or electric heating coil.  In practice, the temperature of dry heat ranges from 160 º C to several thousand degrees Celsius.  The dry heat kills microorganisms by protein denaturation, oxidative damage, and the toxic effect of increased level of electrolytes.  Dry heat is not as versatile or as widely used as moist heat, but it has several important sterilization applications. The temperature and time employed in dry heat vary according to the particular method, but in general they are greater than with moist heat.  Sterilization by dry heat includes sterilization by: o (a) flaming o (b) incineration o (c) hot air oven Flaming: Sterilization of inoculating loop or wire, the tip of forceps, searing spatulas, etc., is carried out by holding them in the flame of the Bunsen burner till they become red hot. Glass slides, scalpels, and mouths of culture tubes are sterilized by passing them through the Bunsen flame without allowing them to become red hot. Incineration: Incineration is an excellent method for safely destroying infective materials by burning them to ashes.  It has many uses:  Incinerators are used to carry out this process and are regularly employed in hospitals and research labs to destroy hospital and laboratory wastes.  The method is used for complete destruction and disposal of infectious material, such as syringes, needles, culture material, dressings, bandages, bedding, animal carcasses, and pathology samples.  This method is fast and effective for most hospital wastes, but not for metals and heat-resistant glass materials.  Hot-air oven:  The hot-air oven provides another means of dry heat sterilization and is the most widely used method.  The hot-air oven is electrically heated and is fitted with a fan to ensure adequate and even distribution of hot air in the chamber.  It is also fitted with a thermostat that ensures circulation of hot air of desired temperature in the chamber.  Heated, circulated air transfers its heat to the materials inside the chamber. While sterilizing by hot-air oven, it should be ensured that the oven is not overloaded. The materials should be dry and arranged in a manner which allows free circulation of air inside the chamber. It is essential to fit the test tubes, flasks, etc., with cotton plugs and to wrap Petri dishes  and pipettes in a paper. Sterilization by hot-air oven requires exposure to 160–180°C for 2 hours and 30 minutes, which ensures thorough heating of the objects and destruction of spores.  Hot-air oven is used in laboratories and clinics for heat-resistant items that are not sterilized well by moist heat.  They are used for sterilization of: o Glass wares (syringes, Petri dishes, flasks, pipettes, test tubes, etc.). o Surgical instruments (scalpels, scissors, forceps, etc.). o Chemicals (liquid paraffin, sulfonamide powders, etc.); and o Oils that are not penetrated well by steam used in moist heat sterilization.  Thermocouples, chemical indicators, and bacteriological spores of Bacillus subtilis are used as sterilization controls to determine the efficacy of sterilization by hot-air oven. Filtration  Filtration is an excellent way to reduce the microbial population in solutions of heat-labile material by use of a variety of filters. Filters are used to sterilize these heat-labile solutions.  Filters simply remove contaminating microorganisms from solutions rather than directly destroying them.  The filters are of two types: o (a) depth filters and o (b) membrane filters. Depth filters: Depth filters consist of fibrous or granular materials that have been bonded into a thick layer filled with twisting channels of small diameter.  The solution containing microorganisms is sucked in through this layer under vacuum and microbial cells are removed by physical screening or entrapment and also by adsorption to the surface of the filter material.  Depth filters are of the following types: Candle filters: These are made up of (a) diatomaceous earth (e.g., Berkefeld filters) or (b) unglazed porcelain (e.g., Chamberlain filters). They are available in different grades of porosity and are used widely for purification of water for drinking and industrial uses. o Asbestos filters: These are made up of asbestos such as magnesium silicate. Seitz and Sterimat filters are the examples of such filters. These are disposable and single-use discs available in different grades. They have high adsorbing capacity and tend to alkalinize the filtered fluid. Their use is limited by the carcinogenic potential of asbestos. o Sintered glass filters: These are made up of finely powdered glass particles, which are fused together. They have low absorbing property and are available in different pore sizes. These filters, although can be cleaned easily, are brittle and expensive. Membrane filters:  Membrane filters are made up of : (a) cellulose acetate, (b) cellulose nitrate, (c) polycarbonate, (d) polyvinylidene fluoride, or (e) other synthetic materials.  These filters are now widely used and have replaced depth filters for last many years.  These filters are circular porous membranes and are usually 0.1 mm thick. Although a wide variety of pore sizes (0.015–12 µm) are available, membranes with pores about 0.2 µm are used, because the pore size is smaller than the size of bacteria.  These filters are used to remove most vegetative cells, but not viruses, from solutions to be filtered.  In the process of filtration, the membranes are held in special holders and often preceded by depth filters made of glass fibers to remove larger particles that might clog the membrane filter.  The solution is then pushed or forced through the filter with a vacuum or with pressure from a syringe, peristaltic pump, or nitrogen gas bottle, and collected in previously sterilized containers.  Membrane filters remove microorganisms by screening them out in the way a sieve separates large sand particles from small ones.  These filters have many uses: o They are used to sterilize pharmaceutical substances, ophthalmic solutions, liquid culture media, oils, antibiotics, and other heat-sensitive solutions. o They are used to obtain bacterial free filtrates of clinical specimens for virus isolation. o They are used to separate toxins and bacteriophages from bacteria.