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Chapter 13: Sterilization & Disinfection

STERILIZATION, DISINFECTION, & STANDARD PRECAUTIONS

The purpose of sterilization and disinfection procedures is to prevent transmission of microbes to patients. In addition to sterilization and disinfection, other important measures to prevent transmission are included in the protocol of “standard precautions” (previously known as Universal Precautions). These standard precautions should be used in interaction with all patients because it is unknown whether any particular patient may be the reservoir of transmissible bacteria, viruses, or other microbes.

Standard precautions include (1) hand hygiene, (2) respiratory hygiene and cough etiquette, (3) safe injection practices, and (4) proper disposal of needles and scalpels. Further, if exposure to body fluids or aerosols is likely, personal protective equipment (PPE) such as masks or face shields, gloves, gowns, and protective eyewear should be used. The precautions taken should be specific for the task rather than for the particular patient.

In addition, there are transmission-based precautions that supplement the standard precautions and should be employed when the patient is infected (or suspected to be infected) with a highly transmissible organism. The three categories of transmission-based precautions are contact, droplet, and airborne and are described in Table 13–1. For additional information, please consult the Centers for Disease Control and Prevention (CDC) website (http://www.cdc.gov/hai/), where healthcare-associated infections (HAI) are discussed.

Table 13–1Infection Control Precautions and Practices
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Table 13–1 Infection Control Precautions and Practices
Type of Precaution Example of Type of Patient or Type of Infection Important Precaution Practice Employed
Standard All patients

  1. Hand hygiene

  2. Respiratory hygiene and cough etiquette

  3. Safe injection practices

  4. Proper disposal of needles and scalpels
Standard If exposure to blood, secretions, or body fluids is likely to occur Personal protective equipment (PPE) such as mask, face shield, goggles, gloves, or gown
Contact

  1. Stool incontinence, e.g., Clostridium difficile, norovirus

  2. Generalized rash, e.g., varicella (chickenpox)

  3. Draining wounds

  1. Wear gloves and gown

  2. Disinfect room
Droplet

  1. Respiratory viruses, e.g., influenza

  2. Bordetella pertussis

  3. Early infection with Neisseria meningitidis

  1. Face mask or face shield for patient and provider

  2. Disinfect room
Airborne

  1. Tuberculosis

  2. Measles

  3. Varicella (chickenpox) when patient is coughing

  1. Isolation room; negative pressure room

  2. Face mask or face shield for patient and provider; N-95 respirator, if available

  3. Disinfect room

PRINCIPLES OF STERILIZATION & DISINFECTION

Sterilization is the killing or removal of all microorganisms, including bacterial spores, which are highly resistant. Sterilization is usually carried out by autoclaving, which consists of exposure to steam at 121°C under a pressure of 15 lb/in2 for 15 minutes. Surgical instruments that can be damaged by moist heat are usually sterilized by exposure to ethylene oxide gas, and most intravenous solutions are sterilized by filtration.

Disinfection is the killing of many, but not all, microorganisms. For adequate disinfection, pathogens must be killed, but some organisms and bacterial spores may survive. Disinfectants vary in ...

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