Definition
Sterilization is defined as a process where all microbes are removed from a defined object, inclusive of bacterial endospores. Disinfection is the process of cleaning something especially with a chemical, in order to destroy bacteria.
Purpose
To ensure that healthcare personnel follows proper evidence-based practices for cleaning and organizing to minimize the risk of infection.
Levels of Disinfection
These levels are based on the microbicidal effect of the chemical agents on the microorganisms and can be as follows:
1. High-level disinfection (HLD): This is carried out with liquid chemical agents that eliminate all of the microorganisms. Examples are orthophthaldehyde, glutaraldehyde, peracetic acid, chlorine dioxide, hydrogen peroxide, and formaldehyde, among others.
2. Intermediate-level disinfection (ILD): This is carried out using chemical agents that eliminate vegetative bacteria and some bacterial spores. This includes the phenol group, sodium hypochlorite, cetrimide, and benzalkonium chloride.
3. Low-level disinfection (LLD): This is carried out by chemical agents that eliminate vegetative bacteria, fungi, and some viruses within a short period of time (less than 10 minutes). One example is the group of quaternary ammoniums.
Guideline Criteria for Disinfection or Sterilization of Equipment’s/Articles
In 1968, Earl Spaulding established the first criterion for disinfection, with the objective of rationalizing guidelines for processing materials and instruments. Spaulding considered the level of infection risk that the utilization of these articles would represent and classified them in the following way:
Critical articles: Critical articles are instruments that come into contact with cavities or sterile tissues, including the vascular system. Examples are surgical instruments, needles, cardiac probes, catheters, implants, blood compartment of a hemodialyzer, and prostheses. Most of the items in this category are either purchased sterile or are sterilized by autoclaving if possible.
Semi-critical articles: Semi-critical articles are instruments that come into contact with the mucous membrane of the respiratory, genital, and urinary tracts and with skin that is not intact. Although mucous membranes are usually resistant to infections by bacterial spores, they can present infection when contaminated with other microbial forms. For this reason, they should be sterile, or at the least, they should be submitted to high-level disinfection (HLD). This includes, e.g., respiratory assistance devices, anaesthesia, and endoscopic devices.
Noncritical articles: Noncritical articles refer to all instruments that only come into contact with intact skin. In this case, healthy skin acts as an effective barrier to keep out the majority of microorganisms. As a result, the level of disinfection needed is lower. In general, only adequate cleaning and drying are required, with the need for intermediate- or low-level disinfection on some occasions. Some examples of this type of instruments are sphygmomanometers, bedclothes, incubators, mattresses, and furniture.
| CLASSIFICATION OF EQUIPMENT AND STERILIZATION METHODS | |||
| Classification | Equipment | Method | |
| 1. | Critical | Surgical and treatment instruments. Vascular, skeletal, and other prostheses. IV and angiography catheters. Urinary catheters, syringes, needles, forceps, implants, cardiac probes, and blood compartment of a hemodialyzer. | Autoclave or poupinel sterilization; ethylene oxide with sterilization and aeration equipment |
| 2. | Semi-critical | Respiratory assistance devices. Anesthesia devices. Endoscopes, laparoscopes, bronchoscopes, endotracheal cannulas, probes, aspiration tubes; tongue depressor; rectal thermometers. | Sterilize (if possible) or high-level disinfection |
| 3. | Noncritical | Phonendoscopes, sphygmomanometers and sleeves, incubators, mattresses and furniture as well as objects for patient use: glasses, plates, silverware, bedpans, urinals, and bedclothes. | Intermediate-level and low-level disinfection |
| DISINFECTANTS AND ANTISEPTICS USED IN THE HOSPITAL | ||
| Disinfectants | Recommendations | Instructions |
| Disinfectants Chlorhexidine gluconate 2.5% ethanol alcohol 70% (Avagard) | Disinfection of skin or cleaning rubber bungs of vials prior to puncture. Furniture. | Swab site to be cleaned carefully prior to puncture. |
| Glutaraldehyde (2%) | All metal instruments Airways and endotracheal tubes PlasticGlass | Sterilizes articles in 10 hours. Sterilizes articles in 10 minutes. |
| Isopropyl alcohol (70%) | All metal instruments Scope lensesAmbu bag and face maskThermometer probes Clinical glass thermometerTrolley tops | Disinfects articles in 10 minutes. |
| Sodium hypochlorite (10%) | All types of metal, glass, plastic, rubber items, and scope lenses. | Decontaminates/disinfects articles in 10 minutes Fresh solution to be prepared daily |
| Povidone iodine (5%) solution | Preoperative disinfection of skinWound antiseptic | Apply undiluted to skin, wound, or mucous membrane Allow to dry |
| Hydrogen peroxide (3%) | Cleaning wounds | Use diluted on wounds, dilute 1:1 |
| •Didecyl dimethyl ammoniun chloride:8.7% •n-Alkyl dimethylbenzyl ammonum chloride: 8.19% (Virex) | FoggingInstrument disinfectionHigh-level disinfection Semi critical instrumentsSurface disinfection | Prepare 1% solution by adding 10 mL of Virex in 1 L of water. Use 10% solution (100 mL Virex in 1L of water). Soak completely inside the Virex solution. Soak for only 30 minutes. Use 0.4% solution (4 mL in 1 L of cold water) |
| COMMON DISINFECTION AND STERILIZATION METHODS FOR SOME OF THE EQUIPMENT/ARTICLES | |
| Items | Guidelines |
| Thermometer | Wipe with Chlorhexidine gluconate 25% and ethanol alcohol 70% (Avagard) swab after each use. |
| Stethoscope | Wipe with Avagard swab between patients (ear plugs, diaphragm) Dedicate one stethoscope for patient who is in isolation/infectious. |
| BP cuff | Wash and dry after use on infected patient Wash monthly and when visibly soiled Rubber tubing should be cleaned with Avagard daily. |
| Nebulization set | Use disposable nebulization set for each patient Clean with Avagard after each use. |
| O2mask | Use disposable O2 mask Clean with Avagard after each use |
| Spirometer | Use disposable spirometer for each patient Clean with Avagard after each use |
| Laryngoscope | Remove the bulb, clean the blade with soap and water, and wipe with Avagard. Wipe handle with Avagard |
| Suction catheter | Use disposable suction catheter |
| Suction tubing | Use disposable tubing for each patient |
| Suction bottle | Empty contents, rinse with water, and then disinfect with 10% hypochlorite solution for 30 minutes. |
| Airways | Use disposable airway for each patient. |
| Ambu bag | Disinfect with 10% hypochlorite solution, wash with water, dry, and send for Ethylene oxide sterilization (ETO). |
| Oxygen humidifiers | Change sterile water daily when it is in use. Do not put sterile water into the container when it is not in use. Wash humidifier with soap and water daily, disinfect when contaminated with 10% hypochlorite for 30 minutes. Wash and dry thoroughly. |
| Instruments (forceps, scissors, retractor, and speculum) | Rinse of any blood and secretion with water and disinfect with enzyme cleaner, dry and send to central sterile services department (CSSD) for sterilization. |
| Sharps | Use disposable needles and discard it into white puncture proof container after use Biopsy needles: Rinse of any blood and secretion with water and disinfect, dry and send to CSSD for sterilization. |
| Baby incubator | Clean with soap and wipe with Virex daily and after each patient’s discharge. |
| Warmer | Clean with Virex daily and after each patient’s discharge. |
| Basinet | Clean with disinfectant after each patients discharge. |
| Portable suction machine | Clean with disinfectant solution after each use. |
| Dressing/ procedure trolley | Clean with Avagard daily Surface must be dry before placing sterile pack. |
| Urinal/bed pan | Wash with soap and water, then wipe with freshly prepared 10% hypochlorite solution. |
| Cardiac table | Clean with Avagard daily and after each patient’s discharge/transfer/death. |
| Electric fan | Clean with disinfectant solution and water weekly. |
| Sputum mug | Disposable. |
| Curtains | Change and wash when visibly soiled and every month and in case of infected cases, on discharge of patient (critical areas every 15 days). |
| Mattress and pillow | Clean with Virex disinfectant and water after transfer/discharge/death. |
| Bed/bed rails | Clean with Virex disinfectant and water after transfer/discharge/death. |
| Operation theaters and critical care areas (daily cleaning) | Wash floors and other tiled surfaces with Virex 04% solution. |
| Operation theaters (fogging) | Fogg with 1% Virex solution and close the rooms and allow to dry for 1 hour. |
| DISINFECTION OF SPECIAL EQUIPMENT | |
| ENT Equipment | Recommendation |
| Naso-endoscopes (ENT) | Wash with neutral detergent; immerse in 2% glutaraldehyde for 20 minutes. Rinse thoroughly in tap water and dry. |
| Rigid endoscope (ENT) | Wash with neutral detergent, rinse and dry; immerse in 2% glutaraldehyde for 20 minutes. |
| Laryngeal mirrors (ENT) | Wash with detergent and water, dry and wipe with a swab impregnated with Avagard. |
| Laser lenses | Single use or wipe with Avagard. |
| Eye covers (pin holes-used for testing) Slit lamp. Tonometer heads Transducers | Wipe with a swab impregnated with Avagard. |
Linen Care
- Noncontaminated linen is free of body substances and is put in linen hamper.
- Contaminated linen is any linen soiled with blood or body substances within it.
- Contaminated linen should be washed under tap water and soak in 10% sodium hypochlorite solution for 30 minutes.
- Drain the linen, place in a yellow plastic bag, and sent to laundry.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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