Sterilization.pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. infection

3. infection Diseases caused by microorganisms Bacteria Viruses Fungi Parasites Prions

4. Sterilization Introduction & History.

5. Sterilization Introduction & History. Problems of Surgery: Pain Hemorrhage Shock Infection

6. Sterilization Introduction & History. Semelweis and Holmes Pasteur Lister Asepsis

7. Sterilization Some terms

8. Sterilization Some terms Infection Sterilization Asepsis Disinfection Decontamination Degerming Antiseptics

9. Sterilization

10. Sterilization Sterilization: killing all microorganisms i.e.. Bacteria Spores Viruses Fungi Parasites

11. Sterilization Asepsis: Preventing access of microorganism into an operative wound. By- Scrubbing Donning Sterile supply Laminar airflow

12. Sterilization Disinfection: Killing of pathogenic microorganisms (not all) on inanimate objects through the use of chemical agents. instruments and equipments Floors Excreta

13. Sterilization High level Disinfection: only few endospores are spared.

14. Sterilization Decontamination: Thorough mechanical cleansing with soap or detergent and water to remove all traces of blood pus protein mucus Ultrasonic washer for delicate instruments. Enzymes

15. Sterilization Degerming Antiseptics Chemical substances used to kill pathogenic microorganisms from skin of Operative site or operating hands.

16. Sterilization Methods

17. Sterilization Methods Physica l Heat Radiation Filtration Chemical Alcohols Aldehydes Dyes Halogens Phenols Metallic salts Gases- ETO, Hyrogen Peroxide Plasma Peracetic acid

18. Sterilization Methods Heat Dry heat Flaming Incineration Hot air Moist heat Boiling Autoclaving

19. Autoclaving:

20. Autoclaving: Most efficient method of Sterilization For heat resistant articles. Steam under pressure Attention to details is important Must exhaust all air at the beginning. Newer models have vacuum pump ..

21. Sterilization by boiling

22. Sterilization by boiling Disinfection rather than sterilization i.e.. Spores are not killed. Metallic and glass articles Boil for 30 to 40 minutes.

23. Sterilization By dry heat

24. Sterilization By dry heat Hot air Oven For glassware, sharps For materials that resist penetration by steam- talc Vaseline, fats and oils @121 o C---6hours @170 o C---1hours More useful in pathology lab.

25. Sterilization By dry heat Flaming Trays, surfaces, steel instruments

26. Sterilization By dry heat Incineration: Hospital waste

27. Colour coding of Hospital waste

28. Colour coding of Hospital waste Red : Infectious Non bio degradable Yellow: Infectious biodegradable White : Sharps Blue : Non Infectious Non biodegradable Green Non Infectious biodegradable Black: Unused expired medicines

29. Colour coding of Hospital Waste Transfer out if COVID-19 negative Discharge: afebrile for 48 hours; normal vital signs (pulse, respiration and BP

30. Sterilization by radiation

31. Sterilization by radiation Two types of Radiation are used: -Ionizing radiation :gamma rays -high energy electrons Used commercially for: Plastic disposables Sutures

32. Sterilization by radiation Ultraviolet Used for disinfection of air of OT -UV lamps in OT - UV lamps +fan in air sterilizer -inside OT’s AC Harmful to the eyes.

33. Chemical Sterilization

34. Chemical Sterilization Prior decontamination and subsequent cleansing of equipment is mandatory

35. Chemical Sterilization Glutaraldehyde 2% aqueous solution is used Heat sensitive equipment are immersed for 25 to 45 minutes. Sterilant in10 hours. Ideal for Endoscopes, Laparoscopes and accessories,

36. Chemical Sterilization Isopropyl alcohol/Ethyl alcohol (Spirit): Used for degerming before: Operations Injections Dressing On surgeon’s hands after scrubbing.

37. Isopropyl alcohol/Ethyl alcohol

38. Isopropyl alcohol/Ethyl alcohol Can be used for instruments and endoscopes Complete decontamination prior to its use is a must. Doesn’t kill spores.

39. Autoclaving:

40. Autoclaving: - 15 psi 121 o C 20minutes 30 psi 134 o C 3minutes 45 psi 141 o C 1minute

41. Steps of Autoclaving Loosely pack articles in drum. Keep open the holes of drum. Fill water in autoclave up to the mark Put drums inside the autoclave. Close the lid. Close all valves. Switch on.

42. Steps of Autoclaving When pressure reaches 2psi>Open air release valve. When pressure reaches zero>Close air release valve. When pressure reaches 15 psi whistling starts> Note Time DO NOT SWITH OFF Autoclave maintains pressure & temperature by releasing small amounts of steam. If autoclave has multiple heating elements keep only one on.

43. Steps of Autoclaving After 20 minutes at this pressure and temperature i.e. 15 psi, 121 o C:- 1.Switch off power. 2.Open steam release valve 3.When all steam has exited> CLOSE STEAM RELEASE VALVE. Allow to cool for 10 minutes. Open the lid and take out drum Close holes of drum

44. Autoclaving Instead of drum articles can be put in open pots or on the racks.

45. Storage

46. Storage Sterile and disinfected articles should be kept in storage area which should be clean and dry. Remain sterile for one week if lid is not opened.

47. CSSD

48. CSSD Autoclaving is carried out in CENTRAL STERILE SUPPLY DEPARTMENT From CSSD supplied to OT and various other wings of the hospital.

49. Sterilization Cycle

50. Sterilization Cycle Contamination from patient Soak in0.5% chlorine Cleaning Disinfection Sterilization Rinsing Drying Storage

51. Chemical Sterilization

52. Chemical Sterilization Lysol Sharp instruments are kept immersed in it ready for use.

53. Chemical Sterilization Formalin Used for fumigation of rooms For endoscopes, rubber and plastic articles Vapor is used in formalin chambers. Exposure time 10 to 24 hours. Must be wiped away before use. Not favooured nowadays

54. Chemical Sterilization Gas E.O./E.T.O.—Ethylene Oxide Sterilization is achieved on 3 to 6 hours of exposure. Specially designed chamber is used. Gas is highly explosive hence used mixed with Nitrogen or Carbon Dioxide

55. Gas Sterilization

56. Gas Sterilization Useful for Endoscopes Tubing and plastic parts of heart-lung machine and respirators Prepacked plastic products like syringes, iv sets Blankets, Pillows Mattresses .

57. Gas Sterilization Gas is toxic Is absorbed by rubber, plastics, Fabric and leather. Gas must be removed from these by aeration for 24 hours. Plastic and metal objects can be used immediately.

58. Chemical Sterilization

59. Chemical Sterilization 0.5% Chlorine (Sodium Hypochlorite) All articles contaminated with body fluids are immersed for 30 minutes even prior to handling. Surfaces are mopped with.

60. Filtration

61. Filtration Filtration is the preferred method of sterilizing heat sensitive liquid and gases without exposure to denaturing heat. method of choice for sterilizing antibiotic solutions, toxic chemicals, radioisotopes, vaccines, and carbohydrates, which are all heat-sensitive.

62. Filtration The liquid or gas is passed through a filter, a device with pores too small for the passage of microorganisms, but large enough to allow the passage of the liquid or gas. 

63. Relative size of human cells, bacteria and virus

64. Filtration Materials Name of the filter Asbestos pad Seitz filter Diatomaceous earth Berkefeld filter Procelain Chamberland-Pasteur filter Sintered glass disks Sintered glass filter Cellulose Membrane filter Borosilicate glass fiber HEPA filter Clay, mud Candle filter

65. Sterilization: Overview

66. Sterilization: Overview Sharps ETO/Cidex/Lysol Wrapped Autoclaving Sutures Radiation/Autoclaving Diathermy Electrodes ETO/Radiation Silicon oil Autoclaving

67. Tests for Sterilization:

68. Tests for Sterilization: Indicator tapes. Culture Test strips for Cidex Browne’s tube.

69. Degerming

70. Degerming Painting the operative site Standard Practice: Chlorhexidine scrub Remove with sterile swab Paint with Povidone Iodine Paint with 70% Ethyl alcohol / Isopropyl alcohol Recent trend- Paint with povidone Iodine then allow to dry

71. Antiseptics Chlohexidine (Savlon) Iodophores: Povidon Iodine Ethyl/Isopropyl alcohol Eusol Chlorooxylonol Cetrimide(Cetavlon)

72. Antiseptics Chlohexidine (Savlon) Iodophores: Povidon Iodine Ethyl/Isopropyl alcohol Eusol Chlorooxylonol Cetrimide(Cetavlon)

73. Antiseptics General principles: To be used on healthy skin not on other tissues. Tissue debris interferes with action If used on Instruments must be rinsed prior to use. Avoid using antibiotics as antiseptic

74. Maintaining Sterility in OT

75. Maintaining Sterility in OT Center For Disease Control (CDC) guidelines: Surveillance and classification Preparation of patient Preparation of surgical team Ventilation and air quality in OR Cleaning and culturing Operative technique Wound care Prophylactic antibiotics

76. Surveillance and classification

77. Surveillance and classification All Operations: Clean Clean contaminated Infected Record Infection rates

78. Preparation of patient Preexisting bacterial infection Short preop hospital stay Nourishment Bath night before Hair removal Painting Draping

79. Preparation of surgical team

80. Preparation of surgical team Wear: Mask Cap/hood Beard must be covered Scrubbing Sterile gowns and gloves

81. Ventilation and air quality in OR

82. Ventilation and air quality in OR Doors kept closed Minimum number of personnel allowed 25 air exchanges per hour Filtered air

83. Cleaning and culturing

84. Cleaning and culturing OR must be cleaned: Between Operations Daily Weekly Routine culturing is not recommended Mats not recommended

85. Operative technique

86. Operative technique Gentle tissue handling Prevent Bleeding Eradicate dead space Minimize devitalized tissue and foreign material in the wound

87. Wound care

88. Wound care Dirty and infected wounds should not be closed primarily Drain Wash hands before and after Gloves Change of dressing

89. Prophylactic antibiotics

90. Prophylactic antibiotics Parenteral 2 hours before (except Cesarean section) Oral not recommended Colorectal: 24 hours before operation Dirty/infected:- therapeutic

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