Chapter 10 Disinfection

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5 Factors that effect the effectiveness of disinfectants

1. Type and level of microorganisms 2. Direct contact with item 3. Temp of disinfection 4. Ph Levels 5, Material compatability

OPA soak time

12 minutes a t room temperature 68f 20c in a manual system or 5 minutes at 77f 25 c in an automatic endoscope reprocessor to destroy all pathogenic microorganisms.

Glutaraldahyde

A 2% alkaline solution with a pH of 7.5 -8.5 kills microorganisms by alkylation of protein

Disinfectant

A chemical which kills pathogenic organisms, but does not kill spores, and is not a sterilant. Used on inanimate objects . Can not make objects sterile.

Families chemicals

A group of chemicals that have similar characteristics

Sterilization

A process by which all forms of microbial life including bacteria, viruses, spores and fungi are completely destroyed.

Antiseptics

A solution which inhibits the growth of bacteria. Usually used topically and only used on animate objects. Slows the growth of microorganisms on living tissue

Nonlipid Virus

A virus which nucleic acid core is not surrounded by a lipidenvelope. These Viruses are generally more resistant to inactivation by disinfection.

Lipid Virus

A virus whose core is surrounded by a coat of lipoprotein. Viruses included in this structural category are generally easily inactivated by many types of disinfectanats, including low level disinfectants.

Quats

Are cationic surface active compounds also known as wetting agents. They lower surface tension of the solution and allows greater penetration of the disinfectant into the soil.

AER

Atuomatic endoscope reprocessor

Mycobacteria

Can be destructed by High Level disinfection

Prions

Can be destructed by extended sterilization times.

Fungi

Can be destructed by intermediate level disinfection

Non Lipid and small viruses ( poliovirus)

Can be destructed by intermediate level disinfection

Gram Positive and Negative Vegatative Bacteria

Can be destructed by low level disinfection

Bacterial Spores

Can be destructed by sterilization

Phenolic residues

Can cause skin irritation, and even skin depigmentation if exposed to phenolic residues left on instruments

Sterile

Completely devoid of all living microorganims.

Cationic

Compounds that contain a postivie electrical charge on the large organic hydrophobic molecule, cationic detergents exhibit germicidal properties.

Anionic

Compounds which have a negative electrial charge on the large organic portion of the molecule which is relavtively hydrophobic and lipophilic. These form the large group of synthetic detergents.

Classification of Patient Care Items

Critical items, semi-critical items and non-critical items

Alcohol

Denatures (changes the structure of) proteins. 70% isopropyl alcohol possessess the most effective disinfectant properties. 70 % gets into the cell wall

After OPA immersion

Devices should be thoroughly rinsed by completely immersing it in a large volume 2 gallons of water. Repeat this procedure twice with fresh water rinse.

Thermal Disinfection

Disinfection done by heat. Kills are organisms except spores.

Two agencies that regulate chemical germicides

EPA and FDA

Kills Microorganisms by aklylation of protein

Glutaraldahyde

Turns green when activated Has a sharp odor Ittitant to skin eyes and res. System Can cause occupation asthma

Glutaraldahyde

Levels of Formaldehyde

High Level 8 percent formalin plus 70 percent alcohol Intermediate Level 4 to 8 percent formalin in water Low level less than 4 percent limited activity against tb

Glutaraldehyde

High level disinfectant used for semi critical devices such as endoscopes, and ultrasonic probes used in radiology. Avtivation of the solution is usually accomplished by mixing the solutions with a pre-measured activator

Three levels of disinfectants

High-Level Intermediate Level and Low Level

Buffered iodine

Poisons cells of nucleic acids, quickly pentetrates the cell walls of microorganisms

High Level Disinfectants

Process that utilizes a sterilant for a shorter contact time than that used for steriliaztion. And that kills all microbial organisms but not necessarily large numbers of bacterial spores.

Low Level Disinfectants

Process that utilizes an agent that kills vegatative forms of bacteria, some fungi and lipid viruses.

intermediate Level Disinfectants

Process that utilizes an agent that kills viruses, mycobacteria, fungi, and vegatative bacteria, but not bacterial spores.

Quarternary Ammonium Compounds

QUATS, low level disinfectant. Benzalkonium choride and cetylpyridinium chloride are members of this family

The Joint Commision

Regulates mechanical washers and washer decontamination

Bacterial

Relating to the destruction of bacteria

Used to accomplish sterilization

Steam pressure autoclaving, dry heat and low temp. methods (ethylene oxide gas, hydrogen peroxide (gas plasma) ozone, and liquid parasitic acid

Risk levels are based on

The Spaulding Classification system adopted for use by the cdc

Disinfection

The destruction of nearly all pathogenic microorganisms on an inanimate objects.

Ceiling limit

The employees exposure to an air component which shall not be exceeded during any part of the work day. If instantaneous monitoring is not feasible then the ceiling shall be assessed as a 15 minute time weighted average exposure which shall not be exceeded at any time over a working day

Shelf Life (disinfectants)

The length of time a disinfectant can be properly stored after which it must be discarded

Use Life ( disinfectants)

The length of time or number of times used after which the efficiency of a disinfectant is disminished.

Mec Miminum effective concentration

The percentage concentration of the active ingredient in a disinfectant or chemical steriliant that IA the minimum concentration at which the chemical meets all its label claims for activity against specific microorganisms.

Mechanical Washers

Use high pressure, high temp water jets to disinfect

OPA solution test strips

Used to assure that the mec of 0.3 % is present. The OPA solution may be used and reused for up to 14 days and then discarded.

A longer contact time

When liquid chemicals are labeled as both a high level desinfectant in a sterilant what is the time difference

EPA and FDA

Which agencies regulate the chemicals germicides utilized in health care

Cholorine

inhibits some key enzymatic reactions within the cell denatures proteins, and inactivates nucleic acids.

Summary of QUATS

mode of action - inactivates energy producing enzymes and denatures essential cell protein and disrupts cell membranes

Ortho-Phthaladehyde OPA

most commonly used high level disinfectant that provides a fast and effective way to disinfect a wide range of instruments and endoscopes.

Commonly used disinfectants

quaternary ammonium compounds, phenolics, alcohol, halogens, glutaraldehyde, ortho-phtalaldehdye, formaldehyde

14 to 28 days

Most glutaraldehyde based instrument sterilants are labeled for reuse during this period,.

Formaldehyde

Inactivates microorganisms by alkylation.

Red bagged, regulated as medical waste

Infectious waste is caterogrized as

Critical Items

Instruments or objects indroduced directly into the blood stream or into other normally sterile areas of the body. Sterile Body Cavity requires sterilization

Halogens

Intermediate level disinfectant that have similar elements possessing some unique properties. This family is known for its reactivity and two memebrs (cholrine and iodophores) possess disinfecting and sterilizing properties.

Phenols

Intermediate to low level disinfectants containing phenol (carbolic acid)

Iodophors

Iodine. Reactive member of the halogen family.

Semi Critical Items

Items that come in contact with mucous membranes but do not ordinarily penetarte body surfaces. High Level Disinfection

Non Critical Items

Items that usually only come in contact with unbroken skin. low level disinfectant

High level disinfectant

Kills alkalation

Lipid or medium size virusus ( Herpes, Hantavirus)

Low Level Disinfection

MEC

Minimum effective concentration

High Level Disinifection

Minimum sterility recommended by the cdc

Summary oh Phenolics

Mode of action - penetrates cell wall and precipitates cell protein


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