Cleaning
- removal of visible soil (organic and inorganic)
- usually involves mechanical or manual methods
- uses detergents or enzymes, water
Surgical hand antiseptics
- no jewelry below elbow
- agent order of effectiveness: alcohol, CHG, iodophors, tricolsan, plain soap
- combo agents, CHG/alcohol, most persistent activity to decrease boiburden
Decontamination
-removal of pathogenic organisms so equipment safe to handle without PPE
Antiseptic
-germicide applied to living tissue or skin
Sterilization
- all microorganisms killed or destroyed, including spores
- physical or chemical methods
germicide
- kills organisms
- includes antiseptics and disinfectants
Disinfectant
-antimicrobial agents used for inanimate objects
Disinfection
-all microorganisms, except spores, killed or disabled
Spaulding Classification: critical items
- enter sterile tissues or vascular system
- sterilization required
High level disinfection
- free of all vegetative microorganisms
- small number of spores may be present
- includes aldehydes, hydrogen peroxide, peracetic acid
Intermediate disinfection
- destroys vegetative bacteria, mycobacteria, most viruses, most fungi, not spores
- includes phenolics, alcohols, iodophors
Spaulding classification: Semi-critical items
- contact with mucous membranes or non-intact skin
- high level disinfection required
Spaulding classification: noncritical items
- contact with intact skin
- intermediate or low level disinfection
Low level disinfection
- destroys vegetative bacteria, some fungi, some viruses, not mycobacteria, not spores
- includes quat ammonias
Prions
- organisms resistant to sterilization methods
- CJD
- body fluids/tissues should not be allowed to dry on instrument prior to cleaning and decontamination
- critical equipment requires intense sterilization methods, might need to be incinerated
- noncritical equipment: 1:10 bleach solution
Biological indicators
- used in first daily load, or at least weekly
- Bacillus stearothermophilus or Bacillus subtillis
Endoscope disinfection
- poor disinfection methods associated with outbreaks
- steps: clean, disinfect, blow with compressed air, alcohol rinse, hang to dry, store
- require high level disinfection
Positive biological indicator response
- reported to IP, surgeon, OR manager
- remove & reprocess all questionable equipment
Aseptic Technique
- hand antisepsis
- sterile gown and gloves
- sterile drape
- sterile field
Peracetic acid & H2O2
- no activation necessary
- incompatibility with metals (caustic)
- potential skin/eye damage
- limited knowledge regarding use
Glutaraldehyde
- published use studies
- inexpensive
- excellent compatibility
- slow bacterial activity
- respiratory & skin irritation, vapor monitoring needed
- blinds blood & tissues to surfaces
- sporicidal
Hydrogen Peroxide (H2O2)
- no activation necessary
- enhances organism removal
- does not fix blood or tissue to surfaces
- incompatible with metals (caustic)
- eye damage with contact
- published use studies
Peracetic acid (C2H4O3H)
- Enhanced organism and endotoxin removal
- environmentally friendly
- some material incompatibility
- immersible equipment only
- serious eye and skin injury with contact
- point of use system, not sterile storage
- sporicidal
Sodium hypochlorite (bleach)
- inexpensive
- fast acting
- material incombatibility
- enhances organism removal
- bactericidal, virucidal, sporicidal
- not active in presence of organic material
