You're ready to begin heath care with

your patient and the instrument packs

are arranged on the table.

▪ The patient challenges, "How

do
you know those instruments
are safe to use?"

1 4/7/2022
Maha Fathy
Maha Fathy
Prof. of Medical Microbiology & Immunology
Faculty of Medicine
Ain Shams University
ESIC, EPSA, EMRNIC, APIC, IFIC, IPCAN
▪ Define terms associated with patient care
equipment management
▪ Categorize patient care equipment according to
risk associated with their intended use
▪ Identify varieties of cleaning methods and
describe work practice control of each
▪ Identify different methods of disinfection in
healthcare
▪ Describe use characteristics and work practice
control of most commonly used chemical
disinfectants
Maha Fathy 4/7/2022 3
▪ Recognize different methods of sterilization
in healthcare
▪ Identify the technological basis of steam
sterilizers
▪ Recognize the advantages and disadvantages
of different sterilization methods:
➢Steam sterilization
➢ETO
➢Gas Plasma
➢Chemical sterilant solutions

Maha Fathy 4/7/2022 4

▪ Use of physical or chemical means to
remove, inactivate, or destroy
pathogens on a surface or item so that
they are no longer capable of
transmitting infectious particles and
the surface or item is rendered safe
for handling, use or disposal.
▪ It could comprise: cleaning,
disinfection or sterilization

Maha Fathy 4/7/2022 6

▪ It is a process that removes foreign
material (e.g. soil, organic material,
micro-organisms) from an object.
▪ The process by which contaminants are
removed, either by hand cleaning or
mechanical means, using specific
solutions capable of rendering blood
and debris harmless and removing them
from the surface of an object or
instrument.
Maha Fathy 4/7/2022 7
▪ Drying 10-1

▪ Flushing with water 10-2

▪ Cleaning with detergent 10-3 to 4

▪ Disinfection 10-3 to 5

▪ Sterilization 10-6

▪ *Babb JR, Bradley CR JHI 1995

Maha Fathy 4/7/2022 8
It is a process that reduces the number
of pathogenic microorganisms, but
not necessarily bacterial spores to a
level which is not harmful to health.
▪ High level disinfection
▪ Intermediate level disinfection
▪ Low level disinfection

Maha Fathy 4/7/2022 9

▪It is a controlled process
that destroys all
microorganisms including
bacterial spores.

Maha Fathy 4/7/2022 10

Resistant bacterial spores
Bacterial Spores

Mycobacterium tuberculosis
Non lipid viruses

Fungi
Vegetative Bacteria
Lipid viruses

Maha Fathy 4/7/2022 11

Resistant bacterial spores
Bacterial Spores

Mycobacterium tuberculosis
Non lipid viruses

Fungi
Low level disinfectants
Vegetative Bacteria
Lipid viruses

Maha Fathy 4/7/2022 12

Resistant bacterial spores
Bacterial Spores

Mycobacterium tuberculosis
Intermediate
Non lipid viruses
level
disinfectants
Fungi
Vegetative Bacteria
Lipid viruses

Maha Fathy 4/7/2022 13

Resistant bacterial spores
Bacterial Spores
High
level
Mycobacterium tuberculosis
Non lipid viruses

Fungi
Vegetative Bacteria
Lipid viruses

Maha Fathy 4/7/2022 14

 Sterilization
Resistant bacterial spores
Bacterial Spores

Mycobacterium tuberculosis
Non lipid viruses

Fungi
Vegetative Bacteria
Lipid viruses

Maha Fathy 4/7/2022 15

Maha Fathy 4/7/2022 16
▪The FDA definition of high-
level disinfection is a
sterilant used for a shorter
contact time to achieve a 6-
log10 kill of an appropriate
Mycobacterium species
Maha Fathy 4/7/2022 17
▪Items of high risk

▪Items of intermediate risk

▪Items of low risk

Maha Fathy 4/7/2022 18

▪ Penetrate sterile tissues, including
body cavities and the vascular system,
e.g. surgical instruments, intra-
uterine devices, vascular catheters.

▪ Single use (disposable)

▪ Reusable:
2
Cleaning followed by sterilization
Maha Fathy 4/7/2022 19
▪ Equipment that does not penetrate the skin
or enter sterile areas of the body but is in
contact with intact mucous membranes or
non-intact skin
▪ Items contaminated with virulent or
transmissible organisms
▪ e. g., diagnostic endoscopes, respiratory
circuits.
▪ Cleaning followed by disinfection is
adequate when they are heat sensitive
Maha Fathy 4/7/2022 20
▪ Items in contact with intact skin, or the inanimate
environment not in contact with the patient
▪ Noncritical patient care items: e.g. bedpans, blood
pressure cuffs
▪ Noncritical environmental surfaces e.g. bed rails,
some food utensils, bedside tables, patient furniture
and floors.
▪ Cleaning and drying is usually adequate.
▪ Disinfection when indicated by low level
disinfectants where they are used (no need to be
transported to a central processing area).
Maha Fathy 4/7/2022 21
Maha Fathy 4/7/2022 22
▪ Chemical energy
(detergent or enzymatic detergent)

▪ Mechanical energy (friction)

▪ Thermal energy

Maha Fathy 4/7/2022 23

▪ Cleaning reduces the bioburden
and removes foreign material
(organic residue and inorganic
salts) that interferes with the
sterilization process by acting as a
barrier to the sterilization agent.

Maha Fathy 4/7/2022 24

▪Manual

▪Mechanical
ultra-sonic cleaners
washer disinfector

Maha Fathy 4/7/2022 25

▪ A low foam detergent with neutral pH is usually
used for manual cleaning (friction).
▪ A more alkaline detergent is generally used with
mechanical cleaning to compensate for lack of
friction.
▪ Enzymes (including proteases, lipases and
amylases) are sometimes added to neutral pH
detergent solutions to assist in the removal of
organic material.

Enzymatic detergents are cleaners and not

disinfectants, and disinfectants may inactivate
enzymes.
Maha
26 4/7/2022 Fathy
 Sorting
Process
Soaking

Manual cleaning Washing

Rinsing

Drying
Maha Fathy 4/7/2022 27
Maha Fathy 4/7/2022 28
Personnel should be protected with:
Protective clothes: Gown and/or Apron
Protective foot wear (closed plastic foot wear)

Mask &E ye Heavy utility gloves

protection

Anti splash screen Maha

29 4/7/2022 Fathy
▪The use of strainer-
type basket to hold
instruments is
recommended to
visualize them
clearly.

Maha Fathy 4/7/2022 30

▪ The use of long
handled brush is
recommended
▪ The brushing should be
under water surface to
minimize splashing
▪ The brush should be
discarded/
decontaminated after
use

Maha Fathy 4/7/2022 31

Bench top Built in

Maha Fathy 4/7/2022 32

▪ A process of the creation of
minute bubbles or cavities in the
water

Microscopic Brush

Maha Fathy 4/7/2022 33

Ultrasonic generator
Through the mains electricity supply the
electric waves at ultrasonic frequencies are
created.

Transducers
transform the electric waves into ultrasonic
sound waves.

Cleaning tank
The cleaning tank contains the cleaning
fluid (usually water with an enzymatic
detergent). At the bottom of the cleaning
bath the transducers are attached
Maha Fathy 4/7/2022 34
 The sudden decrease
Ultrasonic waves with causes gas bubble
areas of increase and formation.
decrease of pressure
At the subsequent increase
of the pressure the
Maha Fathybubbles
4/7/2022 will collapse
35 again.
For:
stainless steel instruments e.g.
▪ Microsurgical instruments
▪ Dental instruments

NOT for
▪ Flexible endoscopes
▪ Elastic materials e.g. rubber and
silicone
Maha Fathy 4/7/2022 36
▪ The unit should be equipped
with a lid.
▪ Use a cleaning agent or
combined
cleaning/disinfection.
▪ Degassing before use .
▪ Warm water, preferably up to
40°C to stimulate degassing
and improve the cleaning
results.
▪ Water should not be above
60°C to prevent coagulation
Maha Fathy 4/7/2022 37
▪Cavitation Test
▪Foil Test
▪Glass slide test

Maha Fathy 4/7/2022 38

before after

Maha
39 4/7/2022 Fathy
 Maha
40 4/7/2022 Fathy
Maha Fathy 4/7/2022 41
▪ Cleaning should be immediately after use of
instruments (whenever possible ).
▪ Brand-new instruments should be cleaned prior to
first sterilization
▪ Instruments submitted for repair must be sent
through the complete preparation cycle before.
▪ Hinged instruments should be opened prior to
preparation.
▪ Disassemble all instruments before treating them
(as far as possible).
Maha
42 4/7/2022 Fathy
▪ Be sure to use only suitable cleaning tools
and accessories.
▪ Never use metal brushes or metal sponges
for manual cleaning.
▪ Do not overload washing machines and
ultrasonic cleaning devices.
▪ Rinse thoroughly and carefully after
cleaning.
▪ If possible, use demineralized water.
Maha
43 4/7/2022 Fathy
▪ Hinged/jointed instruments must
be lubricated with a paraffin oil-
based lubricant (not applicable to
flexible endoscopes and
accessories).
▪ Following assembly, subject each
instrument to a functional test.
▪ Instruments with a ratchet should
only be closed at the first
tooth/notch before sterilization.
Maha
44 4/7/2022 Fathy
▪ Sterilization is not a substitute for
cleanliness!!!!!!!

▪ Exclude healthcare workers with

weeping dermatitis of hands from
direct contact with patient-care
equipment.

Maha Fathy 4/7/2022 45

▪ Data loggers
▪ US cleaner testing
▪ Test Object Surgical Instrument
(TOSI)
▪ Protein Test
▪ Visual inspection: inspection with
lighted magnifying glasses
Maha Fathy 4/7/2022 46
 Maha
47 4/7/2022 Fathy
4/7/2022 Maha Fathy 48
Maha Fathy 4/7/2022 49
▪Thermal
✓Boiling
✓Washer /Disinfector

▪Chemical
Maha Fathy 4/7/2022 50
It is a high-level disinfecting procedure

Maha Fathy 4/7/2022 51

▪ The items should be thoroughly
cleaned at first
▪ The items should be covered with
water.
▪ Disinfection should be timed (5 min.)
from when boiling commences
▪ Addition of 2% solution of sodium
bicarbonate helps to prevent
corrosion
Maha Fathy 4/7/2022 52
▪A high-level disinfected pickups
▪Air dry in a high-level
disinfected tray away from
insects
▪The boiler should be emptied
and dried daily
▪Minimize the deposition of
lime on the boiler with vinegar
Maha Fathy 4/7/2022 53
Maha Fathy 4/7/2022 54
Rationale:
The main use of
chemical disinfection
is for heat labile items
where single use is not
cost effective
Maha Fathy 4/7/2022 55
▪ Concentration of the disinfectant
▪ Concentration and type of
microbial load
▪ Contact time
▪ Physical and chemical factors in
the surrounding environment
including: water hardness,
temperature, biofilms
Maha Fathy 4/7/2022 56
▪Identification of the product:
brand name, generic name, ingredients
▪Registration data
▪Use characteristics: shelf life, use
life, dilution
▪Germicidal activity: spectrum
▪Safety information (MSDS)
Maha Fathy 4/7/2022 57
▪ Made up freshly according to the
manufactures' instructions
▪ Discarded after the correct period of
time or number of uses.
▪ Stored in clean bottles with plastic
stoppers.
▪ When the bottle is empty it should be
thoroughly cleaned before re-filling.
Maha Fathy 4/7/2022 58
▪ All items must be thoroughly cleaned
before disinfection.
▪ Instruments must be completely
submerged for the require period of time.
▪ After HLD, the object must be thoroughly
rinsed with sterile water (filtered or freshly
boiled water). Or alcohol rinse following
tap water.
▪ After rinsing, items must be kept dry and
well protected from being recontaminated.
Maha Fathy 4/7/2022 59
▪ Aldehydes:, glutaraldehyde, ortho-
phthalaldehyde, formaldehyde
▪ Per-oxygen compounds: hydrogen peroxide
(HP), peracetic acid (PA), combination of
HP/PA
▪ Chlorine based compounds
▪ Alcohols
▪ Quaternary ammonium compounds (Quats)
▪ Phenolics?
▪ Iodophors?

Maha Fathy 4/7/2022 60

▪Glutaraldehyde ≥ 2%
▪Ortho-phthalaldehyde
(OPA) 0.55%

Maha Fathy 4/7/2022 61

Used most commonly as a high-level
disinfectant for medical equipment such as
endoscopes (20- 90 min.)

4/7/2022 Maha Fathy 62

▪ Relatively ▪ Relatively slow
inexpensive mycobactericidal
▪ Excellent material activity.
compatibility ▪ Coagulates blood
▪ Compatible with and fixes tissue to
lensed instruments surfaces.
(e.g., endoscopes), ▪ Irritant and toxic
metal, rubber, and
plastic materials

Maha Fathy 4/7/2022 63

▪ Activation before use (alkaline pH).
➢Once activated: shelf life= 14 days.
▪ Use life: 14 days.
▪ Safe work environment
▪ Ensure effective concentration before
use: not less than 1.5% (test strips)
▪ Monitoring results of efficiency
testing

Maha Fathy 4/7/2022 64

▪ A dip stick type monitor with a chemical
indicator pad that changes from white to
yellow in the presence of a >1.5%
minimum effective concentration (MEC)
of glutaraldehyde.

Maha Fathy 4/7/2022 65

▪ Ducted exhaust hoods,
▪ Air systems that provide 7–15 air exchanges
per hour,
▪ Ductless fume hoods with absorbents for the
Glutaraldehyde vapor,
▪ Tight-fitting lids on immersion baths,
▪ Personal protection (e.g., nitrile gloves but
not natural latex gloves, goggles) to
minimize skin or mucous membrane contact
▪ Automated endoscope processors

Maha Fathy 4/7/2022 66

Used as a high-level disinfectant for
medical equipment such as endoscopes

4/7/2022 Maha Fathy 67

▪ High level ▪ Very expensive
disinfectant in 12 ▪ It stains proteins
minutes gray (including
▪ Excellent material unprotected skin)
compatibility
▪ Ready to use needs
NO activation
▪ Resist organic
matter

Maha Fathy 4/7/2022 68

▪ Shelf life 2 years, 75 days after
opening the bottle
▪ Use life= 14 days
▪ Must ensure effective concentration
(chemical test strips)- minimum
effective conc.=0.3%
Contraindicated for processing of
urological instruments for patients
with history of bladder cancer
Maha Fathy 4/7/2022 69
 2017

Maha Fathy 4/7/2022 70

▪Chlorine-based products.
▪Phenolics.
▪60-90% alcohols

Maha
71 4/7/2022 Fathy
▪ Chlorine-based products.
▪ Phenolics.
▪ Quaternary ammonium
compounds
▪ 60–90% alcohols

Maha
72 4/7/2022 Fathy
▪Sodium hypochlorite aquous
solution (house bleach 5.25%)
▪Sodium di-chloro-isocyanurate
tablets: more stable
▪Chlorine dioxide?: prepared
fresh as required by mixing 2
components
Maha Fathy 4/7/2022 73
Chlorine Solution Chlorine Tablets

▪ Less stable ▪ More stable

▪ Unknown ▪ Known
concentration concentration

Maha Fathy 4/7/2022 74

▪ Wide spectrum ▪ Corrosive for
▪ Used for metals
decontaminating ▪ No cleaning
blood and OPIF action

Maha Fathy 4/7/2022 75

▪ Disinfecting tonometer heads,
▪ Spot disinfecting counter tops and floors
▪ Decontaminating blood spills.
▪ Irrigating agent in endodontic treatment
and disinfecting dental appliances
▪ Disinfectant for laundry, , hydrotherapy
tanks, regulated medical waste before
disposal, and the water distribution
system in hemodialysis centers and
hemodialysis machines.

Maha Fathy 4/7/2022 76

▪ Antiseptic for patient skin and as
hand rub.
▪ Disinfectant for:
➢ Some medical instruments (e.g.
thermometers and stethoscope)
➢Small surfaces (e.g. rubber stoppers of
multi dose medication vials and vaccine
bottles and
➢External surfaces of equipment

Maha Fathy 4/7/2022 77

▪ Alkyl dimethyl benzyl ammonium chloride
▪ Alkyl didecyl dimethyl ammonium chloride
▪ Dialkyl dimethyl ammonium chloride.
▪ The newer quaternary ammonium
compounds (i.e., fourth generation), (e.g.
didecyl dimethyl ammonium bromide and
dioctyl dimethyl ammonium bromide):
active in hard water and are tolerant of
anionic residues
Maha Fathy 4/7/2022 78
▪ Cleaning/Disinfecting solutions
▪ Mainly for environmental use
▪ Disinfecting medical equipment
that contacts intact skin (e.g.,
blood pressure cuffs)

Maha Fathy 4/7/2022 79

▪ Cleaning/ ▪ Low level
disinfection in ▪ Can not be
one step applied on
▪ Material visibly soiled
compatibility surfaces with
blood or OPIF

Maha Fathy 4/7/2022 80

 Advantages Disadvantages

▪ Wide spectrum ▪ Have some material

▪ Rapid incompatibility as
copper, brass and
▪ Environment aluminum
friendly (oxidizing agent)

Maha Fathy 4/7/2022 81

▪ It is a potential carcinogen.
▪ Ingestion of formaldehyde can be
fatal
▪ Long-term exposure to low levels
in the air or on the skin can cause
asthma-like respiratory problems
and skin irritation, such as
dermatitis and itching.

Maha Fathy 4/7/2022 82

▪ Preparation of viral vaccines
▪ Preservation of anatomic
specimens
▪ Gaseous decontamination of
laminar flow biologic safety
cabinets when maintenance work
or filter changes are needed
(recently H2O2 can be used
instead).
Maha Fathy 4/7/2022 83
Maha Fathy 4/7/2022 84
▪Steam under pressure
(Autoclaving)
▪Dry heat (Hot Air Oven)
▪Low temperature methods
➢Ethylene oxide gas
➢Hydrogen peroxide gas plasma
➢Chemical??

Maha Fathy 4/7/2022 85

Maha Fathy 4/7/2022 86
▪ Autoclaves heat water in a closed vessel to form and accumulate
steam above atmospheric pressure.
▪ High temperature of steam produced at an additional
atmospheric pressure

121 °C at 1.036 Bar (15.03 psi) above atmospheric

pressure
134 °C at 2.026 Bar (29.41 psi) above atmospheric
pressure

1.036 Bar = 15.03 psi ( pound per square inch) = 106 kPa
(kilopascals) =
1 kgf/cm2 (kilogram of force per square centimeter) = 776 mm Hg
(millimeters of mercury).
Maha Fathy 4/7/2022 87
Gravity (Downward)
displacement

Porous Load (Pre vacuum).

Maha Fathy 4/7/2022 88

Maha Fathy 4/7/2022 89
 Closed
Closed

Air
Air Air
Air

Open
Open
Open
Steam

Steam

Maha Fathy
Closed
4/7/2022 90
Suitable for
▪packaged and wrapped items,
▪Porous items (linens),
▪Instruments with lumens.
Capable of producing a high
vacuum to dry the load.
Maha Fathy 4/7/2022 91
Class S Class B

Maha Fathy 4/7/2022 92

▪ Downward (Gravity) Displacement
▪ Positive Pressure Displacement

▪ Single Phase Pre-vacuum (class S)

▪ Triple Vacuum Autoclave
(Fractionated Pre-vacuum) (class B)

Maha fathy 5/7/2017 93

Fully effective for solid unwrapped
instruments.
for specified items as
mentioned by manufacturer)
➢Small porous loads
➢Short hollow loads
a state-of-the-art autoclave
Maha Fathy 4/7/2022 94
▪ Autoclave Testing:
➢New
➢Periodic
➢After repair
▪ Autoclave Operating Procedures
▪ Autoclave Safety Training
▪ Autoclave Maintenance: preventive
and therapeutic
▪ Record keeping: Autoclave Log
Maha Fathy 4/7/2022 95
Maha Fathy 4/7/2022 96
Used to sterilize materials that
might be damaged by moist heat
▪ Metal instruments when
corrosion by moist is a problem
▪ Glass ware
▪ Powders and anhydrous material
like oil and grease in sealed
containers
Maha Fathy 4/7/2022 97
 ▪ Static type
▪ Forced air type
Holding Sterilization time
Temperature
Forced air types Static types
180oC 30 min 1 hour
170oC 1hour 2 hours
160oC 2 hours -------------

Maha Fathy 4/7/2022 98

▪ Clean and dry all items to be sterilized.
▪ Either
(1) wrap with foil or
(2) place unwrapped items on a tray or shelf, or
(3)put them in a closed metal container.
▪ Place items in the oven and heat to the holding
temperature.
▪ Monitor : mechanically and by biological
indicators.

Maha Fathy 4/7/2022 99

▪ For heat, moisture
or pressure
sensitive items
▪ ETO 100%
▪ Mixed ETO
▪ FOLLOW the
manufacturer’s
instructions
4/7/2022 Maha Fathy 100
1. Preconditioning and
humidification
2. Gas introduction
3. Exposure
4. Evacuation
5. Air washes (aeration):
➢ External aerator
➢ Built in aerator (modern)
Maha Fathy 4/7/2022 101
▪ Gas concentration should be 450 to
1200 mg/L
▪ Temperature ranges 37° to 63° C
▪ Humidity from 40% to 80%
▪ Exposure times from one to six
hours.
Monitoring: by mechanical, chemical
and biological indicators

Maha Fathy 4/7/2022 102

Completely aerate surgical and
medical items that have been
sterilized in the ETO sterilizer
before use
▪ 12 hours at 50°C,
▪ 8 hours at 60°C

Maha Fathy 4/7/2022 103

▪A long cycle.
▪ETO is flammable,
explosive and probable
carcinogen.
▪Chloroflurocarbon depletes
the ozone layer
Maha Fathy 4/7/2022 104
Maha Fathy 4/7/2022 105
▪ Hydrogen peroxide is the chemical
precursor.
▪ A radiofrequency–induced electrical
field accelerates electrons that collide
with each other and generate active
O2 radicals.
▪ The process operates in the range of
37-44oC and has a cycle time of
approximately 75 minutes
Maha Fathy 4/7/2022 106
▪ Evacuation of the chamber
▪ H2O2 injection
▪ H2O2 vaporization and diffusion
▪ A radiofrequency–induced electrical field
▪ Creation of gas plasma (Microbicidal free
radicals)
▪ The excess gas is removed
▪ Return to atmospheric pressure by
introduction of high-efficiency filtered air.
▪ Cycle repeat (new equipment version)
Maha Fathy 4/7/2022 107
▪ Highly sporicidal
▪ Safe
▪ No aeration necessary
▪ Items can be used immediately
after processing or stored for later
use.

Maha Fathy 4/7/2022 108

▪ Not designed for use on cellulose-
based products such as linen and
paper
(specified packaging material)
▪ Not useful for:
➢Dead-end lumens
➢Powders
➢Liquids
➢Certain lumen lengths and diameters

Maha Fathy 4/7/2022 109

▪ The system can sterilize instruments with diffusion-
restricted spaces (e.g., scissors)
▪ Can sterilize devices with single stainless-steel lumen
based on lumen internal diameter and length (e.g., an
inside diameter of 1mm or larger and a length of
125mm or shorter).
▪ Additional devices can be used to assure flow of gas
through device’s lumen
▪ Diffusion into very long lumens with H2O2 injection is
of poor-quality assurance.
▪ Biological and chemical indicators (package label) are
used to assure sterilization

Maha Fathy 4/7/2022 110

Conditional
▪ For heat- labile equipment where
single use is not cost effective.
▪ Immersion for appropriate time
▪ Rinsing with sterile water
▪ Keep sterility during drying and
transport
▪ Use immediately after use: no
storage
Maha Fathy 4/7/2022 111
▪ ≥2% glut (10 hr) at 20-25oC
▪ 7.35% HP and 0.23% PA (3 hr) at
20oC
▪ 7.5% HP (6 hr) at 20oC
▪ 0.2 % PA (12 min) at 50-56oC
(automated system)

Maha Fathy 4/7/2022 112

Advantages
▪ Broad spectrum of activity to include bacteria,
fungi, mycobacteria, viruses, and spores
▪ Innocuous decomposition products—oxygen
and water, acetic acid, and hydrogen peroxide
▪ Rapid action in low concentration
▪ Does not coagulate blood or fix tissues to
surfaces.
Disadvantages
▪ Powerful oxidizing agent and can be corrosive
▪ Unstable particularly when diluted
Maha Fathy 4/7/2022 113
▪ For endoscopes (laproscopes and
arthroscopes)
▪ Process control: A chemical
monitoring strip ensuring a
concentration of >1500 ppm for
the active ingredient

Maha Fathy 4/7/2022 114

▪ A single-dose container of 35% peracetic acid, and an
anticorrosive agent .
▪ The container is punctured at the time of use, immediately
prior to closing the lid and initiating the cycle.
▪ The concentrated peracetic acid is diluted to 0.2% with
filtered water (0.2 μm) at a temperature of approximately
50oC.
▪ The diluted peracetic acid is circulated within the chamber
of the machine and pumped through the channels of the
endoscope for 12 minutes, decontaminating exterior
surfaces, lumens, and accessories.
▪ The peracetic acid is discarded via the sewer and the
instrument rinsed four times with filtered water.
Maha Fathy 4/7/2022 115
Maha Fathy 4/7/2022 116
▪ Factors hindering cleaning process
▪ Endo-cavitary probes
▪ Processing of Endoscopes
▪ Processing of some devices used
in ophthalmology
▪ Processing of instruments
potentially contaminated with
prions
Maha Fathy 4/7/2022 117
Maha Fathy 4/7/2022 118