Sterilization: complete removal, destruction, inactivation

of all forms of microbial life

viruses,
Fungi,
bacteria,
Spores.
• Disinfection: elimination of most pathogenic
organisms excluding sporicidal activity. There are 3
levels;
• HLD, all vegetating bacteria, MTB, fungi, all
viruses
• ILD, all vegetating bacteria, MTB, majority of
fungi, majority of viruses
• LLD, vegetating bacteria except MTB, some
fungi, some viruses
•Antiseptics:
•Antiseptics:chemical
chemicaldisinfectants
disinfectantsapplied
appliedto
to
skin,
skin,mm
mmbutbutnot
notsystemic
systemic

•Cleaning:
•Cleaning:removal
removalof
ofdust,
dust,dirt,
dirt,organics,
organics,FM.
FM.

•Decontamination:
•Decontamination:general
generalterm
termapplied
appliedto
toany
any
procedure
procedureby
bywhich
whichmicroorganisms
microorganismsare
are
reduced
reducedto
toaalevel
levelwhere
whereitems
itemsare
aresafe
safeto
to
handle
handle
Patient’s care items are divided into 3
categories:

Critical items
Semi-critical items
Non-critical items

Depending on the risk of infection due to their utilization

Critical Semi critical Noncritical

Items enter -sterile Items come in Items come in contact

tissues-cavities- contact with with intact skin
vascular system intact mm &
non intact skin

e.g.
e.g. needles, e.g. endoscopes,
sphygmomanometers,
implants, catheters, endotracheal tube,
bed linens, floors
surgical instruments thermometer

High level disinfectant, Intermediate and low

Sterilization: EO,
glutaraldehyde, chlorine level disinfectants,
autoclave,
active, hydrogen alcohols, phenols
plasma, sterilant
peroxide
Decreasing order of resistance of microorganisms
to disinfection and sterilization

Resistant • Prions
• Bacterial spores
• Mycobacteria
• Small non-enveloped
viruses
• Gram-negative bacteria
• Fungi
• Large non-enveloped
viruses
Susceptible • Gram-positive bacteria
• Lipid enveloped viruses
Decontamination Steps
I. Heat
1- Moist heat or steam sterilization
2- Dry heat sterilization

II. Low temperature (cold):

1. chemical
a. ethylene oxide
b. liquid steriliants: GLD, PAA, H2O2
2- plasma sterilizer

III. Other sterilizers:

1- ionizing radiation
2- filtration
3- microwaves; in pharmaceutical industries
• Heat is the most practical, efficient, and
inexpensive method of sterilization and
disinfection of objects that can withstand high
temperatures.

• There are two forms:

– Moist heat is much more efficient than dry heat because:
• it kills microorganisms by coagulating and denaturing
their enzymes and structural proteins
• it is quicker in heating up the article to be sterilized.
– Dry heat is believed to kill microorganisms by causing
destructive oxidation of essential cell constituents.
Autoclave
Autoclave==saturated
saturatedwater
watersteam
steamunder
underhigh
highpressure.
pressure.
heating
heatingwater
waterunder
undercontrolled
controlledconditions
conditionsininaaclosed
closedvessel
vesselininorder
order
that
thatboiling
boilingpoint
pointofofwater
waterrises
risesabove
above100°C.
100°C.
Saturated
Saturatedsteam
steamcarries
carriesthe
thesame
sametemperature
temperatureofofboiling
boilingwater.
water.
ItItisisessential
essentialtotomake
makesteam
steamsaturated
saturatedand
andfree
freeofofany
anyresidual
residualair
airbecause
because
air
airacts
actsas
asan
aninsulator,
insulator,reduces
reducestemperature
temperatureand
andhinders
hinderspenetration.
penetration.
Sterilization
Sterilizationtemperature
temperatureand
andexposure
exposuretime
time: :
atat121°C
121°Cfor
for20-30
20-30minutes
minutesatatdouble
doubleatmospheric
atmosphericpressure
pressure(2(2bar)
bar)
ororatat134°C
134°Cfor
for3-6
3-6minutes
minutes(at
(at33bar).
bar).
• Steam sterilization is
the most common and
preferred method for
sterilizing those items
that can withstand high
temperature and
moisture, e.g. culture
media, surgical
instruments and
dressings.
Autoclave:
Advantages:

1- Non-toxic
2- liberation of latent heat due to condensation of steam
3- Inexpensive
4- Rapidly microbicidal
5- Least affected by organic/inorganic soils
6- Rapid cycle time
7- Penetrates medical packing, device lumens

Disadvantages:

1- Deleterious for heat labile instruments

2- Potential for burns not for powders and oils
Sterilization monitored routinely by
combination of mechanical,
chemical, and biological parameters

• Physical - cycle time, temperature,

pressure

• Chemical - heat or chemical sensitive

inks that change color when
germicidal-related parameters
present

• Biological - Bacillus spores that

directly measure sterilization
(Geobacillus stearothermophilus)
Chemical Indicators