Sterilization &

Disinfection

BY: ARJUN CHAUHAN

ASST. PROFESSOR
DPHS. PU. 1
 CSSD
CENTRAL STERILE
SUPPLY
DEPARTMENT
 Outline

• Overview of
disinfection and
sterilization.

• Various methods.

• Important
perspectives.
 Definitions

Sterilization: complete killing of all

forms of microorganisms, including
bacterial spores.

Disinfection: killing or removing of

harmful vegetative microorganisms.

Antiseptic: disinfectant that can be

safely used on living tissues.
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 Definitions
Bacteriocide
kill microbes
also germicide, fungicide, virucide
Bacteriostatic
Prevents or stops microbial
growth also fungistatic,
virustatic
Aseptic(Asepsis)
Prevent contamination of person or
object by microbes 4
 Definitions
• Sanitize
– Removal of pathogens from
inanimate objects
– Mechanical or chemical cleaning
– need not sterilize of disinfect

• Contamination
– Presence of living microbes on
object
 History
• In 1862, Louis
Pasteur developed
pasteurization
process.
• Joseph Lister,
in 1867, used a
carbolic solution
spray on the wounds
of his patients.
• Charles
Chamberland,
Getting from
here…

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Back To Here:

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 Survival of Pathogens on
Surfaces
Pathogen Survival
MRSA 7 days – 7 months
VRE 5 days – 4 months
Acinetobacter 3 days -5 months
C. difficile (spores) 5 months
Norovirus 12 – 28 days
HIV Minutes to hours
HBV 7 days
HCV 16 hours – 4 days
 Order of resistance
Hardest to Kill
•Prions
•Spores
•Mycobacteria
•Non-enveloped
viruses
•Fungi
•Vegetative
bacteria
Easiest to •Enveloped
Kill viruses 1
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 Methods of sterilization
and disinfection
PHYSICAL METHODS CHEMICAL METHODS
•SUNLIGHT •ALCOHOLS
• DRYING • ALDEHYDES
• DRY HEAT • DYES
• MOIST HEAT • HALOGENS
• FILTRATION • PHENOLS
• RADIATION •SURFACE-ACTIV
•ULTRASONIC AND E AGENTS
SONIC • METALLIC SALTS
VIBRATIONS • GASES
 Choice of Method
• Method to be used
will depend on:
– Device’s intended
use
– Risk of infection
– Degree of soilage
• Process must not
damage the device
Spaulding Classification
 Management of
contaminated items
Contaminated reusable items
should be:
•Handled as little as possible
•Staff should wear appropriate
PPE
•Gross debris removed at point
of use
•Soiled items removed
immediately after use
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It all starts with cleaning
Items can’t
disinfected be
sterilized or
unless
they are

Properly
cleaned.

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 Cleaning instruments
•Soak in enzymatic or
non- enzymatic
detergent
•Wear the appropriate PPE
•Keep instruments
submerged in solution and
scrub with brush
•Thoroughly rinse
the instrument
•Allow instrument to dry 1
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 Automated cleaning
Types:
• Ultrasonic cleaner
• Instrument washer

Benefits:
• Improved efficacy
• Reduced employee
exposure to splash
and sharps
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Disinfectants
 Activity of
disinfectants
•Contamination

•Concentration

•Temperature

•Time

•Range of action
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 High-Level Disinfectants
Germicide Concentration
Glutaraldhyde (Cidex) ≥ 2.0%
Ortho-phthaladehyde (Cidex OPA) 0.55%
Hydrogen Peroxide* (Sporox) 7.5%
Hydrogen Peroxide and peracetic acid* (Peract) 1.0% / 0.08%
Hydrogen Peroxide and peracetic acid* 7.5% / 0.23%
(Endospore
+)
Hypochlorite (free chlorine)* (Sterilox ©) 650-675 ppm
Accelerated hydrogen peroxide (Resert XL) 2.0%
Peracetic Acid (Steris 20) 0.2%
Glutaraldehyde and Isopropanol (Aldahol III) 3.4% / 26%
Glutaraldehyde and phenol/phenate (Sporicidin) 1.21% / 1.93%
 Liquid
Disinfectants
Disinfectant Agent Use Concentration
Ethyl or isopropyl alcohol 70% - 90%
Chlorine (bleach) 100 ppm
Phenolic UD
Iodophor UD
Quaternary UD
ammonium
compound (QUAT)
Improved/Accelerated 0.5%, 1.4%
hydrogen peroxide
Sterilization
 Dry Heat Sterilisation
• Require hot-air ovens
• For glassware, metallic items, powders
and oil/grease
• Time two hours at 160°C and one
hour at 180°C
• Plastics, rubber, paper and cloth
cannot be placed in them due to fire
risk
 Dry Heat Sterilisation
Advantages
• Can be used for powders, anhydrous
oils
• Inexpensive
• No corrosive effect on instruments
Disadvantages
• High temperature damages some
items
• Penetration of heat slow, uneven
 Autoclave
Pressu Temperatu Time
re re (°C) (min
(psi) s)
15 121 15
20 126 10
20 134 3
 Types of autoclave
• Downward displacement
• Positive pressure
displacement

• Negative pressure
displacement

• Triple vacuum autoclave

 Gravity Displacement
Autoclaves
• Steam introduced to
purge out air and build
pressure
• Raise temperature
normally to 121°C at 15
pounds/square inch and
maintain it for 15-45
minutes
• For sterilising liquids and
items in wraps that steam
can penetrate
 High-Vacuum Autoclaves
• Air is first vacuumed out and
then steam introduced
• Faster and better penetration
throughout the load
• Pressure and temperature
higher; 134°C at about at
30 pounds/inch2
• Processing time about three
minutes
• Not suited for liquids due to
need for vacuum
 Low-Temperature
Sterilization
• Mixture of steam (50-80°C)
and formaldehyde vapour
• To process heat-resistant or
heat- sensitive medical
devices in specialised
equipment
• Devices pre-cleaned and
wrapped in standard material
and processed in a three-hour
cycle
• Cannot be used for liquids
 Flash Sterilisation
Only to process a critical
surgical item:
in an emergency
when accidentally
contaminated, or
when other means
of
sterilisation unavailable

Never to be used for

implantable items or to
compensate for shortage
of key instruments
 Ethylene Oxide Gas
Sterilisation
• Used for heat
or moisture
sensitive items
• Prevents
normal
cellular
metabolism
and
replication
 Hydrogen Peroxide Gas
Plasma
• Highly reactive/charged
particles from hydrogen
peroxide generated under
vacuum
• Can be used to sterilise heat-
and moisture-sensitive items
– Some plastics,
electrical/electronic devices,
and corrosion-susceptible
metal alloys
• Special wrapping required
 Fumigation
• For rooms contaminated with
some pathogens
– Such as MRSA and Clostridium
difficile
• Release of hydrogen peroxide,
chlorine dioxide gas or possibly
ozone in sealed rooms
• Spore strips (biological indicators)
placed strategically to monitor
process
• Special equipment required
 Pasteurisation and Boiling
• Semi-critical items can
be pasteurised
– 65-77°C, 30 min
– Example: respiratory
therapy equipment
• Must be retrieved carefully
for safe transport and
storage
 Filtration
• Removal of microbes from
air or heat-sensitive
liquids
• Disinfectant-impregnated
filters may inactivate
trapped microorganisms
• Example: High-efficiency
particulate air (HEPA)
filters
• All filters must be checked
 Ultraviolet (UV) Light
• UV lamps useful for
chemical-free
disinfection of air and
water and also
possibly for
decontamination of
environmental
surfaces
• Broad-spectrum
microbicidal action
• Require regular
cleaning and periodic
replacement
 Microwaves
• Heating from rapid rotation
of water molecules
• Limited use except for
disinfecting soft contact lenses
and urinary catheters for
intermittent self-
catheterisation
• May be used in emergencies
to treat water for drinking or to
‘disinfect’ small
water-immersible plastic or
glass items
 Wrapped or
Packaged
Instrument Sets in
Autoclave
Item Time Temperature Pressur Notes
e
Small 15 minutes 270° F (132° 30 psi Drying time 15-30
wrapped or C) min No drying time
packaged Add 5 min – packs must be
loads to allow for handled with sterile
reaching gloves
parameters

*Not recommended without use of minimum 3

drying times 9
 Instrument wrap

• Should be square wrap

with a 6 inch border
around each side of the
pan.

• Alternative wrap: 140-

thread count, 100%
cotton muslin.
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 Wet packs?
Cause Solution

Over packed autoclave Run smaller loads

Dehydrated wrap Launder wrap after
each use
Short drying time Extend drying times
Stored on solid Store on wire
cool surface mesh shelving
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 Storage of Sterile Items
•A well-ventilated area that
provides protection against dust,
moisture, and temperature and
humidity extremes.
•Sterile items should be stored so
that packaging is not
compromised.
•Label sterilized items with a load
number that indicates the
sterilizer used, the cycle or load
number, the date of sterilization,
and if applicable the expiration 4
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 Monitoring

Autoclave tape –
external indicator

Chemical indicator –
internal indicator

Indicators should be checked prior to using any

item.
No color change – do not use and return for proper
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sterilization. 3
 Biological
METHOD OFmonitorsBIOLOGICAL CONTROL
STERILIZATI
ON
•Hot Air Oven Bacillus subtilis subsp. Niger
Clostridium tetani

•Autoclave Bacillus stearothermophilus

•Filtration Serratia marcescens,

Pseudomonas diminuta

•Ionizing Radiation
Bacillus pumilis
Dental Surgery Perspective

Gigasept which
contains
succindialdehyde and
dimethoxytetrahydrofura
n are used for
disinfection of plastic
and rubber materials
eg: dental chair
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 Asepsis of surgical
theaters

Fumigation is done
by two methods:
• Electric
boiler
method
• Potassium
permanganat
e
 BIOPSY SPECIMEN

Biopsy collection &

transportation can also be a
source of infection.
• It should be kept in sturdy
containers with secure lid.
• Avoid contaminating the
external surface of the
container.
• Swab used for collecting micro-
organisms should be
transferred slowly and carefully
to the swab container
 Impression Trays
Impression trays are sterilized as
follows
• metallic - autoclave
• plastic – ethylene oxide

Disinfection of alginate impressions –

Methods
• - Spraying
• - Immersion
• Iodophors, sodium hypochlorite
(1:10 concentration ) ,
• phenols, formaldehyde,
 DENTAL CASTS
Spraying until wet
or Immersing in a
1:10 dilution of
sodium
hypochlorite or an
iodophor then
rinse

Casts to be
disinfected should
be fully set (i.e.
stored for at least 24
hours
 ROTARY INSTRUMENTS - BURS
Diamond and carbide burs:
After use they are placed in 0.2%
gluteraldehyde and sodium phenate
(Eg. Sporicidin) for at least 10
minutes,
cleaned with a bur brush or in an
ultrasonic bath.
Sterilize in an autoclave or dry heat

Steel burs:
May get damaged by autoclaving. Can be
sterilized by using a chemical vapor
sterilizer or glass bead sterilizer at 2300C
for 20-30 seconds.
 INSTRUMENTS
Sharp instruments are ideally sterilized
by : conventional hot air oven

BUT NOT BY:

Boiling
Autoclav
e
2% glutaraldehyde

Blunt instruments are sterilized

by Autoclave
 Sutures
Sutures are pre sterilized
by gamma radiation
Sutures are re- sterilized by
two recommended
methods
1. Soak for a full 10
minutes completely
immersed in
povidone iodine 10%
solution, then rinse in
sterile saline/water.
 ENDODONTIC INSTRUMENTS

• Glass Bead or salt sterilizer

• Gutta percha points are

pre- sterilized.
• Contaminated points are
sterilized by 5.25% sodium
hypochlorite(1 min
immersion).
Then rinse with hydrogen
peroxide & dry it.
 IMPLANTS
Pre sterilized with
Gamma radiation
In case the implants needs to
be re-sterilized
conventional sterilization
techniques are not
satisfactory
Steam / Dry heat
sterilization should not
be used
Radio frequency glow
discharge technique
(RFGDT) or Plasma
 Take home points
Cleaning, disinfection, and sterilisation
are the backbone of infection
prevention and control
Proper cleaning is essential before
any disinfection or sterilisation
process

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 Take home points
Steam sterilisation is effective only
when preceded by
Thorough pre-cleaning,
proper packaging/loading,
and careful monitoring of
autoclaves.

Chemical disinfectants must be

selected, used, and discarded to
minimise harm. 5
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Questions ?