Disinfection & Sterilization

Disinfection: destruction of vegetative pathogenic

micro-organisms and reduce them to a level which
becomes not harmful to health.

Sterilization: is destruction of all forms of organisms

either pathogenic or not, vegetative or spores.

Antiseptic: is a special type of disinfectants that can

be safely applied to skin and mucous membrane but

not suitable for systemic administration.

Classification of disinfectants &

sterilization
Natural

disinfectant

Sunlight, air
Not reliable
disinfectant for
infectious
materials

Physical
disinfectant

Heat: Dry and moist

Radiation
filtration

Chemical
method

Dry Heat
Flaming glass slides
Ironing clothes
Hot air oven: 160c, for 60 min effective sterilization
but no power of penetration, so effective only for swabs
small dressings & sharp instruments (not for moist heat).

Burning: excellent disinfectant for hospital waste,

as dressings soiled with blood.

Infrared radiation: mass sterilization of disposals

as syringes, needles

Microwave oven: effective heat but not uniform, so not reliable

Moist Heat
More effective than dry heat because it kills
microorganisms by coagulation, denaturation of
their enzymes & destruction of their protein.
Boiling at 100c 10 min kill all germs but not
spores. Suitable for utensils, instruments, water & milk
Above 100c steam disinfections and autoclaves

121c + double atm. p great power of penetration

Reliable way of sterilization in hospitals & clinics.

Radiation
Ionizing radiation:
Great penetration and sterilization
power without heating.
Excellent for catgut, dressings,
catheters & disposal syringes.
Artificial Ultra-violet rays:
Disinfection of viral lab. & O.R.

of limited penetration

Chemical method
A- solids
B- liquid
C- gases

A- Solid disinfectants
Bleaching powder
k.perminganate

faeces, urine, sputum in hospitals.

act by oxygenation vegetables & fruits.

Lime: disinfectant for stools, walls & excreta of animals

Halozone tablets disinfection of water

B- liquid
.Phenol 10% stools & sputum
floor 5%
.Lysol 10% stool, sputum & room

Dettol 5% instruments & plastic equipments

Volatile disinfectants: alcohol 70% skin & hand washing
Halogens : chlorine, iodine isochloric, mercurochrome, silver nitrate
formalin 40% &

Chain of Infection
Pathogen
Susceptible Host

Entry

Source

Mode

Antimicrobial Resistance:

Key Prevention Strategies

Antimicrobial-Resistant
Pathogen
Susceptible
Pathogen
Pathogen

Prevent
Transmission

Pathogen

Prevent
Infection

Infection

Antimicrobi
al
Resistance

Effective
Diagnosis
& Treatment

Optimize
Use

Antimicrobial
Use

HOW TO PREVENT BLOOD BORNE

PATHOGEN TRANSMISSION IN Dental
?Clinic
:Examples are
HBV, HCV, HIV

Viral hepatitis

Etiology:
Seven different types of hepatitis viruses
are identified:
A, B, C, D, E, F, G, H.
Transmitted
parenrally by infected blood,
except A & E by contaminated food & drinks.

Viral B hepatitis
serum hepatitis
By hepatitis B virus:
HBc Ag: core antigen first 3 months.
Then HBs Ag: surface antigen 2 years
This can cause the disease ranging
from mild liver dysfunction to acute
fulminant hepatic necrosis

Mode of transmission
Parentral transmission is most common:

Through blood of patients & carriers

IV, IM,ID, Blood transfusion, infected needles,
haemodialysis, acquipuncture, tattooing, or
any injury from sharp instrument soiled by
infected blood.

Incubation period: 2-3 ms

Infection is followed by antibodies to HBs Ag

Susceptible groups
Occupational:

medical & paramedical stuffs

Nosocomial infection: patients receiving blood

or blood products, haemodialysis, infected
needles or tools during surgery
Persons subjected to infected dental
instruments. Tattooing.
Infants of infected mothers.

Prevention
1-

Sanitary precaution to prevent blood transmission;

Good selection of donors, exclusion of carriers, addicts &

those with history of hepatitis
2-examination of blood donors (free from H.Bs Ag.)
3- sanitary precautions in dental clinics, Surgery theatre
& handling of needles and sharp objects.
4- using disposable gloves, syringes, scalpel and razors.
5- care during tattooing & acquipuncture.
6- all blood spills should be cleaned with soap and water.

Specific prevention
(Vaccination and Seroprophylaxis)
Vaccination by inactivated vaccine
against HB V.
to high risk group:
Long contacts with cases & sexual contacts

workers exposed to blood or blood

products, laboratory workers.

haemodialyis patients.
International travelers to endemic areas.

Value of vaccination against

. H.B s Ag
Gives protective antibodies in 95%
For 5-7 years

Seroprophylaxis
(human specific immunoglobulin) HSIG

INDICATIONS: preferred for postexposure prophylaxis:

After vaccination to accelerate
antibody production.
After exposure during surgery.

Preventing Transmission of
Bloodborne Pathogens
Bloodborne viruses such as
hepatitis B virus (HBV), hepatitis C
virus (HCV), & human
immunodeficiency virus (HIV)

Are transmissible in health care settings

Can produce chronic infection
Are often carried by persons unaware of
their infection

Factors Influencing
Occupational Risk
of Bloodborne Virus
Infection

Frequency of infection among

patients
Risk of transmission after a blood
exposure (i.e., type of virus)
Type and frequency of blood contact

Elements of Standard Precautions

Handwashing
Use of gloves, masks, eye
protection, and gowns
Patient care equipment
Environmental surfaces
Injury prevention

Average Risk of Bloodborne

Virus
Transmission after Needle stick
Source
HBV

Risk

HBsAg+ and
+
HBeAg

clinical 31.0%-22.0%
hepatitis; 37%-62%
serological evidence of
HBV infection
clinical 6.0%-1.0%
hepatitis; 23%-37%
serological evidence of
HBV infection

HBsAg+ and
HBeAg

Concentration of HBV in Body

Fluids
High

Blood
Serum
Wound exudates

Moderate

Semen
Vaginal Fluid
Saliva

Low/Not Detectable

Urine
Feces
Sweat
Tears
Breast Milk

Hepatitis B Vaccine

Vaccinate all DHCP (doctors & health care medical staff)

who are at risk of exposure to blood

Provide access to qualified health care

professionals for administration and
follow-up testing

Test for anti-HBs 1 to 2 months after

3rd dose

Risk Factors for HIV Transmission after

Percutaneous Exposure to HIV-Infected
Blood
Deep

injury
Visible blood on device
Needle placed in artery or vein
Terminal illness in source patient
Source: Cardo, et al., N England J Medicine
1997;337:1485-90.

?Why Is Hand Hygiene Important

Hands are the most common mode of

pathogen transmission

Reduce spread of antimicrobial resistance

Prevent health care-associated infections

Hand Hygiene Definitions

Surgical antisepsis

Handwashing with an antiseptic soap or an

alcohol-based hand rub before operations by

surgical personnel

Efficacy of Hand Hygiene

Preparations in Reduction of
Bacteria
Good

Better

Plain Soap

Antimicrobial
soap

Best

Alcohol-based
handrub

Source: http://www.cdc.gov/handhygiene/materials.htm

Personal
Protective
Equipment

A major component of Standard

Precautions
Protects the skin and mucous
membranes from exposure to
infectious materials in spray or spatter
Should be removed when leaving
treatment areas

Protective Clothing

Wear gowns, lab coats, or

uniforms that cover skin and
personal clothing likely to
become soiled with blood,
saliva, or infectious material
Change if visibly soiled
Remove all barriers before
leaving the work area

Gloves

Minimize the risk of health care personnel

acquiring infections from patients
Prevent microbial flora from being
transmitted from health care personnel to
patients
Reduce contamination of the hands of
health care personnel by microbial flora
that can be transmitted from one patient
to another
Are not a substitute for hand washing!

Recommendations for Gloving

Wear gloves when

contact with blood, saliva,
and mucous membranes is
possible
Remove gloves after
patient care
Wear a new pair of gloves
for each patient

Recommendations for Gloving

Remove gloves that
are torn, cut or punctured

Do not wash, disinfect

or sterilize gloves for reuse

7- Sterilization and
Disinfection
of Patient Care Items

Critical Instruments
Penetrate mucous membranes
or contact bone, bloodstream,
or other normally sterile
tissues (of the mouth)

Heat sterilize between uses or use sterile

single-use, disposable devices
Examples include surgical instruments, scalpel
blades, periodontal scalers, and surgical dental
burs

Semi-critical
Instruments
Contact mucous
membranes but do not
penetrate soft tissue
Heat sterilize or high-level disinfect
Examples: Dental mouth mirrors,
amalgam condensers, and dental
handpieces

Noncritical Instruments &

Devices
Contact intact skin
Clean and disinfect using a low to
intermediate level disinfectant
Examples: X-ray heads, face bows,
pulse oximeter, blood pressure cuff

Risk Assessment:

Decontamination Agents ... Kill Summary

Bacterial Spores

Mycobacterium

Non-lipid Viruses

Fungi

Vegatative Bacteria

Lipid Viruses

B. subtilis

M. tuberculosis

-Polio
-Rhino

,Cryptococcus sp
.Candida sp

.Pseudomonas
.Staphylococcus
.Salmonella

sp
sp
sp

Herpes
CMV
HBV
HIV

Sterilization
HLD

ILD
LLD

Automated Cleaning
Ultrasonic cleaner
Instrument washer
Washer-disinfector

Heat-Based Sterilization
Steam under pressure
(autoclaving)
Gravity displacement
Pre-vacuum
Dry heat
Unsaturated chemical vapor

Liquid Chemical
Sterilant/Disinfectants
Only for heat-sensitive
critical and semi-critical
devices
Powerful, toxic chemicals
raise safety concerns
Heat tolerant or
disposable alternatives are
available

PLASMA Sterilization System

Features

Fast - provides fast turnaround time

Instruments are packaged and have
shelf-life Terminal Sterilization
Non-toxic - Decomposition byproducts of hydrogen peroxide plasma
consist of oxygen and water vapor
Environmental Friendly - No process
odor or hazardous emissions
Safely Contained - Patented Cassette
Sterilant replaces bulky tanks = the only
sterilant that can be shipped by air

Sterilization Monitoring
Types of Indicators

Mechanical

Measure time, temperature, pressure

Chemical

Change in color when physical parameter is

reached

Biological (spore tests)

Use biological spores to assess the

sterilization process directly

Environmental Surfaces
May become contaminated
Not directly involved in infectious
disease transmission
Do not require as stringent
decontamination procedures

Clinical Contact
Surfaces

Housekeeping Surfaces

Principles of Waste
Infectious
Segregation
Waste
Patients
Room
Operation
Theatre
Kitchen

Sharp
Materials
&
Syringues
Glass
Liquids &
Chemicals
Waste

Red

Shar
p Box

Bag

Incinerator
White
Bucket

Blue
Opaque
Container

Waste generated by food

preparaion, cleaning,.

Black
Bag

Non-infectious Waste
Landfills

Dental Unit Waterlines

and Biofilm

Microbial biofilms
form in small bore
tubing of dental units
Biofilms serve as a
microbial reservoir
Primary source of
microorganisms is
municipal water supply