1. J.J.M MEDICAL COLLEGE, DAVANGERE.
DEPARTMENT OF ANAESTHESIA
SEMINAR ON STERILIZATION OF OPERATION
THEATER & OPERATION THEATER EQUIPMENTS
PRESENTED BY
Dr. PRITAM
P.G IN ANAESTHESIA
DATE- 28/05/2010 .
2. DEFINITIONS
• Antiseptic Substance that has antimicrobial
activity & that can be safely applied to living
tissues.
• Bacteriostatic Agent which prevents
bacterial growth but doesn’t kill bacteria.
• Bioburden The number & types of viable
organisms with which an object is
contaminated.
3. • Biological Indicator It is sterilization process
monitoring device consisting of a standardized
viable population of micro-organisms of high
resistance to mode of sterilization being
monitored.
• Chemical Indicator It is sterilization process
monitoring device designed to respond with a
characteristic chemical change to one or more
parameters of sterilization cycle.
4. • Chemosterilizers A chemical used for
destroying all forms of microbiological life
including spores.
• Decontamination The process by which
contaminated items are rendered safe for
personnel without protective attire to handle or
render item safe for reuse.
5. • Disinfection Destruction of many but not
all micro-organisms on inanimate objects.
• The Center Of Disease Control & Prevention
(CDC) has given 3 levels of disinfection
LEVELS OF DISINFECTION
LEVELS BACTERIA LIPID & NON LIPID
MEDIUM OR SMALL
VEGETATIVE TUBERCLE SPORES FUNGI SIZED SIZED
VIRUSES VIRUSES
HIGH + + + + + +
INTERMEDIATE + + +/- + + +/-
LOW + - - +/- + -
6. • Disinfectants chemical germicides formulated
to be used on inanimate objects.
The Environmental Protection Agency (EPA)
classified them as those
With Tuberculocidal activity
Without Tuberculocidal activity.
• Mechanical Indicators sterilizer components
that gauge & record time, temperature,
humidity pressure during sterilizing cycle.
7. • Sterilization destruction of all form of micro-
organisms ( high temperature).
• Terminal sterilization sterilization process
carried out after final packaging of the item.
• Sterility Assurance Level (SAL) the
probability of survival of micro-organisms after
a terminal sterilization process & is predictor of
efficacy of the process. A SAL of 10-6 indicates
non sterile item.
8. ORDER OF RESISTANCE
• In descending order are-
Prions
Coccidia (cryptosporodium)
Bacterial spores (bacillus)
Mycobacterium
Cysts
Small non-enveloped viruses (Polio)
9. Trophozites
Gram Negative Bacteria (Pseudomonas)
Fungi
Large non-enveloped viruses (adenovirus)
Vegetative Bacteria (Staph Aureus)
Lipid or medium sized viruses (HIV, Hepatitis B)
10. STAGES IN THE PROCESS ARE
1. General Cleaning & Decontamination.
• Then if required
2. Sterilization
3. Disinfection
11. CLEANING OF EQUIPMENTS
Aim
To remove retained salt & organic soil which can
inactivate chemical germicides or protect
organisms from destruction during disinfection.
Procedure
Immersible items should be cleaned under
water, with or without detergent for atleast 3
min. to prevent aerosolization of organisms &
those not immersible can be cleaned with cloth
soaked in detergent & water.
12. Disassembly-
• Devices should be disassembeled & jointed
instruments must be opened.
Cleaning-
• Before cleaning, manufacturer`s instruction are
consulted.
• Tapes, soils, adhesive residues are dissolved by
using appropriate solvents.
13. • Devices must be soaked in protein dissolving
solution to prevent coagulation of blood &
then it should be scrubbed thoroughly inside
out.
• Complicated devices can be cleaned by
ultrasonic cleaning after gross soil has been
removed.
14. Rinsing-
• After cleaning, rinsing
should be performed;
lumens & channels are
well flushed during each
rinse. They should be
towel or air dried.
15. METHODS OF STERILIZATION
PASTEURIZATION
• It’s a high level disinfectant.
• The equipment is immersed in water at an
elevated temperature of usually 80°c for 10min
or 70°c for 30min.
• It can`t kill all spores & viruses. So it is
recommended for perishable & where absolute
sterility is not required.
• E.g. Breathing tubes, ETT, Reservoir bags, Face
masks, Laryngoscope blades, ventilator bellows
& any rubber goods.
16. Precaution
• Care must be taking regarding time.
• Addition of extra items in the middle of process
should not be done.
Advantages
• It is simple, inexpensive & reliable.
• Doesn’t emit toxic fumes
• It is less damaging to instruments as low
temperature is required.
17. Disadvantages
• Items will be wet & must be dried.
• Prepackaging is not possible.
• Plastic & rubber articles loose there shape &
antistatic properties because of repeated
exposure to high temperatures.
19. BOILING
• For small articles like face masks.
• It is suitable for metal & also for rubber &
neoprene items.
• Instruments are boiled in water for 5-15min for
destruction of vegetative matter.
20. FILTRATION
• Microfilters are used to prevent entry of
micro-organisms
• They remove particles of diameter 0.5µ or
greater
21. STEAM STERILIZATION
(AUTOCLAVING)
• Here saturated steam under pressure is used.
22. Parts
• Chamber (pressure vessel)–It is the portion of
sterilizer in which the materials are placed &
through which steam is circulated.
• Jacket- It is the portion surrounding the
Chamber. It functions to maintain the temperature
of chamber.
• The equipments are first cleaned & the packaged in
muslin, linen or paper which are easily penetrated
by steam & then placed on shelf in the chamber
23. Phases
Conditioning/Heat Up Phase
• Air, if present, should be evacuated before
sterilization, from the chamber as it reduces the
amount of steam entering the Autoclave & hence
the temperature achieved.
Exposure/Sterilization phase
• As the steam enters the load, it gives Latent Heat to
materials rapidly on contact.
• Microbial destruction will be most effective at these
locations.
• Once intended temperature is reached, sterilization
time is set.
24. Principle
• Water boils when its
vapor pressure equals
that of surrounding
atmosphere.
• Thus when water is
boiled in closed vessel
at increased pressure,
the temperature at
which it boils & that of
steam which is formed
will exceed 100°C.
25. • When steam comes in contact with cooler
surface condenses to water & gives up its
latent heat to that surface.
• Thus 1600ml of steam at 100°C & at
atmospheric pressure condenses into 1ml of
water at 100°C & releases 518calories of heat.
26. TEMPERATURE PRESSURE TIME (MIN)
(°C) (lb/in2)
121 15 15
126 20 10
134 30 3.5
150 50 Few Seconds
27. • It can also be carried out at Low Temperature &
Low Pressure (LTS) i.e. at 37kPa with 74°C, but it
won’t kill spores.
• The addition of vapor of formaldehyde to this is
called as low pressure steam & formaldehyde
(LTSF) which can kill many if not all spores.
• Ordinarily rubber goods, linens & metals are
autoclaved.
Post exposure/ Exhaust Phase.
• At the end the steam should be exhausted from the
autoclave to avoid condensation of water on the
load when cool air is admitted.
29. Characteristics of Steam
• It should be optimum, otherwise efficacy will
be decreased.
• It should be free from air, liquid or solid
particles.
• For this, filters can be installed in the
upstream of streamline.
30. Problems
Problems with the Steam
1. Steam quality should be greater than 97%.
2. Water, if present, results in wet steam.
3. If the pressure is too high, it will cause the steam
to rain & packs will become wet.
4. If the pressure is too low, the steam will be
superheated which is less able to transfer heat to
items & it will be difficult to attain uniform
temperature
31. Air in Autoclave Chamber
• Air in the chamber will impair sterilization as it
is poor conductor of heat & retards the
penetration of steam.
• Efficacy of air removal process can be tested by
Bowie-Dick test.
32. Equipment Malfunction
• Equipment malfunctions like out-of-calibration
temperature or pressure gauges, leaks,
maladjusted control valves etc.
Personnel Errors
• Personnel errors like inadequate cleaning,
packaging methods, poor loading techniques
etc.
34. Monitoring
Mechanical Monitors:
Devices that record
time, temperature & pressure.
Biological Indicators:
they are standardized preparation of
spores.
• A positive biological indicator is
indicative of possible sterilization
process failure.
• They should be used atleast once
a week but time needed for
incubation is long.
• E.g. spores of Bacillus
Sterothermophilus.
35. • Chemical Indicators: these are more practical
means & detect problems immediately.
– The CDC & all major U.S organizations standards &
guidelines advocate that a chemical indicator be
attached to every package that goes through a
sterilization cycle & within each package to be
sterilized in what is expected to be the most
difficult-to-sterilize location.
• These are divided into 6 classes, higher the
class, more sensitive the indicator.
36. • Class 1-
– These are Internal & External Process Indicator
– These inform that item has been exposed to
sterilization process.
– E.g. External Process Indicator – Autoclave Tape.
37. • Class 2-
—E.g. Bowie-Dick test for vacuum steam sterilizer.
—They only access Vacuum Pump efficiency &
detect the presence of air leaks &/or gases in
steam.
38. • Class 3-
—E.g. Temperature Tube.
—Contains chemicals that melts & sometimes
changes color when the appropriate temp is
attained.
• Class 4-
—Respond to one or more sterilization
parameters.
—Contains Ink that changes color when exposed
to correct combination of sterilization
parameters.
39. • Class 5-
—Known as Integrating Indicators or Integrators
—Respond to all parameters of sterilization over a
specified range of temperatures.
• Class 6-
—These are emulating indicators.
—These are designed to react to all critical parameters
over a specified range of sterilization cycles for which
the stated values are based on the settings of the
selected sterilization cycles
40. Advantages
• Can kill all bacteria, spores & viruses.
• Rapid sterilization.
• Ease of use.
• Good penetration
• Economical.
• Absence of toxic products/ residues.
• Materials can be prepackaged & kept sterile
until use.
41. Disadvantages
• Heat sensitive materials are damaged like
plastic & rubber goods.
• Cause blunting of cutting edges, crossing of
metal surfaces.
• Oil, grease, powders are not sterilized because
of lack of penetration.
• Shortened life of electronic components.
43. • Articles are packed in special craft papers and
then placed in a thermostatically controlled Dry
Heat Sterilizer.
• Precaution temperature is raised and lowered
slowly to prevent breakage by uneven
expansion.
• Mainly suitable for ophthalmic instruments and
glass items but not plastics or rubber.
• It is useful for sterilization of powders, grease, oil
and glass syringes.
46. CHEMICAL (COLD) STERILIZATION
• Utilizes liquid chemical agents
• Especially useful for heat sensitive equipment.
• Performed by soaking item in the solution.
• Kill the organisms by coagulation / alkylation
of proteins and also by enzymatic degradation
and lysis of cell membranes.
47. • The criteria to be satisfied in the Chemical
Methods are
1. Must be capable of killing spores.
2. Should be non-corrosive
3. Should be Non-irritant.
4. Should be Economical.
5. Should be stable
6. Should penetrate grease & fibers.
7. Should be non-toxic.
48. Factors Influencing Chemical Sterilization:
a) Concentration of the Chemical:
Rate of kill of bacteria varies directly with the
concentration of the disinfectant.
b) Temperature:
Designed to be used at room temperature.
49. c) Evaporation and light deactivation:
Volatile agents evaporate easily. Exp: Chlorine
Products. Exposure to light adversely affects the
disinfectant.
d) PH:
Alcohols work best in alkaline PH while aldehydes
work best in acidic PH.
e) Bioburden:
The effectiveness of the disinfectant depends on
the nature and number of contaminating
microorganisms
50. f) Characteristics of the item to be sterilized:
• A disinfectant solution will be effective only if it can
contact all the surfaces on the item.
g) Time:
• Time required for different chemical agents to function
effectively varies from seconds to hours.
h) Use Pattern, Use Life & Storage Life:
• Use Pattern refers to how many times the solution can be
used.
• Use Life indicates limited period of time during which
activated solution can be used.
• Storage life is the time period after which the unused or
inactivated product is no longer deemed effective.
51. FORMALDEHYDE:
• Used principally in water based solution called
formalin. Vapor can be generated from
paraformaldehyde tablets which contain 95%
formaldehyde in a polymerized form.
• It is a high level disinfectant.
• It is non corrosive and is not inactivated by
organic matter.
• Widely used for sterilization of endoscopic
equipment, catheters etc.
52. • For better effect it needs relative humidity of
60-80% and temperature of 37°C.
• Residual formaldehyde may affect the skin, but
it can be neutralized by ammonia.
• Limited by its pungent odor and fumes.
• Should be handled as a potent sensitizer and
probable carcinogen.
53. QUATERNARY AMMONIUM
COMPOUNDS (QUATS)
• Low level disinfectants
• They are bactericidal, fungicidal &
viricidal but not sporicidal.
• They are effective against gram
positive than gram negative and
marginally effective against
Pseudomonas. They inactivate HIV
but not hepatitis virus.
• They are inactivated by organic
materials.
• Side effects are allergic reactions
and contact dermatitis.
54. PHENOLIC COMPOUNDS
• They are intermediate to low level disinfectants.
• Derived from carbolic acid (phenol), one of the oldest
germicides.
• They are bactericidal, fungicidal and viricidal but not sporicidal.
• They are active in the presence of organic matter.
• They are irritant to skin & mucous membranes, have bad
odour.
• They are absorbed by rubber and residual disinfectant may
cause tissue irritation.
55. ALCOHOL
• Intermediate level disinfectants.
• Ethyl alcohol is bactericidal in 60-90%
concentration and isopropyl alcohol
in 60% concentration.
• They kill bacteria but not spores,
action against viruses is variable.
• CDC recommends exposure to 70%
ethanol for 15mins to inactivate the
hepatitis virus but 1 min for HIV.
• Their effectiveness is limited because
of rapid evaporation, lack of ability to
penetrate organic matter.
56. • They are used mainly to
disinfect external surfaces of
equipment like stethoscopes,
ventilators, fiberoptic cables.
• They can damage mounting of
lensed instruments and tend to
swell and harden rubber.
57. Chlorhexidine (Savlon) :
• It is a non detergent
chemical disinfectant usually
used in the concentration of
0.5% in 70% alcohol for skin.
• Tubes, masks etc. are
sterilized by keeping for 20
min in 0.1% aqueous
solution.
Chloroxylenol (Dettol):
• It is used as mild antiseptic
agent
58. IODOPHORS
• It is a combination of iodine and
carrier with a resulting complex
providing sustained release
reservoir of iodine.
• They are bactericidal, viricidal and
tuberculocidal but not sporicidal.
• These are intermediate to low
level disinfectants.
• They corrode the metallic items
and non-metallic items may be
stained or discolored.
59. PERACETIC (PEROXYACETIC) ACID
• It is acetic acid with an extra oxygen atom.
• It is bacteriocidal, sporicidal, fungicidal and
viricidal.
• They are effective in the presence of organic
matter. But it is corrosive and irritating to skin in
concentrated solution.
• It is active ingredient in the steris sterilant. This is
a single use concentrate of 35% peracetic acid +
corrosion and degradation inhibitors.
60. • Used in wide variety of heat sensitive and
delicate instruments.
• Used on wet or dry items and there is no
personnel exposure. It can be situated in the
Operating room suite.
• It is useful only for totally immercible objects
and only small number instruments can be
processed in a cycle.
61. CHLORINE AND CHLORINE PRODUCTS
• They are intermediate level disinfectants.
• They are active against bacteria and viruses but
not spores.
• They are available both in liquid (sodium
hypochlorite) and solid (Calcium hypochlorite)
forms.
• They are most widely used, inexpensive and fast
acting.
62. • Highly effective against HIV.
• Household bleach is an
inexpensive and excellent
source of sodium
hypochlorite.
• A 1:100 to 1:1000 dilution is
effective against HIV.
• 1:5 to 1:10 dilution is
effective against hepatitis.
• It also inactivates Cruetz
Feldt Jakob disease with an
exposure time of 1 hr.
63. • Their use is limited by their
corrosiveness, inactivation by
organic matter and may leave
residue which causes irritation
to skin, eye and respiratory tract
• Potential hazard is the
production of carcinogen bis-
chloromethyl ether, when
hypochlorite solutions come into
contact with formaldehyde.
• A mixture of hypochlorite with
acid will cause rapid evolution of
toxic chlorine gas.
64. Hydrogen peroxide
• It is an effective
bactericidal, fungicidal, viricidal and sporicidal.
• It is commercially available as 3% solution but
can be used upto 25% concentration.
• It is non corrosive and not inactivated by
organic matter but irritant to skin and eyes.
65. Glutaraldehyde (cidex)
• It is a saturated dialdehyde. It is used in 1.0%
concentration (but highly effective in 2%
concentration).
• It is high level disinfectant. It kills spores
within 12 hrs and viruses within 10 min.
• Widely used because of their excellent
biocidal properties, activity in the presence of
organic matter, non corrosiveness and
noncoagulation of proteinaceous material.
66. Disadvantages :
• It is noxious and
irritating to tissues and
hence thorough rinsing
of all exposed materials
is mandatory.
• Prepackaging is not
possible and equipment
will be wet.
• Pseudo-membranous
laryngitis has been
linked to disinfection of
tracheal tubes with
glutaraldehyde.
67. Ozone:
• Sterilizers use O2, water & electricity to produce Ozone.
Advantages:
• Useful for most goods that need low temperature
sterilization.
• Process is environmentally friendly.
• Treated objects are dry.
Disadvantages:
• Not approved for flexible scopes & reactive materials
such as copper & brass.
• Unsuitable for natural gum rubber products
68. Advantages of Chemical Sterilization
• Technically easier.
• Suitable for equipments damaged by heat sterilization.
• Sophisticated chemical methods like Ethylene Oxide
achieve perfect sterilization.
Disadvantages:
• Act only on exposed surfaces
• Some chemicals react with metals.
• Some impregnate with the materials such as rubber &
plastics & some agents destroy it.
• Residual chemicals may form the source of infection.
70. Gas sterilization
• EO is used for this purpose.
• It is a liquid below 11°C.
• It is available in high pressure
tanks, unit dose ampoules and
cartridges.
71. 1. Preparation for ethylene oxide (EO)
sterilization (propylene oxide):
• Before packaging, items must be disassembled,
cleaned and dried to allow the gas to penetrate
throughout the whole product.
• Caps, plugs, valves, stylets must be removed.
Hollow bore products and needles should be
open at both ends.
• They should be towel or air dried.
72. • A relative humidity of 35% to 70% and a
temperature of 18 to 22°C are recommended.
• Items to be sterilized are placed in carries that
do not absorb E.O. They should be loaded
loosely to allow for uniform penetration of gas
throughout the load.
73. Factors affecting EO Sterilization :
• Gas concentration: The solubility of EO in the
product and the gas diffusion rate through the
product will influence the sterilant
concentration.
• Temperature: Exposure time can be decreased
by increasing the temperature.
• Humidity: Moisture hydrates microbes, making
then susceptible to destruction by EO.
74. • Protective barriers: Blood and other
proteinaceous materials can act as barriers to
EO.
• Packaging: The wrapping must be permeable
to EO gas and water vapor and allow for
proper aeration.
• Exposure time: Depends on factors
mentioned above, generally range from 1.5 to
6 hrs. or many require upto 12 hrs
75. 3. Sterilizers:
• EO sterilizers are of two types,
⁻ general purpose and
⁻ special purpose.
76. 4. Indicators:
• Physical, chemical or biological indicators can
be used but combination is better.
• CDC recommends the use of biological
indicators at least once a weak.
77. 5. Aeration:
• EO not only comes in contact with all surfaces
of articles being sterilized but also penetrates
some items, which then retain varying
amounts.
• Aeration may be done passively in air i.e
ambient aeration or actively in a mechanical
aerator.
78. Factors affecting aeration:
• Metal and glass items do not absorb EO and require little
or no aeration.
• Plastics, rubber, cloth, paper and muslin may absorb
significant quantities.
• The most common material retaining large amounts of
EO is PVC. Rubber absorbs little, polyethylene and nylon
absorb still less.
• Diluent, gas mixtures with a fluorocarbon require longer
aeration time than those diluted with C02.
79. 6. Complications of EO sterilization :
Patient complications skin reactions,
laryngotracheal inflammation, anaphylaxis, when
blood comes in contact with EO sterilized items,
destruction of red cells can occur.
These are mainly due to by products
• Ethylene Glycol -formed by the reaction of EO and
water.
• Ethylene Chlorhydrin- formed when EO comes in
contact with chloride ions that may be present in
previously γ-irradiated PVC items.
80. Personnel complications:
• Acute exposure may cause URTI, eye irritation,
headache, blunting of taste and smell, coughing.
• With higher concentrations nausea, vomiting
diarrhoea, fatigability, memory loss, drowsiness,
incoordination, shortness of breath, convulsions
have been reported.
• Respiratory paralysis and peripheral nerve damage
may be delayed for 6 hrs or more after exposure.
• Chronic exposure can cause corneal burns,
cataracts, epithelial keratitis, sensorimotor
polyneuropathy, anemia.
• EO may be mutagenic or carcinogenic.
81. 7. Advantages:
• It is effective against all organisms:
• Damage to most equipment is minimal.
• Items can be prepackaged.
• Used for sterilization of delicate instruments like
pump oxygenators, valves, ventilators etc.
8. Disadvantages:
• More expensive
• Fire and explosions have been reported.
• Long duration.
• Personnel need to be highly trained and
supervised.
82. RADIATION STERILIZATION
• Mainly used for disposable products.
• Gamma radiation is an electromagnetic wave
produced during the disintegration of certain
radioactive elements like cobalt-60.
• All organisms including spores, viruses will be killed.
Lethal dose is 2.5 megarads(kills bacteria by ionizing
there DNA).
• The products can be prepackaged.
83. • As there is no temperature rise, thermolabile
materials can be sterilized.
• Equipments may be used immediately after
treatment, with no risk from retained
radioactivity.
• Disadvantage is that it is not practical for
every day use and it is expensive.
84. GAS PLASMA STERILIZATION
• It uses a gaseous chemical germicide
(peracetic acid, hydrogen peroxide) and
gaseous plasma.
85. Advantages
• It is an effective sterilant for a variety of
medical devices.
• It offers rapid low-temperature sterilization.
• Does not have environmental problems
associated with EO.
• No personnel protection equipment are
needed.
86. INFRARED RADIATION
• This is method of sterilization by dry heat
usually used to sterilize the syringes and small
instruments
87. ULTRAVIOLET RADIATION
• It is done by submitting the whole operation
area to the light but the staff has to be
protected from sun burn
88. STERRAD SYSTEM
• In this system, hydrogen peroxide is the precursor of
active species of plasma.
• Total processing time is about 1 hr.
• It can be used for most items with exception of
celluloric materials e.g. cotton, powders, liquid and
devices containing dead end lumens.
• It is well suited to heat and moisture sensitive
instruments since temperature does not exceed
50°C and sterilization occurs in low moisture
environments.
89. Advantages-
• These are small capacity
systems.
• No venting or special
installation is required.
• The process requires no
aeration and
• There are no toxic
residues
90. PLASMALYTE SYSTEM
• In this system the gas plasma is produced in a
separate plasma chamber where the gas mixture of
H2, O2 and Argon is exposed to microwave
electromagnetic field.
• Sterilization is carried out at / below 55°C.
• The duration of entire cycle varies from 3/2 to 4 hrs.
• It can be used for any item, but not recommended
for liquids, powders, flexible endoscopes.
91. CDC rationale for Cleaning,
Disinfection and Sterilization
• CDC has published guidelines on how to
prevent or control specific nosocomial
infection problems.
• They have divided items into three categories,
based on the potential risk of infection
involved in their use.
92. 1) Critical items :
Are those that penetrate the skin and mucous
membranes or are in contact with normally
sterile areas of the body.
These include vascular needles and catheters
and regional block needles.
93. 2) Semicritical items :
These are the items that come in contact with
intact mucous membranes but do not ordinarily
penetrate body surfaces.
• Sterilization is desirable, if not possible, a high
levels of decontamination is acceptable.
• Ex : Endoscopes, laryngoscope blades,
temperature probes, facemasks, airways,
resuscitation bags, breathing lubes and
connectors. ETT, double lumen tubes.
94. 3) Non critical items:
Are those that do not ordinarily touch the
patient or only touch the skin intact.
• Since intact skin normally acts as an effective
barrier to most organisms, these items need
only intermediate to low level of disinfection.
• E.g. Cables, CO2 absorber, assemblies, exterior
of anaesthesia machine, ventilators,
humidifiers, monitors etc.
98. Unidirectional valves, APL valves &
Water Traps
• Cleaned & disinfected
periodically.
• They are disassembled
& cleaned by wiping
disc. The inside of the
plastic dome & the
valve seat with alcohol
or detergent.
• Some APL valves may
be autoclaved & some
may be Pasteurized.
99. Tracheal tubes, Suction
Catheters, Airways
• Washed with soap & water &
rinsed.
• A malleable brush may be used to
clean the inner aspect of tubes &
airways.
• Boiling will sterilize it but tubes
will be softened.
• Chlorhexidine 0.1% solution can be
used. Here equipments should be
soaked for 30-60min for complete
sterilization.
• Autoclaving will be effective. But
ETT should be replaced after 6
uses.
• Gamma radiation is satisfactory.
100. Face masks
• Rinsed, soaked &
scrubbed after use.
• Wash with soap & water
& thoroughly dried.
• Keep in water at 60-70°C
for 20min. this reduces
number of pathogens to
very small no.
• Gas sterilization is
v.effective method.
• It should not be boiled as
boiling deteriorates masks
101. Laryngoscope Blades
• Boiled or Autoclaved
after cleaning, but they
may spoil electric
connections.
• Carbolic acid 1-20% for
30min. can be used.
• Formalin oven can be
used.
• Wiping with 70% alcohol
or 0.1% Chlorhexidine in
70%alcohol is useful.
102. Breathing tubes & Reservoir bags
• Wash thoroughly, rinse &
allow it to dry in air.
• Repeated boiling spoils the
antistatic properties, so it can
be boiled once a week for
10min.
• Can be Pasteurized at 75°C
for 10min.
• Chemical disinfection with
glutaraldehyde for 1hr can be
carried out by using
automatic washing machine
or by immersion. Tube
should be inserted vertically
during procedure
103. Y-piece
• Chemical disinfection.
• Ethylene oxide or
Plasma sterilization can
be used.
• It can be soaked in
solution of water &
detergent, then
scrubbed manually or
placed in washing
machine.
104. Mapleson System
• Should be disassembled
& component cleaned
• Metal components can
undergo Autoclaving.
• Rubber & Plastic parts
can undergo Gas or
Plasma Sterilization.
105. Adaptors
• Rinsed & soaked in
solution of detergent &
water.
• May be washed
manually or in washing
machine.
• Rubber & plastic
adaptors- sterilized with
EO, plasma sterilization
or in Glutaraldehyde.
• Metal adaptors may be
autoclaved or
Pasteurized.
106. Water`s canister
• Can be washed &
boiled.
• Can be Steam
Autoclaved.
• Can be sterilized using
Ethylene Oxide.
107. Circle Absorber
• Gamma radiation
• Ethylene oxide.
• Formalin chamber.
• Can be dismantled &
disinfected with spirit.
• Entry of organisms, while
in use, can be prevented
by using filters.
108. Ventilators
• Bacterial filters
• Ethylene oxide
• Internal irrigation with
antiseptics, provided the
circuit is water tight.
• Ultrasonic nebulization
with alcohol, hydrogen
peroxide.
• Some have breathing units
which can be autoclaved.
• Formalin Chambers can be
used.
109. Humidifiers
• Pasteurized at 60°C.
copper sponges may
be used during this
process as it has
antibacterial effect.
• Frequent & thorough
washing may be
effective
110. Syringes & needles
• Disposable syringes &
needles are ideally
gamma irradiated.
• Glass syringes are
ideally autoclaved.
• In case of
emergency, boiled in
distilled water for 5min.
111. Instruments for local blocks
• Lignocaine &
Bupivacaine
syringes, ampoules can
stand Autoclaving at
160°C for 20min at 20psi.
• Repeated Autoclaving is
avoided.
• Adrenaline ampoules
should be autoclaved
only once.
• Disposable sets are
gamma irradiated.
112. Blood pressure cuffs, Tubing's &
Stethoscopes
• Washed & dried
thoroughly.
• Then subjected to
chemical disinfection or
Gas Sterilization.
• Nonfabric cuffs – plasma
Sterilization is used.
• Stethoscopes can be
washed with water &
wiped with alcohol.
113. Pulse oximeter probes & cables
• Cleaned by wiping with
alcohol.
• Cables – Plasma
sterilization
115. Special concern in open case of
Pulmonary Tuberculosis.
• Endotracheal tubes & suction catheters are
disposed off.
• If it is to be reused then keep in
0.1%Chlorhexidine solution for 1hr, then it is
cleaned & scraped with soap & water & then
sterilized by boiling or autoclaving.
• Boiling for 3min will kill tubercle bacilli.
• It can also be immersed in 2%Glutaraldehyde
solution for 1hr.
116. Special concern in Hepatitis B positive
cases
• The virus is killed by Autoclaving & Gamma
Radiation.
• Chemical sterilization- Sodium Hypochlorite
50ppm,
• Glutaraldehyde 2% for 10 min.
• Iodophor 80ppm
• Isopropyl alcohol 70% for 15 min.
117. Special concern in HIV cases
The virus is relatively unstable in environment &
can easily be inactivated by wide range of
Chemical Disinfectants like-
• Glutaraldehyde 2% for 10 min.
• Sodium Hypochlorite 50ppm.
• Hydrogen peroxide 0.3%.
• Ethyl alcohol 50%, Isopropyl alcohol 70% for 1
min.
• Phenol.
118. Special concern in Prion Diseases
• It is extremely resistant to normal Sterilization
methods.
• For Critical Devices – Steam Sterilization for
30min at 132°C is recommended.
• For Non-Critical Devices- Sodium
Hypochlorite, undiluted or 1:10 dilution is
used. 1N sodium hydroxide at room
temperature for 15min can also be used.
120. • Cleaning programme should be simple and clearly
laid out policy which can be adhered to.
• Daily cleaning should be carried out after the
operating sessions are over.
• All the surfaces should be cleaned with detergent
and water and may be wiped over with a phenol
if any spills with blood / body fluid are present.
• All the walls must be wiped down to hand height
everyday.
121. • The floors should be scrubbed with warm water and
detergent and dried. No disinfectant is necessary.
• The O.T. table and other non clinical equipments must be
wiped to remove all visible dirt and left to dry.
• Weakly cleaning of all the areas inside the operating
theatre complex should be done thoroughly with warm
water and detergent and dried.
• The storage shelves must be emptied and wiped
over, allowed to dry and restacked.
122. Procedure for fumigation:
• The windows should be sealed and
formaldehyde should be generated either by
boiling a solution of formalin 40% or by adding
it to potassium permanganate, in a metal vessel
on the floor, since heat is also generated. The
door is than closed and scaled.
• For a 10 x 10 x 10 ft room - 150 gm potassium
permanganate and 280 ml of formalin are used
123. Duration:
• In case of any construction in O.T. 48 hrs
• In case of inflected cases 24hr
• For routine clean cases 12 hrs.
• Alternatively 250 ml of formalin and 3000 ml
of tap water are put into a machine (auto
mist) and time is set for 2 hrs. The mist is
circulated for 2hrs inside the closed room.
124. • Room is kept sealed for another 2 hrs for
action of vapor. Ventilate for suitable time for
vapor to dissipate. Room then can be used.
• Three swabs are taken from walls, all
equipments, floor or O.T. table at intervals.
• 1st swab - 48 hrs after fumigation
• 2nd swab- 24 hrs after Is' swab
• 3rd swab - 12 hrs after 2"d swab
125. • All three consecutive swabs should come
negative.
• In some centres, Bacillocid is being used for
fumigation. It is combination of chemically
bound formaldehyde and glutaraldehyde.
• Ideally all O.T. rooms should be fumigated
once a week