Cleaning & Disinfection Instruments
Eng. Reyad Al-Darawsheh
BODE Consultant for ME and GCC
1-2/11/2006 Muscat
Disinfection and Sterilization?
" Sterilization: killing of all MicroOrganism mainly by
Heat or Gaz Sterilzation
" Disinfection: Killing of MicroOrganism by using
chemicals (Disinfectants)
" Cleaning: is removing dirts only.
1-2/11/2006 Muscat
Instruments
" All instruments that penetrate the body
through the skin and cause injury and mixed
with blood circulation has to be sterilize
" All instruments that penetrate the body
without causing injury or mix with blood
circulation needs high level disinfection
" All instruments that comes in contact with the
skin without penetrating the body needs low
level disinfection
1-2/11/2006 Muscat
Disinfection of Instruments
Types of Instruments
Types of Instruments
, Surgical and ward instruments
drillers, sciccors, tongs, scalpels
, Rigid and flexible endoscopes
, Intensive care and anaesthesia materials
(plastic, rubber)
1-2/11/2006 Muscat
Disinfection of Instruments
Two standard applications
Two standard applications
, Washing maschines
chemo-temperature treatment
, Immersion procedure (manual processing)
1-2/11/2006 Muscat
Instruments
" We must clean instruments before disinfection?
" Why?????
1-2/11/2006 Muscat
HBV-contamination: Success (failure) in
disinfection
Study with angioscopes after contamination with duck-HBV
Disinfection : GDA, 2%ig
contamination rate [%]
Sterilization: Ethylenoxid,
6h
100
X. Chaufour et al.,
80
Evaluation of disinfection
Water
and sterilization of re-usable
60
Disinf.
angioscopes with the duck
hepatitis B model
Cl.+Dis.
40
J.Vasc. Surg. 1999;
Ster.
30: 277 -282
Cl.+Ster.
20
0
5 min 10 min 20 min
1-2/11/2006 Muscat
Influence of cleaning
worse cleaning
effect
Mechanical pre-
cleaning
of the channels with
an adequate brush
good cleaning effect
1-2/11/2006 Muscat
Influence of cleaning
Application time
Circulation procedure in
Blood removal
Soil of blood
room temperature,
[%]
1% solution of cleaner,
100
dried blood,
(BODE-internal
80
investigation 1999)
60
40
20
0
02468
Time [Min]
Dried blood removes very slowly !
Clean immediately after use !
1-2/11/2006 Muscat
Influence of cleaning
Interaction of blood with cleaner and disinfectant
Glass capillary:
left: cleaned with Bodedex forte,
disinfected with a glutaraldehyde
containing disinfectant
and rinsed with water
right: cleaned and disinfected
with a glutaraldehyde containing
disinfectant and rinsed with water
Working without cleaner, blood
coagulates and cannot removed
from channel systems
1-2/11/2006 Muscat
Influence of cleaning
Interaction of biofilm with cleaner and disinfectant
Biofilm
Mucus
Channel
Contamination
Flow
direction
Disinfectant
Bacteria within biofilms are very
resistant to disinfectants !
A good pre-cleaning is important !
1-2/11/2006 Muscat
Influence of cleaning
Other influences of a good cleaning:
Low foaming property
Neutralize hard water
Good compatibility with all materials
Neutral pH-value
1-2/11/2006 Muscat
Disinfection of Instruments
Active ingredients
Active ingredients
Gram neg. Gram pos. Myco- Fungi Spores Virus Virus not
Bacteria Bacteria bacteria envelopped envelopped
(HBV/HIV (Polio
Vaccinia, Rota, Papova,
Herpes) Adeno)
Form-
+ + + + + + +
aldehyde
GDA
+ + + + + + +
QAC
+ (+) - (+) - + (+)
Amine
+ (+) + (+) - + (+)
Peracetic
+ + + + + + +
acid
Phenole
+ + + (+) - (+) -
Aldehydes und Peracetic acid have the best microbicidal spectrum,
1-2/11/2006 Muscat
but ...
Disinfection of Instruments
Fixing blood
Fixing blood
model of soil with dried blood on metal plates
The metal plates had been disinfected (15 minutes),
then cleaned with a alcaline cleaner (5 minutes)
soil of blood
(%)
100
90
80
70
60
50
40
15 min
30
Disinfect.
20
10
5 min
0
cleaning
1-2/11/2006 Muscat
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Disinfection of Instruments
Fixing blood - optical results
Fixing blood - optical results
model of soil with dried blood on metal plates, some exemples
Influence on blood of a
Influence on blood with products
aldehydic products
based on peracetic acid
These two product-types have a fixing effect of proteins.
Peracetic acid decolourize the blood !
1-2/11/2006 Muscat
Disinfection of Instruments
Fixing blood - optical results
Fixing blood - optical results
model of soil with dried blood on metal plates, some exemples
Influence on blood of a product
Influence on blood with a
with QAC and a alkylamin
phenolic product
These two product-types havn't any fixing effect on proteins. All
soils are removed !
1-2/11/2006 Muscat
Disinfection of Instruments
Fixing blood - situation unter practical
Fixing blood - situation unter practical
conditions
conditions
Some exemples of channels from endoskopes which had been
reprocessed under different conditions
Automatic chemo-thermic
reprocessing with a aldehydic
The channels are
product, manuell precleaning
normally clean
1-2/11/2006 Muscat
Disinfection of Instruments
Fixing blood - situation unter practical
Fixing blood - situation unter practical
conditions
conditions
Some exemples of channels from endoskopes which had been
reprocessed under different conditions
Manuell reprocessing
Heavy fixation
under aldehydic
conditions
1-2/11/2006 Muscat
Disinfection of Instruments
Practical issues / endoscopes
" Ensure that all surfaces and hollow cavities are completely wetted by the
disinfectant solution. Air bubbles must be eliminated.
" The prescribed concentrations and contact times must be adhered to.
" Particular care must be given to the cleaning and disinfection of the channel
systems. Attention must be paid to both the biopsy channel and the air and
rinse channels, the storage container for rinse solutions and the relevant
tubing.
" After disinfection, rinse thoroughly w demineralised water or water at
ith
least of drinking water quality, and dry.
" Danger of recontamination! Stor
e endoscopes only when dry, and protect
against recontamination until re-use!
1-2/11/2006 Muscat
Disinfection of Instruments
Summary
Summary
QAC and
Aldehydes are
Alkylamines
fixing proteins
havn't any
fixing effect
Safety by careful
Safety by careful
cleaning
cleaning
Phenolic,
amines
Peracetic acid is
substances
fixing proteins
hav't any fixing
effect
1-2/11/2006 Muscat
Thank you and wish you all the best
1-2/11/2006 Muscat