• Disinfection

    Disinfection - measures aimed at the destruction of pathogens of infectious diseases in the external environment, in other words, disinfection. Disinfection aims at destroying pathogenic microorganisms. This is different from sterilization, in which all types of microorganisms and their spores are destroyed.

    All products that do not have contact with the wound surface, blood or injections should be disinfected.

    Distinguish preventive disinfection and focal.

    1. Prophylactic disinfection is carried out continuously to prevent diseases in the family or any team. For example, disinfection of drinking water, sewage, boiling milk. Preventive disinfection is carried out in children's and treatment and prevention institutions.

    2. Focal disinfection is carried out in case of occurrence of infectious diseases or suspicion on them. Divide:

    • into the current one;

    • Final disinfection.

    The current disinfection is a disinfection in the immediate environment of a patient or bacillator, carried out with the purpose of dispersing the causative agent of infectious diseases in the environment. The current disinfection is carried out as necessary until the patient presents a danger to others as a source of infection. The current disinfection is organized by a preventive or sanitary preventive institution, conducted by the relatives of the patient or by the patients themselves and supervised by the employees of the SES and dezstanstva.

    Final disinfection is the prevention of the spread of pathogens of infectious diseases through objects that were in contact with the patient. Unlike the current disinfection, it is usually performed once after recovery, isolation of the infectious patient, and also in the event of his death at home. In case of his death in hospital, the latter also carries out final disinfection. The timing of the final disinfection should be minimized as much as possible. It is desirable that it be carried out immediately after the source of the infection is removed. The final disinfection is carried out by the forces of the station. Methods and means of disinfection.

    I. The physical method of disinfection is based on the destruction or removal of pathogenic microorganisms from the surface of objects to be disinfected by the influence of a number of physical factors.

    1. Actions of high temperatures: burning, calcination;boiling, pasteurization;the action of hot air, drying.

    2. Actions of radiant energy: ultraviolet radiation;radioactive and ionizing radiation;current of ultrahigh frequency.

    3. The mechanical methods of disinfection are based on the removal of pathogenic microbes by washing, shaking, washing with soap and synthetic detergents.

    Disinfection of products made of glass, metals, heat-resistant polymer materials, rubber is more often used by boiling in a disinfection reboiler in distilled water for 30 minutes, with the addition of 2% soda - 15 minutes. If the products have internal channels, for example syringes, they are washed in containers with water to remove blood, serum, other biological fluids and medicinal products. Water is disinfected by boiling for 30 minutes and covered with dry chlorine lime for 60 minutes at the rate of 200 g of bleach per 1 liter of water.

    II.The chemical method of disinfection is based on the use of various chemicals. The most commonly used aqueous solutions. Chemical methods of disinfection are used for products made of glass, corrosion-resistant metals, polymeric materials, rubber. Make a complete immersion in a disinfectant solution or double wiping with a calico cloth moistened with disinfectant, with an interval of 15 minutes.

    1. Chlorine-containing disinfectants: bleach;chloramine;hypochlorites;potassium and sodium salts of dichlorine isocyanuric acid;dichloro-1;dezam;chlordesin;chlorocine;DG1-2.

    Chlorine lime is a white, fine powder with a sharp smell of chlorine. When stored in the light over time, decomposes and loses some of the active chlorine, so it should be stored in a dark place, in a tightly closed container. Chlorine lime produces three varieties - 35, 32, 28% of the active chlorine. Even with proper storage, bleach loses up to 3% of active chlorine per month. Chlorine lime, containing less than 15% of active chlorine, is not suitable for disinfection.

    Ways of use: in dry form they are used for disinfection of patient's excreta( feces, urine, sputum, vomit), food residues, outhouse latrines, garbage cans. It should be remembered that dry chlorine lime gives a disinfecting effect only on moistened surfaces.10% and 20% solutions are also used for disinfection before disposing of dressings, cotton wool, gauze napkins.

    For the preparation of 10 liters of a 10% solution of bleach, 1 kg of dry preparation is needed, to which a small amount of water is added, thoroughly mixed to a gritty state. After that, while stirring, add water to a volume of 10 liters. The use of solutions of chlorine-lime milk is carried out immediately after its preparation. They are also used in the form of clarified solutions.

    In order to obtain working solutions of bleach, it is necessary to prepare the main 10% mother liquor. Uterine and working solutions are prepared in glass bottles of dark glass with ground glass stoppers, enameled or plastic utensils. The finished solution is stored in a closed form in a dark container. The mother liquor is prepared as follows: freshly prepared 10% chloride solution is left for 24 hours in a dark, cool place, in a sealed container. During the first 4 hours, the mixture is stirred. After a day, the solution carefully, without stirring the sediment, is drained. The clarified solution can be stored for 10 days. With a decrease in the content of active chlorine in dry chlorine lime, it is necessary to increase the amount of dry drug.

    The average amount of active chlorine in dry bleach is 25%.The following formula can be used:

    X = 25 x 1000 / s,

    where c is the concentration of active chlorine in the dry preparation, 25 is the average content of active chlorine in the dry preparation.

    Chloramine. A white crystalline powder containing 25-29% of active chlorine. Preparations of chloramine are highly soluble in water. Solutions of 0.2-0.5% concentration are used for decontamination of linen, dishes, toys, nursing items, conditions in residential and hospital premises. In contrast to chloric lime, chloramine is more resistant to the action of environmental factors and loses 0.1-0.2% of active chlorine, when properly stored, per year.

    Ways of use: in dry form, like bleach, and in the form of conventional solutions. As chloramine dissolves in water without residue, it can be used without prior settling, lightening. Shelf life of solutions up to 15 days.

    The required amount of chloramine is stirred in water, preferably heated to 50-60 ° C and adjusted to the desired volume. Chloramine is also used in the form of activated solutions when adding activators. At the same time, the rate and completeness of the release of active chlorine sharply increases, which makes it possible to reduce both exposure and concentration. Respiratory tract and mucous membranes of the eyes of persons engaged in the preparation and work with these solutions must be protected. Activated solutions are used immediately after preparation. They are recommended to be used for decontamination of overalls, linen, for general cleaning in operating rooms, dressings, procedural. As activators, ammonium sulphate or nitrate is used in a ratio of 1: 1 or 1: 2 or ammonia( ammonia).Activators are added to the solution of chloramine.

    PTSGK( bisintertreated basic calcium hypochlorite) contains 47 - 52% active chlorine. The main clarified 5% solution is prepared by diluting 500 g of dry calcium hypochlorite in 10 liters of room temperature water;mix, stand for 30-45 minutes in a dark, glass or plastic dish with a stopper, then pour into a similar one. Can be used for the preparation of working solutions. Shelf life - 10 days. TSSG is used for disinfection purposes:

    • in dry form - for disinfection of precipitations, food residues, but in this case the amount of DTSG is used in 2 times less than bleach;

    • in the form of non-clarified solutions of 3.5% and 10% concentration. Applied for irrigation of the surface of premises, for disinfection of toilets, liquid discharge of the patient. These solutions are prepared at the rate of 350 g or 1 kg of DTSGK per 10 liters of water;

    • clarified solutions are used in the same cases as working solutions of clarified bleach.

    Chlorhexidine( gibitane).The drug has no odor, it mixes well with water, has a detergent effect, is stable during storage. Has a pronounced antimicrobial activity. Gibitane is intended for current and final disinfection, disinfection of the hands of the surgeon, medical staff, surgical instruments. Prepare gibitan in the form of aqueous and alcoholic solutions. Water solutions are prepared in any container by mixing it with water. The alcohol solution of gibitan is prepared by diluting it in 70% alcohol in a ratio of 1:40.Aqueous solutions are used for current disinfection, for disinfection of wards, bandages, operating rooms, for disinfection of equipment, linen in a concentration of 0.5-1%, exposure 30-60 minutes. Alcohol solutions are used to disinfect hands and tools. Surgical instruments and endoscopic equipment are disinfected with 0.5% alcohol solution by immersion in solution for 30 minutes, with the exception of the optical part, which is disinfected by wiping with a solution of the same concentration. Then, tools and equipment are washed twice in distilled water. When preparing solutions of gibitane, rubber gloves should be used.

    Sulfochlorantin - a powder of cream color with a moderate smell of chlorine, contains 15,0 active chlorine, preserves the activity of chlorine for 1 year. Store in a dark place. Working solutions remain active for 24 hours from the time of preparation. By their activity, solutions of sulfochlorantin are 5-10 times higher than the activity of chloramine. Working solutions are prepared in any container by dissolving the drug in water. Applied for disinfection of linen, dishes, toys, objects of care for patients, for current and final disinfection. The premises are irrigated at a rate of 300 ml / meter of surface or wiped with rags soaked in solution. Baths, sinks, toilets are irrigated twice with an interval of 15-30 minutes or treated with a clean dry preparation, and then washed with water.

    Dichlor-1 - a powder of white or slightly yellowish color with a weak smell of chlorine. Has a high bactericidal effect against gram( +) and gram( -) microorganisms, has tuberculocidal action in a concentration of 1-3%, 1-2% solutions are used for current and final disinfection in the foci of intestinal and dropping infections, with thesethe same goals - in surgical departments, maternity hospitals. Working solutions are prepared in any container by dilution in water until complete dissolution. When preparing the solution, wear suitable respirators and safety goggles.

    Chloridesin is a white powder with a mild chlorine odor. Contains 10-12% of active chlorine, it dissolves well in water. Solutions are colorless, do not spoil processed objects, have high antimicrobial activity. The solutions are prepared in any dish by dissolving in water.

    Dezam - white powder with a weak smell of chlorine. It contains 50% of chloramine, 5% of oxalic acid, 45% of sodium sulfate. The drug contains 13% of active chlorine. Dezam is very soluble in water, its solutions are colorless, do not spoil the processed objects. Shelf life - about a year. Has high antimicrobial activity. Working solutions are prepared in any vessel by dissolving it in water. All work with chlorine-containing drugs is carried out in rubber gloves, glasses, dust or universal respirator, in dressing gowns and apron. At the end of the work, the hands are washed with soap. In case of contact with skin or mucous membrane, immediately wash the affected area with clean water.

    2. Other disinfectants.

    Hydrogen peroxide belongs to the group of oxidants. A liquid without color and odor, when stored in an open form, activity decreases. The liquid perhydrol produced from it contains 29-33% hydrogen peroxide.3% solution of hydrogen peroxide has a bactericidal property, and 6% solution - sporicidal. Apply a solution of hydrogen peroxide in pure form for the disinfection of glass products, corrosion-resistant metals.3% solution - exposure 180 minutes, 4% solution - exposure 90 minutes, 6% solution - exposure 60 minutes. Solutions of hydrogen peroxide can be used with detergents "Astra", "Lotus", "Progress" in 0.5% concentration. In this case, they are used for current disinfection. When preparing the working solution, hydrogen peroxide is poured into the detergent solution.

    Dexozone-1 is a colorless liquid with the smell of vinegar. Contains 5.0-8.0% peracetic acid in its composition. The drug is very soluble in water, alcohol. Decokson solutions corrode items made of low-grade steel. Store it in a container of glass or polyethylene at a temperature of no higher than 30 ° C.Aqueous solutions are used immediately after preparation, as it quickly loses its active-acting properties. Shelf life 6 months. Has a high bactericidal activity. Applied for current, preventive and final disinfection, sterilization of medical products from plastic, glass, corrosion-resistant metals. Working solutions are prepared in any vessel by dissolving it in water. Packaging, preparation of working solutions is carried out in a fume hood or in a separate ventilated room. The solutions and the objects to be treated are stored in closed containers equipped with vent holes. All work with dexon-1 is carried out in a respirator, goggles, rubber gloves, oilcloth apron.

    Ampholane is a mixture of cationic and ampholygous surfactants. The preparation is brown in color, contains 30% of active substance, is readily soluble in water. Has bactericidal properties against gram( +) and gram( -) bacteria. Aqueous solutions in 0.025% concentration have a harmful effect on Staphylococcus aureus, typhoid and Escherichia coli, enterococcus, vulgar prothea for 5-15 minutes, Pseudomonas aeruginosa perishes for 25 minutes. Ampholan is intended for current disinfection with infections of bacterial etiology( except for tuberculosis) and preventive disinfection in medical institutions of various profiles. The drug is recommended for the final disinfection using methods of immersion, soaking, wiping. At a solution concentration of 0.5%, exposure is 60 minutes, at 1% concentration is 30 minutes. All works with ampholan are carried out in overalls with the use of personal protective equipment. The temperature of the disinfectant solution must be at least 18 ° C.All disinfectants are used once.

    III.Air way of disinfection.

    Suitable for glass and metal products. Disinfection occurs with dry, hot air in an air sterilizer( dry-fire cabinet) in trays without packaging. At a temperature of 120 ° C - an exposure of 45 minutes.

    IV.Steam method of disinfection.

    Suitable for glass, metal, rubber, latex and heat-resistant polymers. It is produced centrally, water saturated steam under excessive pressure in an autoclave in sterilization boxes. The pressure is 0.05 atmosphere, the temperature regime is 110 ° C, the exposure is 20 minutes.

    Disinfection of single-use medical products from plastics

    1. Disinfection is carried out in rubber gloves.

    2. Before disinfection, the syringes are rinsed in containers with water, the washings are disinfected by boiling for 30 minutes or by falling asleep with a dry disinfectant for 1 hour in a ratio of 5: 1.

    3. When immersed in the solution, the needle is actively filled with disinfectant, disposable systems and catheters are cut into small parts.

    4. For guaranteed filling of the channels with a disinfectant, the product must be immersed with a smaller diameter cover.

    5. For disinfection use the following means: 6% solution of hydrogen peroxide;5% solution of chloramine;1.5% solution of neutral hypochlorite;0.5% sulphonyl chloride.