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Instrument Decontamination

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					Instrument Decontamination
 Methods for Prevention of
         infection
   Dr. Aidah Abu Elsoud Alkaissi
   An Najah National University


            Dr. Aidah Abu Elsoud Alkaisi
            devision of Intensive Care &
           Anaesthesiology University of
                 Linköping Sweden
  Instrument Decontamination
   Methods for Prevention of
           infection
Instrument should be immediately submersed in water
or a germicidal solution at the close of the procedure to
prevent blood and other substances from drying on the
surface or in the cervices
The cleaning method should be economic and must be
provide protection fromcross-contamination damage to
the instrument and injury to the worker
Washed and sterilized instruments are inspected,
reassembled(To fit together the parts or pieces of) into
sets, placed in containers or wrapped and sterilized &
stored for future used
                     Dr. Aidah Abu Elsoud Alkaisi
                     devision of Intensive Care &
                    Anaesthesiology University of
                          Linköping Sweden
          Mechanical Washing
  During surgical procedure instrument should be
  kept as free of body substances (bioburden) as
  possible by wiping off the gross material with a
  moistened sponge
  Sterile water is selected because saline causes
  corrosion and deterioration of the instrument
  surfaces
  All instruments that can be immersed are placed
  in a basin, disassembled or box locks opened
and covered with water or a detergent/germicidal
  solution
                    Dr. Aidah Abu Elsoud Alkaisi
                    devision of Intensive Care &
                   Anaesthesiology University of
                         Linköping Sweden
           Mechanical Washing
Mathods may be selected for decontamination of
instruments and equipment
  To cover and transport all items used during the surgery to
  a centralized location for processing.
  The cover should be watertight and remain intact during
  transport to the central decontamination area.
  Examples of covers include case carts (A small wheeled
  vehicle typically pushed by hand), plastic bags & impervious
  (Incapable of being penetrated) surgical drapes (To cover,
  dress, or hang with or as if with cloth in loose folds)
  Soiled instruments should be handled by gloved personnel
                      Dr. Aidah Abu Elsoud Alkaisi
                      devision of Intensive Care &
                     Anaesthesiology University of
                           Linköping Sweden
       Mechanical Washing
Appropriate apparel for personnel in the
central decontamination area includes scrub
attire, cap and mask, protective eye wear, a
waterproof apron or coverall suit and long,
cuffed, heavy-duty rubber gloves
Upon arrival the instruments are uncovered,
arranged loosely in an open mesh tray with
the lightest instruments on the top and
placed directly into a washer sterilizer
               Dr. Aidah Abu Elsoud Alkaisi
               devision of Intensive Care &
              Anaesthesiology University of
                    Linköping Sweden
         Mechanical Washing
If gross debris is present a hand prewash in
a detergent/germicide solution is
recommended
When decontaminated instruments are
removed from the washer-sterilizer they
transported to the ultrasonic cleaner


                 Dr. Aidah Abu Elsoud Alkaisi
                 devision of Intensive Care &
                Anaesthesiology University of
                      Linköping Sweden
   Instrument decontamination

When a centralized area is not available,
autoclave in the substerilizing room, the
other involves a thorough hand washing
The later is time consuming, less efficient
and higher in labor expense



                  Dr. Aidah Abu Elsoud Alkaisi
                  devision of Intensive Care &
                 Anaesthesiology University of
                       Linköping Sweden
          Ultrasonic Cleaning
Once the terminal strilization is complete the
second phase of instrument processing with an
ultrasonic cleaner may begin
This process removes tenacious soil that remains
on instruments after they have been mechanically
or manually washed
By cavitation process debris and material are
removed from all surfacesof the instrumantation
Most manufactures instructions warn against
placing instruments to dissimilar metals (as
stainless steel, coppar & titanium) in the
ultrasonic cleaner at the same time
                   Dr. Aidah Abu Elsoud Alkaisi
                   devision of Intensive Care &
                  Anaesthesiology University of
                        Linköping Sweden
          Ultrasonic Cleaning
Ultrasonic cleaning is not recommended for
some delicate instruments, chrome-plated
instruments
Then instrument are inspected and all movable
parts are lubricated with an antimicrobial, water
souble lubricant to protect against rusting,
staining (To discolor, soil, or spot), or corrosion
Instruments then rearranged into sets, placed in
containers or wrapped and sterilized or stored
for future used
                   Dr. Aidah Abu Elsoud Alkaisi
                   devision of Intensive Care &
                  Anaesthesiology University of
                        Linköping Sweden
     Sterilization Methods for
      Prevention of Infection

Methods of sterilization of surgical items
must result in complete destruction of
microbial life, including spores, and the
absence of toxic residue on the objects as
well as little or no deterioration or damage
to treat and moisture sensitive instruments


                 Dr. Aidah Abu Elsoud Alkaisi
                 devision of Intensive Care &
                Anaesthesiology University of
                      Linköping Sweden
     Sterilization Methods for
      Prevention of Infection
Steam sterilization
Saturated steam under pressure is
recognized as the safest most practical
means of sterilizing surgical supplies,
fluids , the majority of instruments and
other inanimate (Not having the qualities
associated with active, living organisms.
See Synonyms at dead) objects
                Dr. Aidah Abu Elsoud Alkaisi
                devision of Intensive Care &
               Anaesthesiology University of
                     Linköping Sweden
        Theory of microbial
           destruction
Microorganisms destroyed by moist heat
through a process of denaturation (To
change the nature or natural qualities of)
and coagulation of the enzyme-protein
system within the bacterial cell
Microorganisms are killed at a lower
temperature when moist heat is used than
when dry heat is used
                Dr. Aidah Abu Elsoud Alkaisi
                devision of Intensive Care &
               Anaesthesiology University of
                     Linköping Sweden
        Theory of microbial
           destruction
When steam comes in contact with a cold
object, condensation takesplace
immediately
As the steam condenses it gives off latent
heats and wets the object




                Dr. Aidah Abu Elsoud Alkaisi
                devision of Intensive Care &
               Anaesthesiology University of
                     Linköping Sweden
           Principles and mechanism
              of steam sterilization
In conventional steam sterilizer, the sterilization
process may be divided into 5 phases
  Loading phase, in which the objects are packaged and
  loaded in the sterilizer
  Heating phase, in which the steam is brought to the
  proper temperature and allowed to penetrate around and
  through the objects in the chamber
  Destroying phase, or the time-temperature cycle, in which
  all microbial life is exposed to the killing effects of the
  steam
  Drying and cooling phase, in which the objects are dried
  and cooled, filtered air is introduced into the chamber, the
  door is opened and the objects are removed and stored
                       Dr. Aidah the efficiency of the sterilization
  Testing phase in whichAbu Elsoud Alkaisi
  process is checked   devision of Intensive Care &
                      Anaesthesiology University of
                        Linköping Sweden
  High speed (flash) sterilization
Referred to a flash sterilizer, adjusted to
operate at 132 degree
It can be used for sterilizing packs and
solutions
Most frequently used in the operating room
for urgently neededunwrapped instrument
Please read figure 5.10

                 Dr. Aidah Abu Elsoud Alkaisi
                 devision of Intensive Care &
                Anaesthesiology University of
                      Linköping Sweden
 Prevacuum, high-temperature
         sterilization
Accomplished by mean of an air-blasted
(destructive force ), oil-sealed rotary
pump, protected by a condenser and
coupled with an automatic control
mechanism
Please read Figure 5.11



                Dr. Aidah Abu Elsoud Alkaisi
                devision of Intensive Care &
               Anaesthesiology University of
                     Linköping Sweden
   Boiling water (nonpressure)

Boiling does not sterilize instruments
Heat resistant microorganism, bacterial
spores and certain viruses can withstand
(resist or confront with resistance)
boiling water at 100 degree for many hours

                 Dr. Aidah Abu Elsoud Alkaisi
                 devision of Intensive Care &
                Anaesthesiology University of
                      Linköping Sweden
         Dry Heat Sterilizatin

Rarely used in hospitals today
As the proteins become dry during
exposure to dry heat, their resistace to
denaturation increases, for this reason, at a
given temperature,, dry heat sterilization is
much less effective than moist heat



                  Dr. Aidah Abu Elsoud Alkaisi
                  devision of Intensive Care &
                 Anaesthesiology University of
                       Linköping Sweden
        Chemical Sterilization
New material that cannot be heat sterilized are
continually being introduced for use in hospitals,
they require the use of other methods of
sterilization
Restricted to ethylene oxide ( a gaseous
chemosterilizer) and aqueous glutaraldehyde ( a
liquid chemosterilizer)
Refered to as cold sterilization
This term refers to the maximum temperature of
54 °C to 60 of gaseous sterilization as compared
                   Dr. °C temperature of steam
with 121 °C to 132Aidah Abu Elsoud Alkaisi
sterilization      devision of Intensive Care &
                  Anaesthesiology University of
                    Linköping Sweden
  Gaseous chemical sterilization

to sterilize of heat-labile and moisture
sensitive items as intricate (having many
complexly arranged elements), delicate
surgical instruments, large pieces of
equipment used in the hospital, plastic and
porous (able to absorb fluids) materials, all
of which are difficult to steam sterilize
without deterioration and damage

                  Dr. Aidah Abu Elsoud Alkaisi
                  devision of Intensive Care &
                 Anaesthesiology University of
                       Linköping Sweden
 Gaseous chemical sterilization

Ethylene oxide is the most frequently used
gas, odor similar to ether
Has inhalation toxicity similar of ammonia
gas, kept as a liquid
Item that can be steam sterilized should
never be gas sterilized


                Dr. Aidah Abu Elsoud Alkaisi
                devision of Intensive Care &
               Anaesthesiology University of
                     Linköping Sweden
      Liquid chemical sterilization
Destroy all forms of microbial life, including bacterial and fungal
spores, tuercle bacilli and viruses
Aqueous glutaraldehyde and aqueous formaldehyde
aqueous formaldehyde rarely used because it takes 12-24hto be
effective
Aqueous glutaraldehyde 2% useful in the disinfection of lensed
instruments such as cystoscope and bronchoscopes because it has
minimal deleteriuos (Harmfu) effects on the lens cement and
noncorrosive
Instruments must be free of bioburden and completely immersed an
activated Aqueous glutaraldehyde solution for 10 hto acheive
sterilization
Following immersion instruments must be rinsed thoroughly with
sterile distilled water before being used
                           Dr. Aidah Abu Elsoud Alkaisi
                           devision of Intensive Care &
                          Anaesthesiology University of
                                Linköping Sweden

				
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