Standard safety measures (

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Standard safety measures (“right practice is the safest investment towards hazards free OT system”) :

Standard safety measures (“right practice is the safest investment towards hazards free OT system”) Conducted by: Ms.Monika (clinical instructor) Army College of Nursing Fumigation ,Disinfection & sterilization in operation theatre

Disinfection & sterilization :

Disinfection & sterilization Disinfection refers to the process of killing micro-organisms by physical or chemical means. Sterilization refers to the destruction or total elimination of all types of pathogenic & non pathogenic microorganism & spores. Sterile refers to an objects that is totally free from all kinds of microorganism & spores(reproductive cell of molds) .

Various Methods of sterilization :

Various Methods of sterilization There are many methods practiced for sterilization: High temperature Light rays Certain chemicals Dry heat ,moist heat etc. Heat & light are used universally are more effective . Temp. is most effective of all methods in destroying microorganism.

Sterilization methods :

Sterilization methods Physical Methods -Moist heat sterilization - Dry heat Sterilization - Sterilization by Radiation b) Chemicals Methods - Disinfection by chemical solution - Disinfection by Chemicals vapours

Moist heat sterilization:

Moist heat sterilization Heat is most commonly used for sterilization. Moist heat is most effective, it helps to destroys the micro-organism from the surface of equipments. Moist heat is applied by two different methods: BOILING AUTOCLAVING

1) Boiling :

1 ) Boiling Boiling is done at 100° C or 212 °F temperature for 30 mins to 1 Hour in a boiler or Boiling water sterilizer. Boiling water sterilizer is a metallic tank with a lid that is fitted with water supply & connected with electricity.

Cont……….d:

Cont……….d The articles to be boiled are first cleaned thoroughly with soap & water & washed under running water. The sterilizer is filled with clean plain water so that the articles that are to be boiled are fully submerged. The sterilizer cover is to be kept closed always & specially when the articles are boiling. The rubber items & glass articles such as catheters ,syringes are to be wrapped in gauze before they are placed in a sterilizer. This prevents injury to the rubber goods & also prevents crack or break of the glassware.

Cont…….d:

Cont…….d Sharp instruments such as knife ,scissors ,needles etc are never to be boiled because heat destroys the sharpness & make the instruments blunt. The sterilizer should be thoroughly cleaned daily. The water in the sterilizer should be changed every 6 hourly.

Advantages of sterilization :

Advantages of sterilization It becomes economic when one single or just two items are to be sterilized. DISADVANTAGE : some of the virus & spores cannot be destroyed by boiling.

2) AUTOCLAVING :

2) AUTOCLAVING Autoclaving is a method in which a steam under pressure is used for sterilization. This is also a moist heat sterilization method. Heat at high temp. which can be obtained only by steam under pressure is the most effective of all sterilization methods available for destroying all types of micro-organisms including spores.

Cont………d:

Cont………d A single exposure of the steam with a temperature of 121° C or 249° F for 20 to 30 mins is enough to render the articles for sterilization. When the sterilization is to done within a short period then the temperature as high as 133° C or 272° F is used also the pressure is increased. While sterilizing the articles they are wrapped in a porous cloth wrapped & are placed in the inner chamber of the autoclave. Steam penetrate the wrapper & circulates round the articles.

Advantages of autoclaving:

Advantages of autoclaving It is most widely used sterilization method. It is economic – at lot & also different types of articles can be sterilized at time. Linen can be sterilized in an autoclave. Trays containing operations set packaged in a cloth wrapper can be sterilized in an autoclave & afterward it can be opened & utilized for specific operations. Dressing drums containing cotton balls ,sponges ,gauzes ,dressings ,bandages ,sutures ,gloves ,rubber catheters ,syringes ,needles etc can be sterilized together.

Disadvantages of autoclaving :

Disadvantages of autoclaving The disadvantages is that the sharp instruments such as knives ,blades etc turn blunt when exposed to moist heat .so these are not sterilized by autoclaving.

Slide 14:

Autoclave should be cleaned periodically or daily. Articles that are to be sterilized are to be wrapped in porous cloth wrapper or paper wrapper so that steam can penetrates. Articles ,bundles ,packages & dressings drums should be loosely packed so that steam can penetrates & circulates thorougly b/w & around the staffed articles. The inner camber of the autoclave should not be too tightly packed so that steam can circulate freely around the contents.

cont……….d:

cont……….d The porous sidewalls of the dressing rums should be opened by adjusting its cover so that steam can enter the drums through the holes. There should be adequate space between the contents & the lids of the drums. The drums should not be tightly packed. If drums are to be sterilized then these are placed in the sterilizer turned on their sides so that the steam can penetrate the content .

b) Dry heat sterilization :

b) Dry heat sterilization Dry heat sterilization is also known as hot air sterilization . The articles which cannot be sterilized by other method are sterilized by this method. Dry heat or hot is used for sterilizing minerals oils ,powders or ointments . But dry heat is less effective than moist heat.

Cont………..d:

Cont………..d The items to be sterilized are kept for a long time in high temperature. i-e these must be exposed from one to three hours at 160°c to 320 ° F. Hot air is a method of choice to sterilize glass syringes ,LP needles ,fine metal cannula , Fabric ,gauze cannot be sterilized by this method as these are poor conductor of electricity.

c) Sterilization by radiation :

c) Sterilization by radiation Radiation is a physical process of sterilization where sterilization is done by exposure to radiation by : Sunlight or ultraviolet rays Gamma rays

a) Sunlight or ultra violet sterilization :

a) Sunlight or ultra violet sterilization Mechanical cleansing of items & then exposure to direct sunlight or UV rays is used for items with large surface that cannot be sterilized by another method. Unwashable articles such as : mattresses ,pillows ,quilts ,blankets etc are sterilized by exposure to sunlight or UV rays for 6 or more hours.

Cont……..d:

Cont……..d Advantages Disadvantages It s readily & universally available & also cheapest of all methods. The disadvantage is that the rays donot have penetration power. Sunlight or UV rays can bring about 50-75 % reduction in the bacterial count of the surface of the articles.

b) Gamma Rays Sterilization :

b) Gamma Rays Sterilization These rays have greater penetration power. These rays are used for sterilization of heat sensitive disposable items such as syringes ,sutures ,drugs ,intravenous drip etc.

Cont………d:

Cont………d Advantage The advantage is that the articles are to be sterilized can be packed in sealed plastic cover or aluminum foil before sterilization. Gamma rays can penetrate the seals or the cover & sterilize the items in it. Disadvantage It is expensive method of sterilization.

b) Chemical method of sterilization :

b) Chemical method of sterilization In chemical method the sterilization is done by the chemical process. Chemical method of sterilization is used to disinfect certain articles that are damaged by heat. This process is also known as cold sterilization.

a) Disinfection by chemical solution :

a) Disinfection by chemical solution In this method ,the articles to be sterilized are submerged into the disinfectant solution. The chemical solution coagulate the protein content of the micro-organisms. Thus the microorganism are destroyed. Sharp instruments be sterilized by chemical process.

Commonly used solution are ::

Commonly used solution are : Cidex- is used for sterilizing sharp instruments ,rubber wares ,endocsopes Savlon : concentrated is used for glass ware sterilization. Lysol : concentrated is used for sterilization of sharp instruments.

Implication of disinfection by chemical solution :

Implication of disinfection by chemical solution After the articles are used they are to be cleaned thoroughly of blood ,pus or saliva. Presence of blood ,pus or saliva on the articles can inactivate the chemical solution. Cleaning allows the disinfectant to work more effectively. First the articles are wiped off from blood ,pus or saliva. then cleaned with soap & water ,washed or rinsed thorougly under plain running water.

cont…d:

cont…d Then the articles are placed either in a covered tray or in a covered jar over a layer of gauze or linen submerged in the chemical disinfectant. The articles should remain submerged in the chemical solution for the prescribed period. Most of the chemical disinfectant work best in the room temperature. The articles dipped in the disinfectant need to be washed thoroughly with distilled water or normal saline before they are used.

b)Fumigation by chemical vapors :

b)Fumigation by chemical vapors Fumigation is a chemical method of sterilization in which chemicals vapors are used for the destruction of microorganism suspended in the air. Since the sterilization or disinfection is done by exposure of fumes of a vaporized disinfectant the process is also called gas sterilization. Fumigation also destroys insects & rodents.

Equipments needs to be destroyed :

Equipments needs to be destroyed Fumigation helps in the disinfection of : Patient’s ward Unit Cubicle ICU Infected operation theatre etc.

Chemicals used in fumigation :

Chemicals used in fumigation a) Sulphur These bactericidal vapors kill the airborne infection. b)Formalin

Points To make fumigation most effective :

Points To make fumigation most effective Increase the concentration of sulphur fumes or formaldehyde gas. Maintain humidity above 60 % Maintain temperature at around 18° C. Doors ,windows ,ventilators should be tightly closed or the rooms should be sealed to avoid leakage of the sulphur or formaldehyde gas. Maintain exposure time for 20 to 24 hours Vapors or gas must penetrates &circulates in all areas of the room.

Disadvantage :

Disadvantage These gases have pungent smell & are irritant to skin ,eyes & mucous membrane. A room of 100 cubic feet would requires 200 grams sulphur which is placed in an earthen pot & is placed in a larger pot containing water. A little methylated spirit is poured over the sulphur to burn completely. Seal the room for 24 hours. All articles & furniture should be kept exposed for thorough exposure to the fumes. a) Sulphur fumigation

2) Formalin fumigation :

2) Formalin fumigation Formalin is a 40% of formaldehyde. For a room of 100 cubic feet 140 gms of potassium permanganate (KMNO4) crystals & 250 ml of formalin are mixed in a bowl. The heat produced by the chemical action of the mixture & produces formaldehyde gas. The room should remain sealed for 24 hours.

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