Introduction
Disinfection and sterilization in the operating theatre (OT) are critical to preventing infections and ensuring patient safety.
Definition
Disinfection describes a process that eliminates many or all pathogenic microorganisms on inanimate objects, with the exception of bacterial spores, and is usually accomplished by the use of liquid chemicals or wet pasteurization.
Sterilization is the complete elimination or destruction of all forms of microbial life and is accomplished in healthcare facilities by either physical or chemical processes.
Purposes
- To eliminate all microorganisms from the surgical instruments and surfaces.
- To prevent infection of the surgical site.
- To ensure safe surgical intervention.
- To maintain surgical asepsis.
- To prevent transmission of organisms.
- To promote speedy recovery.
- To improve the quality of surgical care and health of the patient.
Guidelines for Disinfection/Sterilization
The Spaulding’s classification of items can be used as a guide for disinfection and sterilization of items.
Methods
Disinfection
- Surfaces (Noncritical)
- Clean surfaces such as wall and floor, by wiping using water and detergent.
- Instruments and Equipment (Critical)
Instruments can be disinfected by
Rinsing
- Immediately after surgery, rinse instruments under warm
(not hot) running water. - Rinse should remove all blood, body fluids, and tissues.
Cleaning
This can be done by any of the following methods:
- Ultrasonic cleaning is a process of high-quality cleaning that uses ultrasonic energy (cavitation and implosion) to scrub the parts and a liquid solvent to rinse away the residue and loosened particulate matter.
- Automatic washer sterilizers wash, clean, disinfect, and sterilize instruments automatically in a mechanical device.
- Manual cleaning is preferred for disinfecting fragile or difficult-to-clean instruments. This is done through two essential components:
- Friction (rubbing/scrubbing the soiled area with a brush).
- Fluidics (fluids under pressure to remove debris from deep/internal areas which are difficult to reach).
Disinfection
- High-level disinfection kills all organisms, except high levels of bacterial spores and prions, and is effected with a chemical germicide cleared for marketing as a sterilant by the Food and Drug Administration, for example, glutaraldehyde-based and ortho-phthalaldehyde-based agents.
- Intermediate-level disinfection kills mycobacteria, most viruses, and bacteria with a chemical germicide registered as a tuberculocide by the Environmental Protection Agency (EPA).
- Low-level disinfection kills some viruses and bacteria with a chemical germicide registered as a hospital disinfectant by the EPA.
Used for semi-critical items (e.g., endoscopes, laryngoscope blades) that contact mucous membranes.
| Level | Agents | Examples |
|---|---|---|
| High-level | Glutaraldehyde, Ortho-phthalaldehyde | Endoscopes, respiratory equipment |
| Intermediate-level | Alcohols, Iodophors | Thermometers, stethoscopes |
| Low-level | Quaternary ammonium compounds | Bed rails, BP cuffs |
Sterilization
This is principally accomplished by;
- Steam under pressure (autoclave).
- Dry heat (hot air oven).
- Chemical agents such as ethylene oxide or low-temperature methods.
- Chemical sterilant as glutaraldehyde 2%.
Used for critical items (e.g., surgical instruments) that enter sterile body areas.
| Method | Application | Notes |
|---|---|---|
| Steam (Autoclave) | Surgical tools, linens | Most common; 121–134°C under pressure |
| Ethylene Oxide (EtO) | Heat-sensitive items | Requires aeration due to toxicity |
| Plasma (H₂O₂) | Endoscopes, electronics | Low-temp, fast turnaround |
| Dry Heat | Glassware, powders | 160–180°C for 1–2 hours |
Other Specifications
- Label all items with the date of sterilization.
- Every sterilized item has an expiry date.
- Inspect items before use to ensure that there are no tears, punctures, open seams, moisture, soiling from being dropped on the floor, etc.
- Once a package has been opened, it is no longer considered sterile, whether or not its contents are used.
- Do not store nonsterile items along with sterile items.
- If the sterility of an item cannot be assessed, it must be resterilized or discarded.
A well-done surgery can be spoiled by infection. Infection increases the cost for both the patients and the hospital. OT sterilization and proper instrument maintenance can provide an infection-free environment and quality care for patients.
OT Equipment Processing Checklist
| Step | Action Items |
|---|---|
| 1. Cleaning | – Remove visible soil and organic material – Use enzymatic detergent – Rinse thoroughly |
| 2. Disinfection | – Choose level (high/intermediate/low) – Immerse or wipe per manufacturer’s instructions – Ensure adequate contact time |
| 3. Sterilization | – Select appropriate method (autoclave, EtO, etc.) – Verify correct parameters (temperature, time, pressure) – Use chemical and biological indicators |
| 4. Storage | – Store sterile items in clean, dry, labeled areas – Avoid overpacking or torn wraps – Monitor expiry dates |
| 5. Documentation | – Record lot numbers, operator initials, and results of indicator tests |
| 6. Quality Assurance | – Perform regular validation of sterilization processes – Conduct audits and staff competency checks |
Special Considerations
- Zoning: Maintain sterile, clean, and disposal zones in OT to prevent cross-contamination.
- Daily Checklists: Use standardized logs for cleaning and sterilization cycles.
- Staff Training: Regular updates on protocols, PPE use, and handling of disinfectants.
- Spill Management: Follow biohazard protocols for blood/body fluid spills.
- Fogging: Used periodically for environmental decontamination in unoccupied OTs
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 Kluwers, 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
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