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Nama : Samsul Maarif

Tgl Lahir : Gresik 06 Mei 1972


Status : Menikah, 1 orang Istri, 2 anak
Alamat : Jl Sampurna 74 Malang
Email : samsulmaarifmlg@yahoo.com

Pendidikan : SPK Soetomo Surabaya lulus th 1991


D3 Keperawatan Universitas Muhammadiyah Malang lulus th 2003
Sarjana Keperawatan & Ners Unibraw lulus th 2008
Saat ini menempuh pendidikan Magister Keperawatan Unibraw

Pekerjaan : Staf Perawat IBS RS Islam Aisyiyah Malang


Ketua Komite Keperawatan RS Islam Aisyiyah Malang 2014-2019
Ka Sub Bag SDI RS Islam Aisyiyah Malang
Dosen Tamu pada FIKES Universitas Muhammadiyah Malang
Dosen Tamu pada D IV Keperawatan Periop POLTEKKES Kemenkes Malang

Organisasi : Ketua Pengurus Daerah Himpunan Perawat Kamar Bedah Malang Raya 2017-2022
Bid Diklat & Pengembangan SDM Pengurus Wilayah HIPKABI Jawa Timur 2016-2021
Bid Diklat & Pengembangan SDM Pengurus Pusat HIPKABI 2018-2023
Sterilization & Disinfection

Samsul Maarif
Ojective
The Audience be Able to :
 Describe the several steps of instruments
reprocessing
 Differentiate the usage of sterilization and
disinfection
 Describe the causes of failed sterilization
process

Samsul Maarif
Introduction

 Best practice for instruments


reprocessing cycle will reduce
Failed sterilization process
 Best practices for instrument
reprocessing cycle is an
important to minimize the risk
of Infections

All contaminated Medical instruments are


potential sources of Infections

Samsul Maarif
Attention!!

A dirty instrument cannot be effectively


sterilized, because the soil shields
bacteria and viruses from the sterilizing
agent.

As a result, bacteria and viruses may very


well survive the sterilization process and
can cross infect the next patient.

Samsul Maarif
SEVERAL STEPS OF
INSTRUMENTS REPROCESSING
1. Pre-cleaning
2. Cleaning and rinsing
3. Drying & Lubrication
4. Packaging
5. Sterilization or High-Level Disinfection
6. Storage

Samsul Maarif
Pre-Cleaning

Removes patient’s biomaterial


from the instruments

Pre-cleaning, soak the instruments in


an enzymatic solution or a combined
detergent / disinfectant
Samsul Maarif
Cleaning

Neutral detergents with a pH of seven


that are low-foaming should be used
for cleaning instruments

Neutral pH detergents work well, low-


foaming detergents are more easily
removed during rinsing

Brush all surfaces of the instruments with soft cleaning


brushes while they are submerged in a water bath
Samsul Maarif
Rinsing
Residual detergent may react with and inhibit the
disinfectant or sterilant solution

Rinsing of instruments under running water


Samsul Maarif
Drying

 Elimination of moisture helps prevent rust


formation during instruments storage
 Ethylene oxyde (EO) combines with
water and create ethylene glycol which
is toxic

Drying of instruments with a jet of air.


Samsul Maarif
Lubrication
 Lubricants should be compatible with the method of
sterilization
 Water soluble lubricants allow steam penetration during
sterilization, oil based product cannot be penetrated and
prevent the sterilant from contacting the instruments
surfaces

Samsul Maarif
Sterilization / High Level Desinfection

 High Level Disinfection is a process that destroys all


microorganisms (bacteria, viruses, fungi, and parasites)
but does not reliably kill all bacterial endospores
 Sterilization: The complete elimination of all forms of
microbial life
 The process depend on the usage of instruments
 Semi-Critical instruments
 Critical Instruments

Samsul Maarif
High level Disinfection

 The effectiveness of HLD depends on the amount


and type of microorganisms, organic material
(blood, other fluids, tissues), and other matter (such
as dirt) present on the instrument.
 Therefore it is important to decontaminate and
thoroughly clean instruments before HLD.

Samsul Maarif
High level Disinfection

 The disinfectants begin to degrade upon preparation.


The addition of any debris or solution, such as water, will
reduce the effective concentration.
 Therefore, it is recommended that the minimum effective
concentration (MEC) must be tested prior to each use
according to the manufacturer’s instructions.
 High Level Disinfection is followed by rinsing and drying
before the instruments are stored / used to minimize
adverse tissue reaction (chemical tissue irritation)

Samsul Maarif
Sterilization Methood

 Steam sterilization
 Dry Heat Sterilization
 Ethylene Oxide Sterilization
 Hydrogen Peroxide Gas Plasma

Samsul Maarif
Steam Sterilization
 Saturated steam under pressure is the oldest and most widely
used, economical, effective and reliable method of sterilization
 Steam kills microorganisms by coagulating and denaturing the
cell protein
 Recommended minimum sterilization times : 120⁰C 30 min
exposure; 45 min drying time
 Due to the high temperatures and moisture associated with
steam sterilization it may only be used with heat and moisture
stable medical devices, instruments and compatible materials
 The sterilizer chamber must be free of any air entrapment to
ensure direct contact of the steam to all surfaces to be sterilized

Samsul Maarif
Dry Heat Sterilization
 Dry heat sterilization should be used to sterilize anhydrous
(waterless) items that can withstand high temperatures
 The destruction of organisms occurs by oxidation, which is
a slow burning
 Recommended sterilization time : 6 hours exposure at
120°C
 It is generally to sterilize talcum powder for surgical
procedures, sharp/pointed instruments, such as burrs and
reusable needles that would be damaged by the moisture
of steam

Samsul Maarif
Storage

 Instruments should be stored in a clean, dry, and


well ventilated area to minimize the possibility of
recontamination.
 Temperature and humidity the area should be
controlled
 The sterility life time depend on : The sterilization
methood, packing, and storage place

Samsul Maarif
Failure of Medical Instrument Reprocessing

 Incomplete of Instruments Reprocessing cycle


 The usage of Inadequate Cleaning Agent
 The Usage of Inappropriate Lubricants
 Inappropriate packing materials or technique
 Sterilization process failure
 Inadequate of sterile instruments storage

Samsul Maarif
Incomplete of Instruments Reprocessing cycle

The First & Most Important Step in Instruments


Reprocessing Cycle is Cleaning
If not done immediately, instruments should be
submerged in a neutral PH detergent or
Enzymatic Solution

A dirty instrument cannot be


effectively sterilized, because the
soil shields bacteria and viruses
from the sterilizing agent.

As a result, bacteria and viruses


may very well survive the
sterilization process and can cross
infect the next patient.
Samsul Maarif
The Use of Inadequate Cleaning Agent

Neutral detergents with a pH of seven


that are low-foaming should be used
for cleaning instruments

Neutral pH detergents work well, low- XXXX


foaming detergents are more easily
removed during rinsing
XXX

Samsul Maarif
The Use of Inappropriate Lubricants

Lubricants should be compatible with the


method of sterilization

Water soluble lubricants allow steam


penetration during sterilization, oil based xxxx
product cannot be penetrated and
prevent the sterilant from contacting the
instruments surfaces

Samsul Maarif
Inappropriate packing materials or technique

Packaging for sterilization should be


suitable for the sterilization method used to
ensure that the packaging material can be
penetrated by the sterilizing agent.

The packaging also provides protection


from microbiological recontamination
during transport and storage.

Samsul Maarif
Packaging Material
Sterilization Method Requirements Acceptable Materials

Steam autoclave •Should allow steam to


•Paper
penetrate
•Plastic
•Cloth
•Paper/plastic peel packages
•Wrapped perforated cassettes

Dry heat •Should not insulate items from •Paper bags


heat •Aluminum foil
•Should not be destroyed by •Polyfilm plastic tubing
temperature used •Wrapped perforated cassettes

Unsaturated chemical vapor •Vapors should be allowed to


precipitate on contents
•Vapors should not react with •Wrapped perforated cassettes
packaging material •Paper
•Plastics should not contact •Paper/plastic peel packages
sides of sterilizer

Samsul Maarif
Sterilization process failure

 Malfunctioning Sterilizer
 User Errors
 Sterilizer Loading Errors

Chemical indicators should be used in combination with


mechanical monitors and biological indicators as part of
the quality assurance sterilization program.

Samsul Maarif
Inadequate of sterile instruments storage

 Store sterile surgical instruments on shelving


that is at least 8 to 10 inches from the floor, 18
inches from the ceiling, and 2 inches from
outside walls.
 Humidity should not exceed 65% and the
temperature should not exceed 22°C.
 Minimize over handling and unnecessary
traffic in the sterile storage area.

Samsul Maarif
Samsul Maarif