‫كلية المدائن للعلوم الطبية والتكنولوجيا‬

AL Madain college for Medical sciences &Technology

Nursing program

Sterilization and Disinfection

Submitted by
Idriss hasab Elrsoul Idriss
.RN,Bsc/ Md /IPC
 Objectives
By the end of this lecture, the student will be
able to:
• Understand the meaning of asepsis.
• Know the types of asepsis techniques.
• Demonstrate competence in sterilization.
• Demonstrate competence in disinfection
 Contents
Meaning of asepsis.
Types of asepsis techniques.
Sterilization.
Disinfection
Summary and conclusion.
 ASEPSIS
The term asepsis means the absence of
disease-producing microorganisms
 Definition
Aseptic technique is the effort taken to keep the
patient as free from hospital micro-organisms
as possible.
It is a method used to prevent contamination of
wounds & other susceptible sites by organisms that
.could cause infection
This can be achieved by ensuring that only
sterile equipment & fluids are used during
.invasive medical & nursing procedures
 Types of Asepsis Technique

:There are two types of asepsis

.Medical asepsis & Surgical asepsis

Medical or Clean Asepsis reduces the number

.of organisms & prevents their spread
 Medical Asepsis
During daily routine care, the nurse uses basic
medical aseptic techniques to break the
.infection chain

Eg. of medical asepsis are changing client’s

bed linen daily, hand washing, barrier
.techniques, & routine environmental cleaning
 :principle of medical asepsis
1- perform hand washing
2 – clean and disinfection shared equipment
3 – clean and disinfection environment
4 – health care provider free of disease
5 – isolate infected patient
6 – All body fluid from patient are considered
contaminated
7 – use of personal protective equipment with
contact
 Surgical or Sterile Asepsis or Sterile
Technique
includes procedures used to eliminate
micro-organisms from an area & is practiced
by nurses in labour & delivery area, major
diagnostic areas
 :principle of surgical asepsis
1 – only sterile items are use with sterile field
2 – sterile person are gowned and gloved
3 – sterile table are level of vision
4 – sterile person touch only sterile area
5 – un sterile person avoid sterile area
6 – sterile item becomes contaminated by
prolonged exposure to air
7 – edges of sterile container are consider
unsterile once package is opened
 Asepsis
 It is keeping medical instruments free from
microorganisms

This is accomplished by:

 Sterilization
 Disinfection
 I. Sterilization
• It is one of the basic steps in surface asepsis.
• Definition: Sterilization refers to the use of
different procedures to destroy all forms of
microorganisms including bacterial spores.
 What to sterilize?
• It is mandatory to sterilize :
– all instruments that penetrate soft tissues and bone.
– Instruments that are not intended to penetrate the
tissues, but that may come into contact with oral
tissues.
• If the sterilization procedure may damage the
instruments, then, sterilization can be replaced by
Disinfection procedure
 II. Disinfection
• It a is less lethal process than sterilization.
• Definition: It is a procedure intended to reduce
microorganisms as far as possible
(but not bacterial spores).
• Thus, disinfection can never replace sterilization
 The Spaulding Classification
CLASSIFICATION DEFINITION LEVEL OF Example's
PROCESSING /
REPROCESSING

NON-CRITICAL Equipment/device that Cleaning followed by ECG machines

equipment/device touches only intact skin low-level disinfection Oximeters •
and not mucous in some cases, cleaning( Stethoscopes •
membranes, or does not alone is acceptable
directly touch the
client/patient/resident

SEMI-CRITICAL Equipment/device that Cleaning followed by Anesthesia

equipment/device comes in contact with high-level disinfection equipment
non-intact skin or mucous .)as a minimum( Most •
membranes but does not Sterilization is respiratory
penetrate them .preferred therapy
equipment

CRITICAL Equipment/device that Cleaning followed by Surgical •

equipment/device ,enters sterile tissues sterilization instruments
including the vascular Biopsy •
system instruments
 Factors that influence the degree of killing

• Types of organisms
• Number of organisms
• Concentration of disinfecting agent
• Presence of organic material (e.g., serum, blood)
• Nature (composition) of surface to be disinfected
• Contact time
• Temperature
• pH
• Biofilms
• Compatibility of disinfectants and sterilants
I. Sterilization - Process
19 idriss Sterilization
Shelf life depends on the following factors:
Strong Condition:
Storage areas must be clean and free of dust and
dirt.
All sterile items must be stored under condition
that protect them from extremes of temp (temp 26 C),
humidity (H30% - 100% ).
Material used in package:
Muslin and paper – may be stored for 30 days.

20 idriss Sterilization
 Sterilization – instrument Packing
• Often instruments are packed for sterilization to be
stored and handled without being contaminated.
• Packing depend on the intended shelf life after
sterilization.
• The available packing options are:
– Textile has shelf life of 1 month
– Paper has shelf life of 1 – 6 months
– Nylon, glass, and metal have shelf life of 1 year if tightly
closed
• Integrity of packages:
• The items is no longer consider sterile after accidental
puncture, leer, rupture.
 Sterilization Principles
• There are 3 different sterilization principles:
1. Heat sterilization
2. Chemical sterilization
3. Radiation sterilization
HEAT STERILIZATION .1
 1. Heat Sterilization
• Advantages:
• It is the simplest, most effective and inexpensive
method.
• There are 2 procedures depending on the
tolerance of the material used:
a) Steam sterilization (Autoclaving)
b) Dry heat sterilization (oven)
25 idris Sterilization
AUTOCLAVE
 Steam Sterilization
Advantages & Disadvantages
• Advantages:
– good penetration
– maintains integrity of liquids (e.g. Lubricants) due to
the 100% humidity within the chamber.
• Disadvantages:
– Non stainless steel metal items corrode
– may damage plastic and rubber items
– sharp instruments get dulled.
 1.b. Dry-Heat Sterilization
• Involves heating at atmospheric pressure and often
use a fan to obtain uniform temperature by
circulation.
• Heat at 180º for half hour , 170º for 1 hr., or 160º
C for 2 hrs.
:Sterilization By Dry Heat • Kills by oxidation effects
• The oven utilizes dry heat to
sterilize articles
• Operated between 50oC to
250/300oC.
• A holding period of 160oC for 1 hr
is desirable.
• There is a thermostat controlling
the temperature.
• Double walled insulation keeps
the heat in and conserves energy,
Hot Air Oven
:Uses
To sterilize Forceps, Scissors

Disadvantages of Dry -Heat Sterilization;

– Less reliable than autoclaving
– Large temp difference may arise within device.
– sharp instruments get dulled
– Many materials do not tolerate dry heat

.
2. CHEMICAL STERILIZATION
 2. Chemical Sterilization - Types
• The chemical compounds used can be:
a) Gas Sterilization
b) Liquid Sterilization
• Generally, chemical sterilization procedures have
the disadvantages of presenting health hazards to
users (e.g. poisonous, flammable)
 2.a) Gas Sterilization
• The gas used in this procedure is ethylene oxide.
• Procedure:
– Keep objects in constant atmospheric humidity.
– Heat to temperatures between 30º and 60º C.
– maintain for a period of 10 hrs.
– Residual ethylene oxide must be ventilated
• Formalin gas autoclaves have been developed for
sterilizing endoscopes and anesthetic apparatus.
 Gas Sterilization – Disadvantages
• Ethylene oxide (& formalin) autoclaves have
the following disadvantages:
– Difficult to operate
– Unsuitable for hospitals but used in industry
(e.g. for sterilizing disposable materials that can
not tolerate high temperatures).
 2.b) Liquid Sterilization
• Can be performed with buffered glutaric aldehyde.
• Procedure:
– Immerse object in liquid for several hours.
– Rinse with sterile water after end of procedure.
3. RADIATION STERILIZATION
 Radiation
The sun is not a particularly reliable disinfecting agent
because
it kills only those microorganisms that are exposed
to direct sunlight. The rays of the sun include the long
infrared
(heat) rays, the visible light rays, and the shorter ultraviolet
(UV) rays. The UV rays, which do not penetrate
glass and building materials, are effective only in the air
and on surfaces.
 3. Radiation Sterilization
• Provides effective way of sterilization when used
in high doses.
• Gamma radiation (from 60o C).
• Procedure:
– Objects on belt conveyer
– Expose objects to 25 to 30 kGy for about 24 hrs.
 Radiation Sterilization
Advantages and Disadvantages
• Advantages:
– Clean process
– Dry process
– Ensures full exposure of object from all directions
• Disadvantages:
– Posses threat to humans (radiation)
– Lengthy process
– Requires very qualified personnel
II. DISINFECTION
 Disinfection - Types
• As mentioned before, disinfection can not kill all
microorganisms but only reduces its number.
• Disinfection can be accomplished with:
1. Heat disinfection
2. Chemical disinfection
• Objects that can be disinfected are bedpans,
patient skin before operation and surgeon hands
before putting gloves.
 1. Heat Disinfection
• It is accomplished by boiling water at
atmospheric pressure for at least 5 min’s
 2. Chemical disinfection
• Number of different agents are used according to
tolerance of objects and infectious agents.
– Using phenol with cleaning component destroy the
membrane of microorganisms.
– Using 70% alcohol for skin which denatures proteins
of microorganisms.
– Use soap containing hexachlorophene for hands.
– In case of hepatitis use 5% solution of chloramines or
heat disinfection
 : Chemical agent used for disinfection
• Alcohol 70% -90% ( kills microorganism by coagu-
lation of cell protein.)
• Formaldehyde; solution or gas( kills microorganism
by coagulation of cell protein).
• (betadine)

(A complex of iodine kills microorganism through the process

of oxidation of essentials enzymes.)
44 BMT_335 Sterilization
45 idriss Sterilization
 Asepsis – Summary
Asepsis

Sterilization Disinfection

Heat Chemical Radiation Heat Chemical

Steam Gas Gamma Boiling water Phenol

Ethylene
Dry heat Alcohol 70%
oxide

Hexachlorop
Formalin
hene

Heat or
Liquid chloramines
solution

Glutaric
Aldehyde
 Sterilization methods Disinfection methods

Physical methods
Physical methods
• Boiling and pasteurisation
• Moist heat in autoclaves • Ultraviolet radiation

• Dry-heat in ovens
Chemical agents
• Gamma irradiaton • Alcohols
• Filtration • Aldehydes
• Halogens
• Phenols
Chemical agents
• Surfactants
• Ethylene oxide • Heavy metals
• Glutaraldehye (high • Dyes
concentration) • Oxidants
 Conclusion
• In summary:
– Sterilization and disinfection are costly and time
consuming process
– However, it is an essential in all health care facilities
to avoid spread of diseases.
– It depends on the ethics of the instrument users.
– Users should keep in mind that contaminated
instrument present risk to patient as well as the user
himself.
49 BMT_335 Sterilization