CLEANING,

DISINFECTION,
AND STERILISATION
 Objectives

1. Define cleaning, disinfection and sterilization

2. Explain process of disinfestation
3. Describe Spaulding classification
4. List the hospital grade disinfectant
5. Explain about equipment and surface disinfection
6. Explain about sterilization and its principles
7. Explain management at CSSD

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 DECONTAMINATION

The killing of organisms or removal of contamination after use,

generally referring to procedures for making items safe before disposal

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 Decontamination

Cleaning Disinfection Sterilization

 CLEANING

• Removal of visible soil (e.g., organic and inorganic

material) from objects and surfaces.
• Normally is accomplished manually or
mechanically using water with detergents or
enzymatic products.

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Significance of cleaning

Surface to be Disinfected
(APSIC, 2017; Dancer, 2014)
 DISINFECTION

A procedure of treatment that eliminates pathogenic microorganisms

with the exception of bacterial spores.
Types :
▪ High level
▪ Intermediate level
▪ Low level

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 Prions

Bacterial Spores

Difficulty in Elimination
Coccidia

Mycobacteria
High Level
Sterilization
Disinfectio
Non-enveloped
virus n
(Chemical
Disinfection
Antisepsis
sterilants)
Fungi
Low Level
Vegetative Disinfectant
Bacterial cells s
Enveloped virus
(APSIC,
CRITICAL SEMI-
Urinary catheters
NON-
CRITICAL CRITICAL
Tonometer
ECG Machine
Laryngoscope
STERILIZATION
Surgical Tools HIGH LEVEL LOW LEVEL
DISINFECTION DISINFECTION
Urinals

Cystoscopes US Probes
Medical
Equipments
Thermometer

Crutches

Implants
Oxymeters
Endoscope
Anaesthesia
equipment
Vascular BP cuffs
catheters
Cleaning Disinfection Sterilization
 Process of disinfection

3. Rinse with 4
clean water

Cleaning Disinfection Dry Inspection

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1. Cleaning with soap and water

Sterilization
Used Instruments
Spaulding classification
In 1968, Dr.EH Spaulding classified medical/surgical devices as:
▪ Critical,
▪Semi-critical and
▪Non-critical based on their potential to spread infections.

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Spaulding Classification
Categorize the Instruments
Categorize the Instruments
Categorize the Instruments
 DISINFECTANT

Antimicrobial agents that are applied to the surface of non-living objects to

destroy microorganisms that are living on the objects.

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Disinfectants
High level disinfectant
Intermediate level

low-level

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How microorganism can be killed?

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 Choice of a Good Disinfectant
Broad spectrum
▪ •

▪ Fast acting
▪ Not affected by environmental factors
▪ Nontoxic
▪Surface compatibility
▪Residual effect on treated surfaces
▪Easy to use with clear label directions
▪Odorless
▪ Economical
▪ Solubility
▪Stability
▪Cleaner
▪Environmentally friendly
Hospital Grade Disinfectant

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Hospital Grade Disinfectant

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Conversion Table

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Instrument disinfection vs surface disinfection

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 Commonly Used Articles and their Disinfection
Articles Standard procedure Alternative procedure
Telephone Disinfect with 70% alcohol
Trolleys Clean daily with detergent and water. After each use
wipe with 70% alcohol or sodium hypochlorite.
IV stands Clean with detergent and water and dry
Locker tops Damp dust with detergent and water
Leads and Disassemble, clean with detergent and water and dry
monitor
Mattress and Clean with detergent and water between patients and
pillows required
Pulse oxyprobe Wipe inside and outside 70-90% IPA or any other LLD
Stethoscope Wipe bell and tubing after each use with 70-90% IPA or
LLD
 Commonly Used Articles and their Disinfection
Articles Standard procedure Alternative procedure
BP cuff Clean cuffs tubing, bulb (if manual) with 70-90%IPA or Disposable preferred
LLD. If visibly soiled wash in soap and water and dry.

Bed and Couch Clean with detergent and water between

patients.Wipe with LLD if necessary.

High touch surfaces Clean at least twice daily when soiled. Clean with 70-
90% alcohol/ sodium hypochlorite

IV monitoring pumps Clean with detergent and water and dry/ disinfect with After use in isolation wipe with 2%
LLD sodium hypochlorite

Humidifiers 48 hrs

Suction bottles If disposable seal when 75% is filled. If reusable , clean

with hypochlorite and dry. Store dry when not in use
Surface Disinfection

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Surface Disinfection
Types of surface Uses
disinfection

Routine Regular, prophylactic disinfection to clean the cover near-patient

surfaces or those with frequent hand or skin contact (bed frames,
bedside tables, doorknobs), which presumably became contaminated
with pathogens without noticeable or visible evidence.
Terminal preparing complete rooms or areas for subsequent patients or
residents for them to be treated or cared for without the risk of
acquiring an infection.
 Surface Disinfection
Contd..
Outbreak Depending on the existing disease or type of pathogen all near-
patient surfaces/objects or all accessible surfaces (floors, walls) are to
be disinfected

Targeted areas Used to clean visibly contaminated with organic material such as
blood, pus, secretions or other body fluids, it is imperative to prevent
the spread of pathogens by disinfection and reduce the
patient’s/resident’s risk of infection in a targeted manner. Eg spillage
kit, disinfection of dialysis unit

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HEOC Guidelines

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Calculation Of Chlorine

Calculation: Desired/Have×volume of water

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 Before Cleaning
▪ Check for Additional Precautions signs

▪Remove clutter before cleaning

▪Follow the manufacturer’s instructions

▪Gather materials required for cleaning before entering the room

▪Clean hands on entering the room

▪Apply required PPE

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During cleaning
▪Progress from the least soiled areas

▪Remove gross soil prior to cleaning and disinfection

▪Place ‘wet floor’ caution sign outside of room or area being mopped

▪Damp mop in Preference to sweeping

▪Minimize turbulence to prevent the dispersion of dust that may contain microorganisms

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During cleaning
▪Change cleaning solutions regularly
▪Change no less often than at 60-min. intervals
▪Replace floor mopping solution every 3 patient rooms
▪Change cloths/mop heads frequently
▪Avoid ‘double-dipping’
▪An area of 120 square feet to be mopped
▪More cloths in 'high-touch surfaces’ than ‘low-touch Surfaces’.

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During cleaning
▪Be alert for needles and other sharp objects;
▪Collect waste, handling plastic bags from the top (do
▪not compress bags with hands)
▪Clean hands on leaving the room

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After cleaning
▪Do not overstock rooms
▪Tools used must be cleaned and dried
▪Launder mop heads daily
▪Clean housekeeping cart
▪Complete required documentation
▪Report any elements that are in poor condition

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 Practical Tips

• Develop a policy for chemical disinfection.

• Disinfectants may be supplied ready to use or may need to be diluted.

• Label bottles or containers with the name and concentration of disinfectant and, for
diluted disinfectants, the date of dilution/preparation.

• Prepare small amounts at a time to avoid wastage and also do not mix new & old
solution.

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 Practical Tips
• Wash and dry the container before filling with new solution.

• Clean, rinse and dry items thoroughly before disinfecting.

• After disinfection, rinse thoroughly with clean water to remove all chemical
residues.

• Alcohol solutions can be allowed to dry without rinsing

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 STERILIZATION
• The complete elimination or destruction of all forms of microbial life by a
chemical or physical means.

• Includes large numbers of highly resistant bacterial spores.

• TYPES:
1) Steam Sterilization
2) Dry Heat Sterilization
3) Gas sterilization
4) Chemical sterilization

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 STERILIZATION
TYPES:
1) Steam Sterilization
2) Dry Heat Sterilization
3) Gas sterilization
4) Chemical sterilization

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 STERILIZATION

STEAM STERILIZATION

• Requires direct contact of an item with steam at a required temperature and pressure
for a specified time
• Most reliable
• Non-toxic
• Has broad-spectrum microbicidal activity
• Good penetrating ability

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Principles
▪All used instruments must be thoroughly cleaned. Agent must be in contact with
every surface of each instrument to be sterilized.

▪All sterilizing equipment must be regularly serviced.

▪Manufacturer’s instructions must be strictly followed.

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 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.

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 ETHYLENE OXIDE (EO)
• Colourless, flammable, explosive and toxic gas.

• Processing cycles overnight or longer.

Gas concentration450-1200mg,temperature37-63℃

• Prevents normal cellular metabolism and replication

• Used for heat or moisture sensitive items

Exposure time 1to 6 hours

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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

• Not compatible with cellulose (linen, paper), devices with dead-end

lumens, powders and liquids

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 FUMIGATION

• For rooms contaminated with some pathogens

• 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
• Risk of damage to sensitive items

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Preparation for Fumigation
▪Clean the area thoroughly by with soap and water

▪Close windows and ventilators tightly

▪Switch off all lights, A/C and other electrical & electronic items.

▪Calculate the required amount of H2O2 200ml h202+800ml WFI per 1000cubic
feet process time for 1 hr.

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Preparation for Fumigation
▪Rooms can be completely decontaminated in less than 120 minutes

▪Whole building scan be decontaminated within a day.

▪Takes typically only 2 hours before the rooms are clean, safe and ready to be
used again.

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▪CDC 2003: “Do not perform disinfectant fogging for routine purposes in patient-
care areas.

▪CDC 2008: “Do not perform disinfectant fogging in patient-care areas

▪CDC 2009 :These recommendations do not apply to newer technologies

involving fogging (e.g., ozone mists, vaporized hydrogen peroxide)

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 FILTRATION
• Removal of microbes from air or heat-sensitive
liquids
• Disinfectant-impregnated filters may inactivate
trapped microorganisms
• All filters must be checked for integrity and
replaced as necessary
• Example: High-efficiency particulate air (HEPA)
filters

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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

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 Sterilisation Process Monitoring

Recommended practices state that both biological and chemical

indicators shall be used to monitor the sterilisation process
• Mechanical monitoring
• Chemical monitoring
• Biological monitoring

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Chemical Indicators

• External Chemical Indicator

• process indicator - autoclave tape
• distinguishes processed from unprocessed medical devices
• secures pack
• labels pack
• Check external indicator to ensure it has changed color before using
any package
• If the indicator did not change, do not use

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Biological Indicators

• Requires routine monitoring daily

• Test must be dated and labeled
• Once removed from the steriliser the test pack opened, BI labeled,
crushed and incubated in the incubator
• Records of time, date of incubation and staff initials is required and
then time and date and initials of the staff reading the final BI result

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Biological Monitoring
• Steam Geobacillus stearothermophilus
• Dry heat B.atrophaeus (formerly B.subtilis)
• EO B.atrophaeus
• New low temperature sterilisation technologies
• Plasma sterilisation (Sterrad) B.atrophaeus
• Peracetic acid - Geobacillus stearothermophilus

December 65
1, 2013
 Main IP&C priorities
• Development of reprocessing protocols for instruments and equipment
based on generally recognised standards and manufacturer's
recommendations
• Use of clean water for cleaning items thoroughly
• Maintenance, use, and monitoring of equipment, e.g., autoclaves
• Discarding items that cannot be cleaned or reprocessed adequately
• Storing reprocessed items away from potential sources of contamination
• Use of PPE

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Central Sterile Supply Department (CSSD)
▪The Central Supply Services Department, SPD, Sterile Processing Department,
is an integrated place in hospital and other health care facilities.

▪That performs initially cleaning, disinfection, decontamination and sterilization

on RIMD, reusable invasive medical devices, equipment .

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CSSD

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Planning of CSSD
▪ Flow process layout designing principle
▪There is no back tracking of sterile goods.
▪One way movement from receiving counter to issue counter.
▪Sterile area should be prior to sterile storage and issue.
▪The receiving counter must be away from the issue counter.
▪Separate receiving and issuing counter .

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Planning of CSSD
▪ There should minimum six basic division in CSSD
▪Cleaning Area
▪Drying Area
▪Packaging Area Sterilization Area
▪Storage Issue counter
▪One supply window on the other end.
▪One collection window

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Storage of Reprocessed Items
▪Reprocessed items should be store properly and safely.

▪Shelf Life of sterile items depends on the condition of storage.

▪ Never keep reprocessed items and packs on floor. Keep in cabinet ten inch
above from floor.

▪Store in clean and low traffic area.

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Storage of Reprocessed Items

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Cont..
▪Avoid dragging, crushing, bending, compressing or puncturing.

▪Storage area should have low humidity and temperature should be maintained.

▪Avoid frequent handling of reprocessed items.

▪Heavy items should be kept at the chest level in cabinet.

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 SUMMARY
• Proper cleaning is essential before any disinfection or sterilisation process
• Failure to sterilise or disinfect reusable medical devices properly may
spread infections
• The type and level of device decontamination depends upon the nature
of the item and its intended use
• Clearly written policies and procedures must be available on-site for
training personnel and for monitoring their performance

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THANK
YOU

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