Complete removal, destruction or

inactivation of all forms of microbial

life
bacteria,
viruses,
Fungi,
Spores.

 Elimination

of most, if not all,

pathogenic microorganisms excluding
spores.

Disinfection may be subdivided according

to the
antimicrobial activity of the disinfectant
into:
1. High-level disinfectant.
2. Intermediate-level disinfectant.
3. Low level disinfectant.

 High-level

disinfectant (HLD):

It is effective against all vegetative bacteria, including

Mycobacterium tuberculosis, all fungi and all viruses.

Intermediate-level

disinfectant (ILD):

Destroys all vegetative bacteria, including

Mycobacterium tuberculosis, the majority of viruses and

fungi.
Low-level

disinfectant (LLD):

Destroys all vegetative bacteria (except Mycobacterium

tuberculosis), some viruses and some fungi.

Antiseptics
special types of chemical disinfectants (e.g. ethyl
and isopropyl alcohol) which can be safely applied to
skin and mucous membranes but are not suitable for
systemic administration.

Cleaning
Removal of the visible dust, dirt, organic load, and

other foreign materials.

It includes:

Cleaning
Disinfection
Sterilization

 Based

on the risk of infection of patients

from contaminated devices
Devices (patient care items) are classified as

critical,
semi-critical,
non-critical.

 Critical

objects enter normally sterile tissue

or vascular system or body cavities.

Examples:

Surgical instruments and devices;

cardiac catheters; implants; etc.

Method:

sterilization

Steam under pressure

plasma sterilizers or
Chemical sterilization.

 come

in contact with mucous membranes

or non-intact skin.

Examples:

endoscopes & thermometers.

Method:
High-level
glutaraldehyde,
hydrogen peroxide
per-acetic acid.

disinfection

 Non-critical

objects come in contact

with normal intact skin, but not with
mucous membranes.

Examples: Sphygmomanometers, bed linen

Method:

Intermediate or low level

disinfection
e.g. alcohols

1. Chemical disinfection.
2. Boiling water
3. Pasteurization

4. Ultraviolet irradiation.

Disinfectant

Use

Alcohol 70% (ethyl and

isopropyl):
at least 5 min.

Thermometers, stethoscopes.

chlorhexidine

Skin and mucous membranes

Chlorine-active
compounds

Blood splashes and laboratory working

surfaces.
Disinfection of water for domestic use.

Disinfectant
Iodophores e.g. tincture
iodine:

Use
For antiseptic purposes.

Phenol-containing
Cleaning of the floors, walls,
preparations (phenolics): furniture.

Disinfectant
Hydrogen peroxide:

Use
High level Disinfection of the soft
contact lenses and some endoscopes.
Antiseptic for open wounds.

Peracetic acid:

High level disinfection or sterilization

of the instruments (endoscopes).

Glutaraldehyde:

High level disinfection or sterilization

of instruments (endoscopes)

2- Boiling Water
Boiling

at 100C for 20 minutes:

achieves high level disinfection.

It can be useful in emergencies if no sterilizer is

available.

3- Pasteurization of milk:
heating at 63C for 30 min. or at 72C for 20 sec.,
followed by rapid cooling.
destroys important pathogenic organisms e.g.
Mycobacterium tuberculosis, Brucella, Salmonella
and Coxiella burnetti.

low-energy, non-ionizing radiation present in sun

rays or artificially produced by mercury lamps.

have

extremely weak penetration power

used only for air and surface disinfection

operating rooms,
laboratory safety cabinets.

I. Heat
1. Moist heat or steam sterilization.
2. Dry heat sterilization.

II. Cold sterilization methods:

A- Chemical
1. Ethylene oxide gas.
2. Liquid sterilization process:
a- Glutaraldehyde
b- Liquid peracetic acid.
c-Hydrogen peroxide 6%.
B- Plasma sterilizers:. Plasma sterilizers
with the use of liquid peracetic acid, or
hydrogen peroxide, or a mixture of both

III. Other sterilization methods

1. Ionizing radiation.
2. Filtration.
3. Microwaves; used in
pharmaceutical industries.

There are two forms:

Moist heat by coagulating and denaturing their

enzymes and structural proteinis much more

efficient than dry heat because:

Dry heat is believed to kill microorganisms by

causing destructive oxidation of essential cell

constituents.

Autoclave

saturated water steam under high pressure.

Sterilization

temperature and exposure

time :
at 121C for 20-30 minutes at double

atmospheric pressure (2 bar)

or at 134C for 3-6 minutes (at 3 bar).

Examples of Items:
culture media, surgical instruments and
dressings.

 Chemical

indicators: chemically impregnated

paper strips which change their color at certain
temperature e.g. 121C or 132C

Biological

indicators:
are paper strips containing the spores of Bacillus
stearothermophilus.

Incineration

Red
Hot

heat
air oven

Incineration:
is particularly applicable for dead animal
bodies, infectious hospital waste such as
used surgical dressings, needles.etc.

Red heat:
Loops and points of forceps are sterilized
by holding them in the flame until they are
red hot.

 The

sterilizing agent is
dry hot air.

170C

for 1 hr

OR
160C for 2hrs

 Two

types of ionizing radiation

Gamma rays: which are emitted by radioactive

elements such as cobalt-60.

High-energy electrons (-rays): which are

produced by electron accelerators.

Sterilization of bone grafts, surgical

sutures, disposable plastic syringes,
gloves, catheters, plastic Petri dishes
and intravenous (IV) infusion sets.

Sterilization of fluids which would not withstand heat such

as antibiotic solutions, blood products, hormones,
vitamins.etc.

Fluids can be rendered free of bacteria by passage

through filters with a pore size of less than the smallest
microbial size.

Filters can be used to remove microorganisms from air

supplied to critical areas such as operating rooms and
drug factories. E.g. High Efficiency Particulate Air (HEPA)
filter.