3._ Instrument Processing.ppt
- 2. 2 Learning objectives At the end of this session, students will be able to: • Describe the steps of instruments and other items processing • list commonly used disinfectants • Explain how disinfectant solutions are prepared • Demonstrate the steps of decontamination process, cleaning process, sterilization and HLD process • Explain how to store sterilized and high level disinfected instrument and other items
- 3. Introduction • Every item, whether a soiled metal instruments or pair of surgical gloves, requires special handling and processing in order to: o Minimize the risk of accidental injury o Provide a high quality end product (i.e., sterile or HLD instruments and other items). 3
- 4. Chemical Disinfectant • Disinfectants are chemicals that destroy or inactivate microorganisms on inanimate objects • They are not meant to be used on the skin or mucus membranes 4
- 5. Factors that influence the effectiveness of disinfectant Nature of the item. Items with joints are more difficult to disinfect. Number and type of microorganisms present on the object. Amount of soil or organic matter Contact time. Disinfection requires direct contact with the agent for a specific time. Concentration of solution. - The more concentrated the 5
- 6. Classification of Patient Care Items Critical items: - items enter sterile tissue, break the mucosal barrier, or come into contact with the vascular system E.g. surgical instruments, catheters, needles, implants etc. Semi critical items - which has contact with mucous membranes and require high- level disinfection , or sterilization. e.g respiratory therapy equipment high level chemical disinfection non Critical items • used only with intact skin. • Intermediate or low-level disinfection is adequate. • E.g. blood pressure cuffs, furniture, linens, bedpans, and eating utensils 6
- 7. Chlorine and chlorine releasing compounds Sodium Hyporchlorite (chlorine bleach) Advantages • It is the least expensive and most readily available • Easy to prepare and use. • Quickly inactivates all viruses as well as killing tubercle bacillus. • Very useful for decontaminating soiled surgical instruments, gloves and other items and large surface areas 7
- 8. Chlorine … continued Limitation • Inactivated by organic matter. • Loses potency on standing if left in open container (replace at least daily). • May corrode metal instruments with prolonged exposure (>20 minutes) to concentrations greater than 0.5%. 8
- 9. Chlorine … cont’d Calcium hypochlorite or chlorinated lime Available in powder form. • Calcium hypochlorite contains approximately 70% available chlorine. • Chlorinated lime contains approximately 35% available chlorine. 9
- 10. Chlorine …continued Advantages • Both decompose more slowly than sodium hypochlorite, but they still should be protected by storing away from heat and light. Limitation • Inactivated by organic matter. • May corrode metal with prolonged exposure (>10 minutes) unless thoroughly rinsed. • More difficult to prepare dilute solutions due to poor solubility in alkaline water (PH >8) 10
- 11. Formaldehyde • It can be used as a chemical sterilant, as well as a high-level disinfectant. • However have the following limitations o Causes skin irritation. o Potential carcinogen o Irritates the skin, eyes and respiratory tract, even at low concentrations. o Produces a dangerous gas (bis-chloromethyl-ether) when mixed with chlorine. • There fore, should not be used for HLD or sterilization if other high-level disinfectants are readily available. 11
- 12. Glutaraldehydes • An alkaline-stabilized 2% glutaraldehyde available commercially as Cidex® or Cidex 7® are the most common • Advantages o Not readily inactivated by organic materials. o Generally can be used for up to 14–28 days. o Noncorrosive and can safely be used on surgical endoscopes (laparoscopes) • Limitation o Can cause skin irritation or dermatitis with chronic exposure. o Vapors are irritating to mucous membranes (eye, nose and mouth) and respiratory tract. o Work best at room temperature (20–25oC or 68–77oF). o Expensive. 12
- 13. Preventing Contamination of Disinfectants • Pour solutions into smaller container for use during service delivery to avoid contaminating the stock container. • Label reusable containers with the date each time they are washed, dried and refilled. • Always use clean water for decontamination, boiled water for HLD and sterile water for sterilization to dilute disinfectants. 13
- 14. Preventing contamination of Disinfectants • Prepare and use disinfectant in a clean, less traffic flow and duty area. • Store disinfectants in a coal, dark area. • Avoid storing them in direct light or excessive heat, as this may reduce their strength. 14
- 15. 15 Household Bleach Safety • Use mask, goggles, rubber gloves, waterproof apron and cape • Mix in well-ventilated and at room temperature • Do not use or mix with other detergents • Use cold water to mix
- 17. What is decontamination? • Decontamination is the process of making inanimate objects safer to handled by staff before cleaning. o Inactivates HBV and HIV o Must be done before cleaning o It is done by soaking the equipment in 0.5% chlorine solution 17
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- 19. 19 Instructions for Preparing Dilute Chlorine Solutions To make a 0.5% chlorine solution from 5% bleach, mix 1 part bleach to 9 parts water. Dilute % e Concentrat % Total parts (TP) (H2O) = - 1 Total parts (TP) (H2O) = Dilute .5% e Concentrat 5% - 1 = 9 Total parts (TP) (H2O)
- 20. 20 Examples Using 5% Bleach for 0.5% Concentration One part bleach to 9 parts water (use the same container to measure the bleach and water)
- 21. 21 Instructions for Preparing a Chlorine Solution from a Powder To make a 0.5% chlorine solution from a 35% chlorine powder, mix 14.2 grams of powder to 1 liter of water. e Concentrat % Dilute % Gram/Liter = X 1000 e Concentrat 35% Dilute .5% Gram/Liter = X 1000 = 14.2 Gram/Liter
- 22. 22 Decontamination practices • Place instruments and reusable gloves in 0.5% chlorine solution after use • Soak for 10 minutes and rinse immediately. • Do not soak instruments in decontaminating solution for more than 10 minutes, because it results corrosion • Use plastic container with cover for decontamination
- 23. 23 Use three buckets, one filled with 0.5% chlorine solution, one with soap and water and one with water
- 25. labeling of the containers is one of the important aspects of decontamination 25
- 26. Cleaning 26
- 27. 27 Cleaning • Physically removing infectious agents and other organic matters • Doesn’t necessarily destroying infectious agents • Use liquid soap for effective cleaning
- 28. 28 Cleaning Cleaning practices • Use PPE during cleaning • Disassemble instruments • Wash with detergent, water, and a soft brush. • Scrub instruments under the water surface until visibly clean. • Thoroughly rinse with clean water.
- 30. 30 Sterilization • Destroys all microorganisms, including endospores • Used for instruments and other items that come in direct contact with the blood stream or tissue under the skin
- 31. 31 Common Methods of Sterilization High-Pressure Steam (Autoclave) Chemical Dry-heat (Oven)
- 32. 32 High-Pressure Steam Sterilization (Autoclave) Requirements: • Adequate contact • Sufficiently high temperature • Correct time • Sufficient moisture
- 33. 33 Autoclave … Continued The temperature, pressure and time combination for steam sterilization is: • 121°C (250ºF); 106 kPa pressure: o 20 minutes for unwrapped items o 30 minutes for wrapped items • 1320C (2700F), under pressure for 15 minutes for wrapped items. • Allow all items to be cooled and dried before removing.
- 34. Techniques for packing instruments for the autoclave 34
- 36. 36 Autoclave…continued Instructions for operating steam sterilizer • Decontaminate, clean, and dry all instruments and other items to be sterilized. • All jointed instruments should be in an open or unlocked position; when possible, instruments should be disassembled. • Instruments should not be held tightly together by rubber bands. Allow free circulation and penetration of steam to all surfaces. • Wrap instruments in double thickness of muslin or newspaper.
- 37. 37 Autoclave…continued Instructions for operating steam sterilizer • Allow instrument packs to dry completely before removal. • Wrapped instrument packs are considered unacceptable if there are water droplets or visible moisture on the package exterior when removed from the autoclave. • Wrapped items remain sterile as long as the pack remains clean, dry (including no water stain), and intact.
- 38. 38 Dry Heat Sterilization (Oven) Principles: • Dry heat sterilization is accomplished by thermal (heat) conduction/ transfer. • Initially, heat is absorbed by the exterior surface of an item and then passed to the next layer. • Microorganisms die as their proteins are slowly destroyed. • Dry heat sterilization takes longer than steam sterilization because the steam speeds up the penetration of the heat. Requirements: • Adequate temperature • Correct time
- 39. Oven…cont’d Recommended temperature/time ratios 39 170°C (340°F) 60 minutes 160°C (320°F) 120 minutes 150°C (300°F) 150 minutes 140°C (285°F) 180 minutes 121°C (250°F) overnight Remember: Depending on the temperature selected, the total cycle time (preheating, sterilization time, and cool down) will range from about 2.5 hours at 170°C to more than 8 hours at 121°C.
- 40. 40 Oven Instructions for dry heat oven • Decontaminate, clean, and dry all instruments and other items to be sterilized. • Items can be wrapped in aluminum foil or placed in a metal container with a tight-fitting lid. • Wrapping helps prevent recontamination prior to use. • Begin timing after the desired temperature is reached • Items should be removed and stored after cooling.
- 41. 41 Chemical Sterilization • It is an alternative for items that would be damaged if subjected to steam or dry heat sterilization. • Glutaraldehyde and formaldehyde are sterilants if used for the appropriate time. • Glutaraldehyde and formaldehyde are not readily inactivated by organic materials. • When handling these products: o Wear gloves to avoid skin contact. o Wear protective eyewear to protect from splashes. o Limit exposure time. o Be in a well-ventilated area.
- 42. 42 Chemical Sterilization…continued • Sterilization takes place by soaking o For 10 hours in 2–4% glutaraldehyde solution or o For 24 hours in 8% formaldehyde. • Rinse with sterile water
- 43. 43 Instructions for Chemical Sterilization • Decontaminate, clean, and dry all instruments and other items to be sterilized. • Completely submerge the items in a clean container filled with the chemical solution and place the lid on the container. • Allow items to soak (10 hours in (2-4% conc.) glutaradehyde or 24 hours in (8% conc.) formaldehyde). • Remove objects from the solution with sterile forceps, rinse all surfaces three times with sterile water, and air-dry. • Store objects in a sterile container with a tight-fitting lid.
- 44. 44 Monitoring Sterilization Procedures Sterilization procedures can be monitored routinely using: • Biological indicators: highly resistant but relatively harmless (non pathogenic ) eg, Stearothermophilus dies after 2 mins when the Temp. reaches at 121 °C or 250 °F used to test steam sterilizers. • Mechanical indicators: visible record of time Temp. & pressure (Graphs/ Gauges of the sterilizers) • Chemical indicators: using sensitive tape or glass containing pellets that melt at certain temp. and duration
- 45. 45 Storage of a Sterile Package • All sterile items should be stored in an area whereby the packs or containers will be protected from dirt, moisture and animals. • As long as the sterile pack remains dry and intact, the shelf life of the item could stay till 21 days - one moth • The storage area is best located next to or connected to the place where sterilization occurs • It should be in a separated enclosed area with limited access that is used only to store sterile and patient care supplies.
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- 47. Storage area 47
- 48. 48 The Shelf-Life System • The shelf-life of an item after sterilization is event-related. • The item remains sterile until something causes the package to become contaminated. An event can be: o A tear or worn area in the wrapping o The package’s becoming wet o Anything that will enable microorganisms to enter the package or container • These events can occur at any time
- 49. 49 The Shelf-Life of a sterilized Object Shelf-life depends on the following factors: • Quality of the wrapper or container • Number of times a package is handled before use • Number of people who handled the package • Status of package storage of in an open or closed shelves • Condition of the storage area (humidity, cleanliness) • Use of plastic dust covers and method of sealing
- 51. 51 High-Level Disinfection • Destroys all microorganisms including HBV, HCV, and HIV; does not reliably kill all bacterial endospores • Only acceptable alternative when sterilization equipment is not available
- 52. 52 Common Methods of HLD Boiling Chemical Steaming
- 53. 53 HLD…Cont’d Practices of HLD by Boiling • Boil instruments for 20 minutes. • Always boil instruments in a jar with a lid. • Start timing when the water begins to boil. • Do not add anything to the jar after timing begins. • Air-dry before use or storage.
- 54. 54 HLD… continued Practices of HLD by Steaming • Steam for 20 minutes. • Be sure there is enough water in the bottom pan for the entire steam cycle. • Bring water to a rolling boil. • Start timing when the steam begins to come out from under the lid, • Do not add anything to the pan after timing starts. • Air-dry and store instruments in covered steamer pans.
- 55. 55 HLD…continued Practices for Chemical High-Level Disinfection • For HLD, a 0.1% chlorine solution shall be prepared from boiled water (stainless steel or plated instruments) • Cover all items completely with disinfectant, • Soak for 20 minutes, • Rinse thoroughly with boiled water three times, • Air-dry before use and storage, • Remove items using HLD or sterile forceps/gloves
- 56. 56 HLD… conteniued Chemicals for HLD • 0.1% Chlorine solution o Safe for stainless and plated instruments o Concentrated solutions >0.5% can corrode metals • 8% Formaldehyde o Vapors are irritating (staff should wear appropriate PPE) o A potential carcinogen o Do not mix with chlorine (can produce dangerous gas)
- 57. 57 HLD… contiued • Glutaraldehyde 2-4% o Less irritating but still needs to in well ventilated area • Hydrogen peroxide 6% o Highly corrosive and should not be used to disinfect copper, aluminum and zinc o Loses potency rapidly when exposed to heat and light, Note o Chemical disinfectants should be stored in a cool, dark area, o Never store chemicals in direct sunlight or in excessive heat
- 58. 58 Table :Effectiveness of Methods for Processing Instruments Method Effectiveness (kill or remove microorganisms) End Point Decontamination Kills HBV and HIV and most microorganisms 10-minute soak Cleaning (water only) Up to 50% Until visibly clean Cleaning (water and soap) Up to 80% Until visibly clean Sterilization 100% High-pressure steam, dry heat, or chemical High-Level Disinfection 95% (does not inactivate some endospores) Boiling, steaming, or chemical for 20 minutes
- 59. Guidelines for which Process to Use Procedure Sterilization HLD Cesarean Section Preferred Acceptable Abdominal Laparotomy Preferred Acceptable Vaginal Childbirth Preferred Acceptable Contraceptive Implants Preferred Acceptable Laparoscopy Preferred (chemical only) Acceptable MVA Cannulaea Acceptable Acceptable IUD (insert/remove) Acceptable Acceptable Pelvic Examination Acceptable Acceptable a MVA: manual vacuum aspiration (for treatment of incomplete abortion) 59
- 60. THANK YOU 60