Decontamination

Learning Objectives,
• To identify the term of decontamination

• To refresh knowledge of methods of decontamination

• To identify the difference between disinfection and

sterilization
 Decontamination
Decontamination removes or destroys contamination, prevents micro-
organisms from reaching a susceptible site in sufficient numbers to initiate
infection or some other harmful response
 Decontamination
The process of
decontamination
may be by:

• Cleaning

• Disinfection

• Sterilization
 Categories of decontamination

• Low risk
• Medium risk
• High risk
 Low risk

• Items used on intact skin

e.g. washbowls, mattresses

• Level of decontamination required:

Clean – wash with detergent and hot water and
dry thoroughly
 Medium risk

• Items that have contact with mucous membranes or are contaminated with
micro-organisms that are easily transmitted e.g. bedpans, crockery

• Level of decontamination required:

Disinfect or Sterilize
Autoclave or chemically disinfect or
pasteurize (80ºC for at least 1 minute)
 High risk

• Items that penetrate the skin or mucous membranes or enter into sterile
body areas e.g. surgical instruments, needles, syringes

• Level of decontamination:
Sterilize
Autoclave and keep sterile or use single-use disposables
 Cleaning

• Removing all foreign material from objects by using

water and detergents or soaps and washing or
scrubbing the object

• Must be done before any disinfection or sterilization process

 Disinfection
• A process that eliminates many or all
microorganisms except spores

• Done with liquid chemicals or by pasteurization

• Proper contact time and dilution of the disinfectant must

be followed
A number of factors influence the activity of disinfectants

• Types of organisms and Number of organisms

• Presence of organic matter
• Concentration of disinfectant
• Surface or material characteristics
• Length of contact time

Common Examples for disnifectants

• Alcohol
• Tropical chloride of lime (TCL)
• Chlorhexidine gluconate (4% , 2%)
• Peracetic acid (Perasafe)
• Lysol (2% , 5%)
 Sterilization
A process that completely eliminates or kills all microorganisms including their spores
 Sterilization /
Disinfecti
on

Physical
Chemical

Heat Radiation Filtration Liquid Gas

Dry Heat Moist Heat

Physical method
01. Heat Sterilization

It is the most widely used and reliable method of sterilization, involving destruction of enzymes
and other essential cell constituents.
Moist Heat

• Moist heat sterilization is one of the most effective methods of sterilization where the steam under
pressure acts as a bactericidal agent.

Moist Heat

At At a At
temperatures temperature temperatures
below 100°C of 100°C above 100°C
At temperatures below 100°C

• The sterilization technique employed at a temperature below 100°C involves

pasteurization.
• In this process, all non-spore forming microbes are killed in milk by subjecting the milk to a
temperature of 63°C for 30 minutes (the holder method) or 73°C for 20 seconds (the flash
method).
• The principle of pasteurization is the logarithmic reduction in the number of viable
microbes so that they can no longer cause diseases
At a temperature of 100°C

• Boiling at 100°C is a moist heat sterilization technique that doesn’t ensure complete
sterility, but is enough for the removal of pathogenic vegetative microbes and some
spores.
• In this case, the items to be sterilized are immersed in boiling distilled water for 30-40
minutes
• Moist heat at 100°C is applicable for contaminated dishes, beddings, pipettes, and other
instruments that are not soiled or contaminated as well as for objects that are
temperature sensitive
At temperatures above 100°C

• Moist heat sterilization above 100°C involves sterilization by steam under pressure.
• Water usually boils at 100°C under normal atmospheric pressure (760 mm of Hg); however,
the boiling point of water increases if the pressure is to be increased.
• This principle is employed in an autoclave where the water boils at 121°C at the pressure of
15 lbs or 775 mm of Hg.
• As a result, the steam under pressure has a higher penetrating power. When this steam
comes in contact on the surface, it kills the microbes by giving off latent heat.
• Autoclaves are used for the sterilization of contaminated instruments along with different
culture media as it ensures complete sterility
Autoclaving

• Standard sterilization method in hospital

• It is to expose each item to direct steam contact at the required temperature and pressure for the
specified time
• The usual temperature achieved is 121 C at a pressure of 15 lbs for 15-20mins
Dry heat sterilization

• Dry sterilization is the process of removing microorganisms by applying moisture-free heat

which is appropriate for moisture-sensitive substances.
• The dry heat sterilization process is based on the principle of conduction
• Dry heat sterilization is used for the sterilization of materials which are difficult to sterilize
by moist heat sterilization for several reasons
• In dry heat sterilization usually higher temperatures in the range 160–180°C are employed
and also require exposure times of up to 2 hours depending upon the temperature
employed

Dry Heat

Hot air
Red heat Flaming Incineration
oven
Red Heat
• Rest heat sterilization is the process of instant sterilization by holding the instruments in a
Bunsen flame till they become red hot.
• This method is based on dry heat sterilization is commonly used for sterilization of
instruments like incubation loops, wires, and points of forceps

Flaming
• Flaming is a type of dry sterilization that involves exposure of metallic objects to flame for
some time where the flame burns microbes and other dust presents in the instrument.
• In the case of flaming, the instrument is dipped in alcohol or spirit before burning it in a gas
flame.
• This process doesn’t ensure sterility and is not as effective as red hot sterilization

Incineration
• Incineration is the process of sterilization along with a significant reduction in the volume of
the wastes. It is usually conducted during the final disposal of the hospital or other
residues.
• The scraps are heated till they become ash which is then disposed of later.
• This process is conducted in a device called incinerator
Hot air oven
• Hot air oven is a method of dry heat sterilization which allows the sterilization of
objects that cannot be sterilized by moist heat.
• It uses the principle of conduction in which the heat is first absorbed by the outer
surface and is then passed into the inner layer
• The commonly-used temperatures and time that hot air ovens need to sterilize
materials are 170°C for 30 minutes, 160°C for 60 minutes, and 150°C for 150 minutes
02. Filtration
• The process of filtration is unique among sterilization techniques in that it removes,
rather than destroys, microorganisms.
• Further, it is capable of preventing the passage of both viable and nonviable particles
and can thus be used for both the clarification and sterilization of liquids and gases

03. Irradiation
• Irradiation is the process of exposing surfaces and objects to different kinds of
radiation for sterilization.
• Mainly electromagnetic radiation is used for sterilization.
• The major target for these radiations is considered to be microbial DNA
Ultraviolet (non-ionizing) radiation

Non-ionizing waves have a very little penetration power, so microorganisms only on the
surface are killed
It is, applied in the sterilization of air, for the surface sterilization of aseptic work areas, and
the treatment of manufacturing-grade water

Ionizing Radiation
X-ray and gamma rays are the commonly used ionizing radiation for sterilization.
These are high energy radiation which causes ionization of various substances along with
water
Radiation sterilization is generally exposed to items in the dried state which include surgical
instruments, sutures, prostheses, unit-dose ointments, plastic syringes, and dry
pharmaceutical products
 Chemical sterilization

Chemical sterilization is the process of removal of microorganisms by the use of chemical bactericidal
agents

Chemical
sterilization

Gaseous Liquid
sterilization sterilization

Nitrogen Hydrogen
Ethylene oxide formaldehyde Glutaraldehyde Hypochlorite
dioxide peroxide
Gaseous Sterilization

Gaseous sterilization involves the process of exposing equipment or devices to different gases
in a closed heated or pressurized chamber

01. Ethylene oxide

• Ethylene oxide (EO) gas is a common gas used for chemical treatment applied to sterilize,
pasteurize, or disinfect different types of equipment and surfaces because of its wide
range of compatibility with different materials.
• EO treatment often replaces other sterilization techniques like heat, radiation, and even
chemicals in cases where the objects are sensitive to these techniques
• EO treatment is usually conducted at the temperature range of 30-60°C for several hours
which aids in the activity of the gas

02. Formaldehyde
• Formaldehyde is another important highly reactive gas which is used for sterilization.
• This gas is obtained by heating formalin (37%w/v) to a temperature of 70-80°C

03. Nitrogen dioxide (NO2)

• Nitrogen dioxide is a rapid and effective sterilant that can be used for the removal of
common bacteria, fungi, and even spores
Liquid Sterilization

Liquid sterilization is the process of sterilization which involves the submerging of equipment
in the liquid sterilant to kill all viable microorganisms and their spores

01. Hydrogen peroxide

• Hydrogen peroxide is a liquid chemical sterilizing agent which is a strong oxidant and can
destroy a wide range of microorganisms.
• It is useful in the sterilization of heat or temperature-sensitive equipment like
endoscopes. In medical applications, a higher concentration (35-90%) is used

02. Glutaraldehyde
• Glutaraldehyde is an accepted liquid sterilizing agent which requires comparatively long
immersion time. For the removal of all spores, it requires as long as 22 hours of
immersion time.
• The presence of solid particles further increases the immersion time
Classification of devices
Critical Items

• Critical items are so called because of the high risk for

infection if such an item is contaminated with any
microorganism, including bacterial spores
• This category includes surgical instruments, cardiac and
urinary catheters, implants, arthroscopes, laparoscopes,
and ultrasound probes used in sterile body cavities
• Process - Most of the items in this category should be
purchased in sterile form or be sterilized by steam
sterilization if possible. If heat sensitive, the object may be
treated with EO, hydrogen peroxide gas plasma, hydrogen
peroxide vapor, or liquid chemical sterilants
Semicritical Items

• Semicritical items are those that come in contact

with mucous membranes or nonintact skin.
Respiratory therapy and anesthesia equipment,
some endoscopes, laryngoscope blades and
handles, esophageal manometry probes,
endocavitary probes, nasopharyngoscopes, prostate
biopsy probes, infrared coagulation device,
anorectal manometry catheters, cystoscopes and
diaphragm fitting rings are included in this category
• Process - Semicritical items minimally require high-
level disinfection using chemical disinfectants.
Glutaraldehyde, hydrogen peroxide, peracetic acid
Noncritical Items

• Noncritical items are those that come in

contact with intact skin but not mucous
membranes
• Examples of noncritical items are blood
pressure cuffs, crutches, bed rails,
bedside tables, patient furniture, and
floors
• Process - low-level disinfection
Waste Disposal
Key aspects of waste management in
hospitals:

• Waste segregation

• Waste handling and storage

• Waste treatment and disposal

• Training and education

• Waste minimization and recycling

Types of hazardous waste generated by health facilities based
on World Health Organization classification
The general steps in waste
management are:
• Waste generation

• Waste handling and sorting

• Waste treatment and processing

• Incineration

• Residue handling

• Final disposal
Thank You !