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CHAPTER I

PRELIMINARY
1.1 Background
Sterilization is an act for a killer (chemical / physical) process all forms of microorganisms
include endospores. In the health field a sterile state is a major condition of success or failure of
our work within take action on the pesien. Knowledge of the basic principles of sterilization and
disinfection is needed to do work in the medical field to be responsible.
1.2 Aim
This paper aims to provide more understanding about sterilization and disinfection for students.

CHAPTER II
LITERATURE REVIEW
2.1 Some Understanding
1. Sterilization is an action to process (chemical / physical) that killing all forms of
microorganisms including endospores sterilization paper

2. Disinfection is an act of killing organisms - organisms pathogens (except bacterial spores)


by physical / chemical means against inanimate objects. for example on the floor of the room,
operating table, and etc. Substance used is called disinfectant.

3. Antiseptic is defined as a chemical used to killing the pathogenic microbes present in


body tissues for prevent the occurrence of sepsis or infection. His action is called antisepsis, for
example remove the skin to be injected with cotton alcohol (ethanol) 70%.

4. Ansepsis is to prevent the growth or activity of microorganisms either by inhibiting or


killing in the paki for substances chemistry of living tissue.

5. Germicides is a substance that can kill microbial (germ = germs). Substances that can kill
bacteria called baktericida. Substance that can kill fungi called fungicida. Substances that can
kill virus called virucida. Bacteriostatics are inhibiting substances growth and bacterial
proliferation.

2.2 History of Sterilization and Disinfection


A few hundred years ago, the Arabs had known that burning wounds with a burning
metal can prevent infection, although the patient will get scarring for the rest of his life. On In
1537 a French surgeon ambroise pare to cure a gunshot wound with sanitary pads with yolk,
turpentine and others ingredients. Turpentine serves as a kind of chemical burning, and egg
yolks will supply antibacterial lysozyme enzymes. The concept of antisepsis then applied by
ignatz semmelweis (1816 - 1865) and joseph lister (1827 - 1912).
Sammelweis sees that the incidence of puerpuralis fever in the nation obstetrics that are
administered by doctors are higher in comparison to manage by the midwife. This is because the
doctors do not pay much attention wash their hands he recommends using chlorinated lime
to wash the hands of joseph lister using carbolic acid for prevent infection from surgery
2.3 The Role of Health Personnel in Disinfection and Sterilization

1. Minimize infections caused by microorganisms


2. Reduce the risk of transmission of life-threatening diseases such as hepatitis and HIV /
AIDS
3. To protect mothers, newborns, families, helpers of labor and labor other health.
4. To prevent serious post-surgical infections.

2.4 Basic Concepts of Disinfection


Disinfection is an act of killing organisms pathogens (except bacterial spores) by
physical / chemical means to do against objects mati.Misalnya on the floor of the room,
operating table, and so forth. Substance which is used is called disinfectant. While antiseptic is
defined as a chemical used to kill the pathogenic microbes present in body tissues for prevent
the occurrence of sepsis or infection. His action is called antisepsis, for example remove the skin
to be injected with cotton alcohol (ethanol) 70%.
There are basically similar types of chemicals used as an antiseptic and disinfectant. But
not all disinfectant materials is an antiseptic material due to the limitation in antiseptic use. The
antiseptic should have no damaging properties of body tissue or not is hard. Sometimes the
addition of disinfectants is also made as one way in the process of sterilization, namely the
process of liberation germs. But in reality not all disinfectants can serves as an ingredient in the
sterilization process. Certain chemicals is an active substance in the disinfection process and is
very decisive effectiveness and functioning as well as target microorganisms to be turned off.

2.4.1 Disinfection Method


In the disinfection process is actually known two ways:
1. Physical way (heating)
2. Chemical way (addition of chemicals)
High-level disinfection (DTT) by physical means (heating) there are 2 namely:
a. DTT by steam
v Preparation:
1. Washing hands
2. Use of gloves adjusted needs
· Sterile gloves
· DTT gloves
· Clean gloves
· Household gloves
3. Use mask
4. Dressing customized needs
· Sterile
· Non sterile
· Skort
5. Use of protective goggles
6. Use of boots / shoes closed
7. Hood
8. Duk
v Tools preparation:
1. Stacking pot
2. Stove
3. Duk
4. Correct
5. Place of sterile equipment
6. Examples of tools that should be in DDT
· Handscoon
· Kassa
· Anatomical tweezers, chirurghis
· Anatomical clamps, chirurghis
· Bak instruments
· Speculum
v DTT steps with steam.
1. Prepare yourself
2. Set up the tool
3. Wash rinse tool to be at DTT
4. Prepare stoves and pots that have been given water
5. Wait for water to boil
6. Insert the tool into the pan already boiling
7. After the tool is steamed for 10 - 20 minutes lift use the span
8. Dried with sterile duk
9. Store the tool in a sterile place.

b. DTT by way of boiled


Use the pan with a tight cover
1. Replace water every time it infuses equipment
2. Soak the equipment so all the equipment soaked in the water and would be better if in add
1-3% Na 2 CO 3, as can be destroying the spore wall.
3. Start to heat the water
4. Start counting the time when it begins to boil, there is some provisions are:
· The vegetative shape will die within 5-15 minutes
· The spore will die within 1-6 hours
· But in general its long boiling in this way 15-30 minutes.
5. Do not add anything when the water begins to boil after calculating the start time
6. Boil for 20 minutes Record the time during boiling equipment at in the book.Let the
equipment dry by the way aerated air before use or saved if the equipment is in a damp state
then the rate of reaching high level disinfection is not awake. After dry equipment use
immediately or store in a high-level disinfection container closed. Equipment can be stored
until ssatu weeks provided the lid is not open.
c. DTT by chemical means
v Preparation:
1. Washing hands
2. Use of gloves adjusted needs
· Sterile gloves
· DTT gloves
· Clean gloves
· Household gloves
3. Use mask
4. Dressing customized needs
· Sterile
· Non sterile
· Skort
5. Use of protective goggles
6. Use of boots / shoes closed
7. Hood
8. Duk
v Tools preparation :
1. Solution
a. 0.5% whitening chlorine for decontamination wide surface
b. Chlorine 0.1% for chemical DTT
c. Glutaraldehyde 2% is used for DTT or chemical sterilization
2. Measuring cup
3. Waskom
4. Examples of tools that should be in DDT
a. Handscoon
b. Kassa
c. Anatomical tweezers, chirurghis
d. Anatomical clamps, chirurghis
e. Bak instruments
f. Speculum
v DTT steps chemically
1. Prepare yourself
2. Set up the tool
3. Wash rinse tool that will be in DTT
4. Prepare a 0.5% chlorine solution
5. Insert the tool into a 0.5% chlorine solution
6. After the tool is soaked with chlorine solution during 10-20 minutes Lift using the span
7. Drained using sterile duk or wait until dry.
8. Washing hands.
d. Low Level Disinfection
v Disinfection that does not kill HIV virus and Hepatitis B
1. chlorhexidine (hibitane, savlon).
2. Cetrimide (cetavlon, savlon)
3. Phenol - phenol (dettol) Chlorhexidine and cetrimide can be used as skin disinfectant
Phenol - phenol can be used for cleaning floors and furniture such as tables and wardrobes
however the use of water and soap is considered adequate.
v Unsafe disinfection to use:
1. Cleaning body fluids (blood, feces, urine and phlegm)
2. Cleaning of body fluids such as blood-borne gloves
2.4.2 Use of Disinfectants
Disinfectants are very important for hospitals, puskesmas, and clinic. Because disinfectant is
very helpful to prevent infection to patients from equipment or staff medical facilities in
hospitals. And also help prevent it the infestation of medical personnel by the patient's illness.
Disinfectants are divided into several groups, namely:
1. Phenol groups and their derivatives
For example phenol, cresol, hexylresorcinol, hexachlorophene. 2-5% phenol solution is used as
disinfectants in seputum, urine, feces or tools
contaminated. Viruses and bacteria form more resistant spores long against phenol compared
with bacterial forms vegetative.
The first person to use phenol (carbolic acid) as a disinfectant is Joseph lister (1827-1912), an
English surgeon. Phenol is also used as standard disinfectant to measure the strength of
disinfectant others. The working principle of phenol is denned protein.
2. Group of Alcohol
Ethyl alcohol (CH 3 CH 2 OH) is a disinfectant most often in use. For disinfection of the skin,
use the level ethyl lacohol 70%. Its working power is coagulating protein and attract water
cells.
3. Group Iodine
Iodine is the oldest germicide. Not good its solubility in water. Better solubility in alcohol or in
solution of KJ or NaJ.Preparatnya called iodine tinctures that can be 2% NaJ in add 2% iodine
dissolved in ethanol 70% or 7% iodine added KJ 5% dissolved in 83% ethanol solution or 5%
iodine dissolved in 10% KJ solution in water. The other preparations is a widely used betadine
for cleaning wounds and antiseptic action on the skin prior to surgery. Betadine consists of
iodine and detergent preparations.
4. Chlorine Preparation Class
Many in use for disinfection of drinking water, for example Calcium hypochorite (chlorine). Its
working power is based oxidation process.
5. Heavy metals and compounds
Its use because heavy metals have a tremendous tendency to bond with protein cells. The metals
are Hg, Ag, and Cu. Mixture Hg: HgCl 2: HgCl: HgO, mercurochrome Ag: AgNO3: Ag lactate:
Ag pircat Cu: CuSO 4. CuSO 4 is used disinfection of swimming pools because apart as
baktericida too could kill algae in 2 / 1,000,000 solutions (two persejuta).
6. Dye Substance
For example gentian violet, especially inhibit positive Graph growth and function (fungi). Other
dyes for example: malachite green, brilliant green, acriflavin.Acriflavin used for antiseptic
action on the laminate and treatment of wounds. The working power of this dye is due to
binding with bacterial proteins.
7. Soap and Detengent Sinestis
Soap is the bond between Sodium and Potassium with high fatty acids and germicida although
not so strong, for example against Pneumococcus and Streptococcus, while other bacteria are
more resistant.Sabun too causing a decrease in surface tension, so microbes are easily released
from the skin or clothing. Various substances germicide is often added to soap.
8. Quarterner Ammonium Compounds
For example: Zephiran, phemerol
9. Oxidizing agents,
For example, H 2 O 2, KMnO 4 is often used to wash wounds.
10. Aerosol
Aerosols are chemicals as anti-microdials sprayed into the air to form the grains fine (1-2
microns) and remain suspended in the air for a long time. Used for disinfection room. Commonly
used substances are prophylene glycol, ethylen glycol, triethylene glycol.

2.4.3 The ideal conditions for disinfectants (germicida)


a. High toxicity to microbes. Ability to killing microbes is a major requirement of germicida
and is expected to have the widest spectrum although in small concentrations.
b. The solubility is high. Should be soluble either in water or liquid, network for effective
working power
c. High stability. Must be stable because of its chemical composition changed it will also
change the germicidanya power.
d. Not toxic to humans and animals, which
Most ideal is very toxic in microbes, but it is not toxic to humans and animals.
e. Homogeneous. The preparations should be homogeneous, evenly split, although mixed with
other substances.
f. It is not easy to form chemical bonds with organic substances other, except with organic
substances present in the cell microbes, because when easily bind to organic compounds
others, then the concentration that will get to the microbe will reduced
g. Are toxic to microbes at room temperature or temperature body (in accordance with its use)
h. Not corrosive and colorless. No making the metal rusty / damaged, not damaging the fabric
and do not dye the fabric so it seems bad
i. No smell that interferes if it can smell good
j. High penetrating power. Expected to have penetrating power which is so large that it can
kill the microbes contained most deeply coated
k. A detergent (wash / wash)
l. The price is cheap and easy to make Until now there has been no germicida (disinfectant)
meet all these requirements.

2.5 Basic Concepts of Sterilization


Sterile is free from any microbial either pathogen or not meanwhile. Sterilization is an action to
process (chemical / physical) that kills all forms of microorganisms including cells endospores.

2.5.1 Types of Sterilization


In principle, sterilization can be done in 3 ways
that is :
1. Sterilization mechanically (filtration) using
a very small porous filter (0.22 micron or 0.45 microns) so that the microbes are stuck on the
filter. This process is intended for sterilization heat-sensitive materials, such as enzyme
solutions, antibiotics, serum, enzyme solution, germ-toxin, extract cell etc.
Various kinds of mechanical sterilization:
a. Filter the liquid
This can be done with various filters such as: Seitz Sieve, which uses the material absestos as a
filter device; Barkefeld sieve, which uses filters from the ground and still many again.
b. Filter air
To prevent contamination by germs - air germs at the time of pouring the seed, can be used a
device called laminar flow bench where air enters into it filtered first with a filter special. This
filter has a usage time limit and should be replaced with a new one if it is already does not work
anymore.

2. Sterilization can physically do with heating & irradiation.


a. Heating

Heating can kill bacteria as it can agglomerate (coagulation) protoplasm. Coagulation of this
protoplasm will be faster if there is more water. Therefore, sterilization with steam hot water
will be faster when compared to using hot air dry.
· Various kinds of sterilization with heating
:
a) Inbreeding (by direct fire)
In this microbiology laboratory is used to make sterile needle inoculation, pipettes and so on.
In life everyday eg burning pin before dipakia spikes or pus. This method can also be used for
sterilize knife operation in circumstances emergency that contaminated because it has been in
contact with sufferers or animals infected, often burned to eliminate source transmission
disease.
b) Dry heat
Sterilization with oven is about 60- 180 0 C is suitable for the dry heat sterilization tools made
of glass for example erlenmeyer, test tube, etc.
c) Heating with running water vapor
The principle is the same as a cormorant for Cook rice. This way first done by Robert Kock. In
a way this too, just kill the bacteria form vegetative. In the laboratory this way is used to create
a sterile test tube, the object glass, to kill pathogenic microbes, before the tools are washed in
order no endanger. Duration heating is one hour, whereas for kill form spores it takes 2 -16
hours.
d) Hot steam
This concept is similar to steaming. Water-containing materials are more appropriate use this
method not to dehydration occurs.
How to use this method are:
v Preparation:
a) Washing hands
b) Use of gloves adjusted needs
a. Sterile gloves
b. DTT gloves
c. Clean gloves
d. Household gloves
c) Use mask
d) Dressing customized needs
a. Sterile
b. Non sterile
c. Skort
e) Use of protective goggles
f) Use of boots / shoes closed
g) Hood
h) Duk
v Tools preparation:
a) Stacking pot
b) Stove
c) Duk
d) Correct
e) Place of sterile equipment
f) Examples of tools that should be in DDT
a. Handscoon
b. Kassa
c. Anatomical tweezers, chirurghis
d. Anatomical clamps, chirurghis
e. Bak instruments
f. Speculum
v UAP sterilization steps:
a) Prepare yourself
b) Set up the tool
c) Wash rinse tool that will be in sterilization
d) Prepare a stove and a pot already in water
e) Wait until it boils
f) Insert the tool into a saucepan already boiling
g) After the tool is steamed for
a. 121 ° C at 106 kPa pressure
b. 20 minutes for no tool wrapped up
c. 30 minutes for the tool in wrap in dry using sterile duk.
h) Store in a sterile place
i) Washing hands.
e) Hot pressurized steam Tool
called autoclave.
The sterilization step with autoclave ie:
v Preparation:
a) Washing hands
b) Use of gloves
customized needs
· Sterile gloves
· DTT gloves
· Clean gloves
· Household gloves
c) Use mask
d) Dressing customized needs
· Sterile
· Non sterile
· Skort
e) Use of protective goggles
f) Use of boots / shoes closed
g) Hood
h) Duk
v Tools preparation
a) Autoclave
b) Correct
c) place of sterile appliance
v Sterilization steps with autoclave
a) prepare yourself
b) prepare tool
· Wash, rinse and dry
· Turn on the autoclave
· Before sterilizing using an autoclave check the state of the parts of the autoclave.
· Look at the amount of water in an autoclave. If water is lacking of the specified limits, then
can be added water to the limit the. Use the results water distillation, to avoid the formation of
crust and rust.
· Enter equipment and materials. If sterilizing the bottle is closed threaded, then the cap
should be relaxed.
· Close Autoclave with last meeting tighten the bolt to prevent it steam coming out of the
lips autoclaves. Security valves do not tightened first.
· Turn on the autoclave, first first time at least 15 minutes at a temperature of 121 ° C
· Wait until the water boils so steam meet compartment autoclave and pressed Exit
from valve security.Later valve security closed (tightened) waiting to done. Time calculation
15 minimize the practice of gripping ai 2 atm.
· If the alert alarm is complete reads, then wait for the pressure in the compartment down
to equal to the air pressure at environment (the needle on preisure gauge pointed to numbers
zero) .Then valves safety opened with use the span and remove autoclave content carefully
heart.
· Store the tool in a sterile place
· Washing hands.

Image autoclave
b. UV radiation
Ultra Violet rays can also be used for sterilization process for example to kill microbes which is
attached to the interior surface of Safety Cabinet with irradiated UV lamp.
3. Chemical sterilization, usually using compound

Vertical autoclave diagram:


1. Timer button backwards (timer)
2. Steam expenditure valve
3. Pressure gauge
4. Safety margins
5. The on-off
6. Thermometer
7. Hot plate
8. Distilled water (dH 2 O)
9. Security screws
10. Limit addition of water. desinfekstan, among others, alcohol
v Preparation:
a. Washing hands
b. Use of gloves adjusted needs
· Sterile sterile gloves
· DTT gloves
· Clean gloves
· Household gloves
c. Use mask
d. Dressing customized needs
· Sterile: surgical room
· Non sterile: ICU, baby room, KB room
· Skort: plastic apron
e. Use of protective goggles
f. Use of boots / shoes closed
g. Hood
h. Duk
v Tools preparation:
a. Chlorine solution 0.5%
b. Measuring cup
c. Waskom
d. Examples of tools that must be sterilized
e. Handcoon
f. Anatomical tweezers, chirurghis
g. Anatomical clamps, chirurghis
h. Bak instruments
i. Speculum
v Step - Step Sterilization with chemicals:
a. Prepare yourself
b. Set up the tool
c. Wash rinse tool that will be in use
d. Prepare a 0.5% chlorine solution
e. Put the tool into solution
· Glutaraldehyde 2-4% (cydex), soaked at least 10 hours
· Formaldehyde 8% soaked 24 hours
f. Lift using the sprinkling rinse with water sterile before re-use or before saved
g. In dry use sterile duk or wait until dry
h. Washing hands.
4. How to sterilize objects that can not stand the temperature high Inject drugs, milk, or
bacterial seeds when heated too high will become damaged. For things like that, pasteur and
tyndall have creating a so-called special sterilization way Pasreurization and Tyndallization
a. Pasteurization
With this pasteurization we do not make sterile, but only kill certain microbes.
Patiurization is done on the milk also on making of grapes. Temperature given and
duration of pasteurization depends on the type microbes that will be in bunuhnya.
b. By tyndallization
We make a sterile object by fraction ( in part). This method is done for create sterile objects that
can not stand temperatures of more than 100 o C. How:
· The first day, the object to be sterilized in kan heat with water vapor menglir 100 ° C for 30
minutes. Enter in the incubator for 24 hours.
· The second day, heating and incubation repeated again.
· Day three, repeated again for the third time and sterilization is considered complete. The
purpose of this warming, that is, at first turned off its vegetative form. After that, things
which will be sterilized for 24 hours to give an opportunity to form the spores to change to his
vegetarian form yanng will be turned off on heating next.
2.5.2 Difference of sterilization with high level disinfection
and low-level disinfection
Sterilization Disinfection high level :
Disinfection low level All microbes including microbes bacteria will killed All microbes,
half of bacterial spores killed will eliminate the amount of microbes so equipment or surface
the body is safe to hold. Could do with use heating steam ( autoclave) or with heat dry.
Could do with boiling for 20 minutes or with saturation with large number disinfectant for 30
In use to disinfect light objects for example such as milk bottles, cutlery, and others minute for
example with use glutaraldehide or H2O2 Can also at do it with saturation with
glutaraldehyde or formaldehyde for 10 hours In use for disinfection like the floor hospital,
check table, trolley and other - other ones polluted by body fluids patient In use untu sterilize
it Handscoon, Kassa, Tweezers anatomical, chirurghis, Clamp anatomical, chirurghis , Bak
instrument, Speculum And other - other.
2.6 Antiseptics
Antiseptic is defined as a chemical used for killing the pathogenic microbes present in body
tissues for prevent the occurrence of sepsis or infection. His action is called antisepsis, for
example remove the skin to be injected with cotton alcohol (ethanol) 70%. Ansepsis is prevent
growth or activity microorganism either by inhibiting or killing in the paki for chemicals to the
living tissues. Many chemicals are classified as antiseptic. Following commonly used
antiseptics:
1. Alcohol 60-90% (ethyl, or isopropyl, or "methylated spirit").
2. Chlorhexidine gluconate 2-4% (Hibiclens, Hibiscrub, Hibitane).
3. Chlorhexidine glucomat and setrimide, in various concentrations (Savlon).
4. 3% iodine, iodine and alcohol products contain iodine or tinctures (iodine tincture).
5. Iodophores 7.5-10% of various concentrations (Betadine or Wescodyne).
6. Chloroxylenol 0.5-4% (the chloro metaxylenol or PCMX) variety concentration (Dettol).
7. Triklosan 0.2-2%. (Syaifudin, 2005). In the selection of an antiseptic, it is necessary to note
the characteristics that are desirable (eg absorption and endurance), safety, effectiveness,
availability, reception by staff and that most important The recommended antiseptic solution,
its microbiological activity and their potential use. (gradation system used on column is very
good, well, enough and not).
2.6.1 Differences antiseptics with disinfectants
Antiseptic Disinfectant Antiseptics are substances that can inhibit or destroying microorganisms
on live tissue The chemical used for kill pathogenic microbes on objects, for example on the
floor of the room, the desk operation and so on. Its use is applied to live skin or tissue
certain to prevent the occurrence of infection and generally not too toxin, so not harmful to the
skin. Disinfectant can be anyway used as an antiseptic or otherwise depends of toxicity.
Antiseptics usually contain alcohol, chlorhexidine, and anilides Use of this compound applied to
the surface, equipment or inanimate objects others, so that the levels more toxins.
Disinfectant tow glutaraldehide, vantocil, phthalaldehyde and formaldehyde

CHAPTER III
COVER
3.1 Conclusion
Sterile is free from any microbial either pathogen or not whereas. Sterilization is an action for
the (chemical / physical) process killing all forms of microorganisms including endospores.
Disinfection is an act of killing organisms pathogens (except bacterial spores) by physical /
chemical means to do against objects mati.Misalnya on the floor of the room, operating table,
and so forth. Substance which is used is called disinfectant. Antiseptic is defined as a chemical
used to kill pathogenic microbes present in body tissues to prevent the occurrence sepsis or
infection. The action is called antisepsis, for example removing the skin will be injected with
cotton alcohol (ethanol) 70%. Ansepsis is to prevent the growth or activity of good
microorganisms by inhibiting or killing in the paki for chemical substances live tissue.
3.2 Suggestions
With this paper we look forward to all candidates health can know more about sterilization and
more professional in dealing with his patients later.

BIBLIOGRAPHY
1. www.google.com
2. Entjang, Indang. 2003. Microbiology and Parasitology. PT Citra Aditya Bakti: Bandung.
3. Sujudi. 2003. Textbook of Medical Microbiology. PT Bina Rupa Aksara: Tanggerang