38. Sterilization and disinfection

Questions

Give examples of items used in healthcare facilities that carry a high, intermediate and low risk of infection

Which decontamination methods should be used at each level of risk and why?

Name the different methods of sterilization and give examples for their application.

Medical devices such as surgical instruments, endoscopes or other healthcare items (e.g. bedpans, dressings, washbowls, linen) may pose a threat to patients if they are contaminated with potential pathogens, particularly when previously used on infected patients. There are a large number of infectious agents that can be transmitted from contaminated instruments, such as blood-borne viruses (e.g. HIV, heptitis B and C virus) and bacteria (e.g. Salmonella, Mycobacterium tuberculosis). The decontamination of such items is, therefore, of utmost importance.

Decontamination removes contamination from areas or objects and includes cleaning, disinfection or sterilization.

Cleaning is physical removal of organic matter such as blood, protein, thus physically removing a bulk of microorganisms.

Disinfection removes or kills a large number of vegetative microorganisms, but not spores.

Sterilization removes or destroys all living microorganisms including spores. It leaves medical devices such as surgical instruments free from viable organisms and is recommended for all items that are introduced into sterile body sites or that come into contact with broken skin or mucous membranes.

The choice of decontamination method (cleaning, sterilization or disinfection) is dictated by the infection risk and may be defined as high, intermediate or low (Fig. 3.38.1).

Fig. 3.38.1 Classification of infection risk.

Cleaning

Physical cleaning with detergents (sanitizers) is appropriate for low-risk items. It is an absolute requirement for items that undergo sterilization or disinfection as organic matter such as blood can protect pathogens from being destroyed.

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