health staff is always on prevention and constant struggle against infection, dating from ancient times. Has been shown to cause numerous diseases are microorganisms that are transmitted using different mechanisms. That's why we have developed different techniques used in clinical practice is essential as are measures of asepsis, disinfection, sterilization and antisepsis.
However, hospital-acquired infections remain a public health problem in all environments parties offering health care. That is why the importance of using appropriate measures for reducing its incidence and have a basic pillar of prevention. As these practices mandatory nature All procedures are performed in the clinical field.
ASEPSIS: is the set of measures and procedures to prevent the arrival of microorganisms to a medium.
STERILIZATION Sterilization is the complete destruction of all microorganisms, including resistant forms such as bacterial spores, non-enveloped viruses and fungi.
There are three types of sterilization: Physical sterilization, gaseous sterilization and chemical sterilization.
physical sterilization
procedures are divided into physical and mechanical energy. Among the former are the heat and radiation, within seconds, the leak.
sterilization methods commonly used in hospital settings are the Moist and Dry Heat, as they are suitable for most materials except for the thermolabile.
Moist heat sterilization by moist heat destroys microorganisms in gradually, with final effect of denaturation and coagulation of proteins. The equipment used is the autoclave, which uses steam at 121-132 ° C over a period of 15 to 20 minutes. The sterilizing action of steam autoclave pressure is fast and efficient is influenced by the following factors:
- and duration of the process temperature.
- size
- Autoclave steam flow rate
- density and size of content
- Placement of the load in the autoclave.
Dry Heat:
The dry heat causes denaturation of proteins, oxidative damage and toxic effects from high levels of electrolytes. Action lethal heat is transferred from the material to which microorganisms have contact. The equipment used was the Pasteur oven or poupinelle. It requires treatment of 171 º C for one hour, or variable depending on the degree. However, this method is not as effective as moist heat because:
- The spread and penetration of heat is slow.
- higher temperatures are required.
- sterilization periods are longer.
For dry heat may be sterilized injectable materials, glass, and metal objects, whether as oil, Vaseline and powder.
GASEOUS STERILIZATION
The most widely used sterilant gas is ethylene oxide. Although very efficient, this substance is flammable, toxic and carcinogenic, which is why their use is gradually being undermined, although many hospitals in Latin America still use it. Ethylene oxide is a colorless gas, soluble in water and organic solvents used in the sterilization of thermolabile objects. The sterilization process is relatively slow and is influenced by the following factors:
- gas concentration
- relative and absolute humidity
- Exposure time temperature
-
Since ethylene oxide can cause damage to viable tissue, the gas must have evaporated before proceeding to use sterilized equipment, for a period of 16 hours more, this being a mandatory regulation.
CHEMICAL STERILIZATION
Within this group is the Formaldehyde and Glutaraldehyde , also considered high-level disinfectant.
DISINFECTION Disinfection is the process and use of substances which kill or inhibit microorganisms on inanimate surfaces, but as having little effect on vegetative spores.
The effectiveness of the disinfection procedure is determined by:
- nature of the object to be disinfected
- The number and degree of resistance of microorganisms
- Quantity of organic matter.
1. High level disinfection: Disinfection this is used for items that do not support invasive mechanisms of sterilization. Is most effective when it removes all traces of organic matter.
2. Mid-Level Disinfection: materials are used in computers where it is unlikely the bacterial spore contamination. 3.Desinfección
Low Level: is used on materials that do not penetrate mucous membranes, only outside contact.
SPAULDING CLASSIFICATION
Spaulding classification indicator is a criterion for disinfection, which dates from 1968 and is governed in the objects and materials used in health and hospital, which will be in contact with the patient, established according to risk of infection.
|
| Level Equipment Type | Example | Minimum required level |
|
| Critical Instrument induced directly into the bloodstream or sterile areas of the body. | surgical instruments, cardiac catheterizations, IV catheters, etc. Sterilization | |
|
| semi-critical items in contact with intact mucosa | flexible endoscopes, endotracheal tubes, laryngoscopes, etc.. | High Level Disinfection (HLD) |
| No Critical Item | contact with intact skin. | blood pressure cuff, otoscope, etc.. Disinfection | Medium and Low |
- Critics: penetrate into the tissues or cavities. Typically must be sterile.
- semicritical: enter into contact with mucosal tissues. Must be free of bacteria.
- Critical No: should be washed at least, have contact with healthy skin.
antisepsis antisepsis is elimination or inhibition of pathogenic microorganisms on surfaces animated, ie in living tissue, through the application of chemicals called antiseptics.
Antiseptics: are chemicals that are applied to living tissue in order to eliminate microorganisms, not being targeted, as they eliminate all kinds of germs.
MECHANISMS OF ACTION
- Bactericide: eliminates microorganisms and prevents their growth. Are irreversible.
- Bacteriostatic: blocks the growth of microorganisms while duration of action.
ANTISEPTICS TYPES
| Antiseptic | Concentration |
| Alcohols (ethyl, isopropyl) | |
| 1-2% iodine | |
| 0.5-4% chlorhexidine | |
| hydrogen peroxide 1.5-3% |
Bactericidal action. widely used as a skin antiseptic prior to injection and blood extraction. The activity of alcohol is greater in the presence of water (70 degrees is more potent than 90 degrees). should not use it directly by wound irritation effect. Produces local tissue pain and inactive against organic matter.
- Hydrogen Peroxide
Although there are contradictions about its bactericidal action. Its effect would be more related to their excitement by acting at two levels: deshibridante Effect of necrotic tissue by mechanical action and the oxygen supply of microorganisms against anaerobes. Besides having oxidizing action is deodorizing, ie, eliminates odors.
- Chlorhexidine
is a broad spectrum bactericide. Not irritating as its absorption is zero, no systemic reactions. Contrary to other antiseptics, its activity is slightly interfered by the presence of organic matter, including blood. It has potent antimicrobial activity.
- iodinated compounds
Within this group is the povidone-iodine or povidone. Is bactericidal. Inactivated in contact with organic matter. Are excellent antiseptics skin. They are slightly more toxic to the skin than alcohol, although some consider a cytotoxic action in routine use. IMPORTANT
cleaning and mechanical removal of organic matter is essential to ensure optimal sterilization, disinfection and antisepsis.
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