Gen eral s u rger y

Welcome to.
Sept. 2024

Sterilization

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 Gen eral s u rger y

Dr. Sahar Mohammed Ibrahim

Department of Surgery and Theriogenology,

College of Veterinary Medicine,
Sept. 2024

University of Mosul,
Mosul, Iraq.

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Sterilization
❑ When you heard the word Surgery, always put in your mind the
other wordmate Aseptic technique.
❑ Disinfection and sterilization are essential for ensuring that
medical and surgical instruments do not transmit infection to
patients

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Sterilization: is a process of complete elimination or destruction of

all forms of microbial life (vegetative and spore forms) by various
physical and chemical methods.
❑ Sterility is absolute; there is no such thing as an object being
“partially sterile.

❑ Disinfection: is defined as a process of complete elimination of

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microorganisms from non-living objects.

❑ Antisepsis: Antisepsis is a process of removal of germs from living tissue

or skin
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Disinfectant : It is a STRONG chemical substances used for disinfection of non-living

objects.

Antiseptic: It is MILD disinfectants. They are non-irritant, non-toxic substances.

Detergents : chemicals that emulsify of skin oils and fats to remove microbes.

Sept. 2024
 Gen eral s u rger y

What should we consider to get full aseptic surgery

To have fully aseptic condition, 5 factors must be considered before, during and even
after surgery

1. The surgeon and all the surgical team.

2. The instruments and equipment's.
3. The animal patient itself.
4. The environment in which the operation is performed.
5. Owner with interested spectators.

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 Gen eral s u rger y

Classification of Surgical Items

(materials to be Sterilized/Disinfected)
❑Critical Items: are those that come in contact with sterile body cavities. Such as
surgical instruments, needles, syringes, and surgical implants. These items require
high level of disinfection HLD.

❑Semi-critical Items: are those that come in contact with mucous membranes, but
not sterile body cavities. Such as endoscopes, speculums, and ear/nose/throat
instruments used for office procedures. These items require high level disinfection
process HLD.

❑Noncritical Items: are those that come in contact only with intact skin and do not
enter sterile body cavities or mucous membranes. Such as blood glucose meters,
stethoscopes, and blood pressure cuffs. These items require a low to intermediate
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level disinfection LLD.
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METHODS OF STERILIZATION
1- Physicals methods includes
❑ Heat methods.
❑ Filtration methods.
❑ Radiation methods.

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2- Chemicals methods includes
❑ Gaseous agents
❑ Liquids agents
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Physicals methods
1. Heat methods includes (dry and moist meat)
❑ Dry heat
Dry heat destroys microorganism by oxidizing their
proteins and other chemical constituents

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A-Flaming
➢ Is an effective method for sterilizing of
sharp instruments because dry heat do
not dull edges of sharp tools.
➢ It is doing by direct exposure to spirit
flame for few seconds.
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Physicals methods
1. Heat methods includes
❑ Dry heat
B-Hot-air oven

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➢ Used to sterilize tools.
➢ The temp of hot air oven is 160c° for 2 hour.
➢ Items that can be sterilized: glassware,
scalpels, syringes, containers.
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Physicals methods
1. Heat methods includes
❑ Moist heat
➢ Below 100c°
➢ At 100c° free steam
➢ Above 100c° saturated steam

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Moist heat kills microbes by denaturing and coagulation their
proteins and enzymes thus lose their three-dimensional functional
shape. It also may melt lipids in cytoplasmic membranes
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Physicals methods
1. Heat methods includes
❑ Moist heat
❑ A- Below 100cº (boiling)

Sept. 2024
➢ The temperature is usually at least 200°F (93.3°C).

➢ It is considers as emergency sterilization. Electrical boiling

➢ Time should be up to 30 minutes.

➢ Could be used for metallic and glass items.

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Physicals methods
2. Moist heat includes
❑ At 100c°
Tyndallizationm
➢ Is a sterilization method proposed by J. Tyndall.
➢ It involves steaming items at 100°C or (100° to 120°C) for 15 minutes for

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several successive times (3-4), with an interval of 24 hours then kept in a
moist environment at a warm room temperature to give chance for
bacteria and vegetative forms to grow then to be killed during the
subsequent heating.
➢ Tyndallization is used for sterilizing medicinal preparations as well as food
products.
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Physicals methods
2. Moist heat includes
❑ Above 100c° saturated steam
Autoclaving(steam under pressure)

➢ It is a sterilization method that uses high-pressure steam to kill microbes

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such as bacteria and spores.

➢ The ideal conditions (temperature, time and pressure) for sterilizing items
are 121c° for 30 minutes and under pressure 15 p/in2 (Pounds per
Square Inch (psi)
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The advantages of autoclave are

➢ Good penetrating properties.
➢ Bactericidal effects.
➢ Perfect sterilization.
➢ Economic method

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The disadvantages of autoclave are
➢ Cause dullness of sharp instruments.
➢ Cause burn of fabrics if too dry.
➢ Leaves packs after sterilization wet.
➢ Will not sterilize grease or oils articles.
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How to ensure the effectiveness of autoclave sterilization

There are three indicators that may be used to detect the efficacy of the
autoclave process

➢ Physical: pressure and temperature recording devices.

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➢ Chemical: indicators that change color after being exposed to
specific temperatures, such as tape.

➢ Biological: Bacillus stearothermophilus spores are used, due to

its resistance to heat.
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Physicals methods
2. Filtration methods
It is used to exclude organisms based upon size through suing a membrane with 0.2
micron or smaller pore size to remove particulates from both liquids and air (gases).

Advantages
➢ Absolute sterilization - separates particles based on size

Sept. 2024
➢ Used for heat sensitive media e.g. antibiotics and hormones.
➢ Removal of multiple particle sizes.
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Physicals methods
3. Radiation method
There are 2 general types of radiation used for sterilization
1. Ionizing radiation used of short wavelength, high-intensity radiation to destroy microorganisms e.g.
gamma or X-rays that react with DNA resulting in a damaged cell. This method used in pre-packing
disposable materials such as: syringes, catheters, surgical blades, needles.

2. Non-ionizing radiation: uses longer wavelength and lower energy. As a result, non-ionizing

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radiation loses the ability to penetrate substances, and can only be used for sterilizing surfaces e.g.
ultraviolet light, which is used for sterilization of surgical theaters
Advantages
➢ Leaves no chemical residue
➢ Administration of precise dosage and uniform dosage distribution
➢ Immediate availability of the media after sterilization
Disadvantages
➢ This method is a more costly alternative to heat sterilization
➢ Requires highly specialized equipment
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Chemical method
1. Gaseous methods
2. Liquids method

Sept. 2024
➢ Chemicals methods will not dull the sharpness of instruments.
➢ They are widely used to wash and disinfection of walls and floors.
➢ Chemical sterilizing agents are adversely affected by dilution,
temperature and dirty, also may be ineffective against spores.
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Chemical method
1. Gaseous methods
❑ Ethylene oxide
❑ Formaldehyde
❑ Nitrogen dioxide (NO2)
❑ Ozone

The properties of these gases are

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➢ They don't dull the sharpness of instruments.
➢ The gases are often flammable.
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Chemical method
1. Gaseous methods
❑ Ethylene oxide (EO)
➢ Highly flammable, toxic and carcinogenic.
➢ EO is used for sterilization of heat- and moisture-sensitive surgical instruments, such as plastic devices
and delicate instruments.

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➢ Ethylene oxide should not be used in closed environment with minimum air exchange.
➢ Evacuation of gases from building is preferable.
➢ EO is hazardous to healthcare workers, patients and the environment because it is moderately toxic
when inhaled
➢ Residual EO on instruments can cause skin injuries and inflammatory reactions in patients.
➢ The materials should not be used until 6 hours aeration after the recommended 12 hours of
sterilization.
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Chemical method
1. Gaseous methods
❑ Formaldehyde
➢ This gas is obtained by heating formalin (37%w/v) to a temperature of 70-80°C.

➢ Vegetative form killed within 1-2 hours. Up to 12 hours is required to kill bacterial
spores

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➢ It possesses broad-spectrum biocidal activity and has found application in the
sterilization of reusable surgical instruments, specific medical, diagnostic and
electrical equipment.
➢ Formaldehyde doesn’t have the same penetrating power of ethylene oxide but works
on the same principle of modification of protein and nucleic acid.
➢ As a result of the low penetrating power, its use is often limited to paper, cotton
fabrics, and for disinfection of surgical theaters.
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Chemical method
1. Gaseous methods
❑ Nitrogen dioxide (NO2)
➢ Nitrogen dioxide is a rapid and effective agent that can be used for the removal of
common bacteria, fungi, and even spores

➢ NO2 has a low boiling point (20°C) which allows a high vapor pressure at standard

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temperature.
➢ The biocidal action of this gas involves the degradation of DNA by the nitration.
➢ No need for direct aeration after sterilization.
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Chemical method
1. Gaseous methods
❑ Ozone

➢ Ozone is a potent oxidizing property that is capable of destroying a wide range of

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organisms.
➢ Ozone is usually generated from medical-grade oxygen.
➢ It is also very hazardous and thus only be used at a concentration of 5ppm, which is
160 times less than that of ethylene oxide.
➢ Is used in industrial settings to sterilize water and air, as well as a disinfectant for
surfaces.
➢ On the other hand, it is a toxic and unstable gas that must be produced on-site, so it is
not practical to use in many settings.
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Chemical method
2.Liquid sterilization
❑ Hydrogen peroxide
❑ Glutaraldehyde
❑ Hypochlorite
❑ Alcohol
❑ Phenol (carbolic acid)

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❑ Quaternary ammonium
❑ Iodine
❑ Acriflavine
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Chemical method
2.Liquid sterilization

➢ Liquid sterilization is the process of sterilization which involves the

Sept. 2024
submerging of equipment in the liquid sterilizing agent to kill all viable
microorganisms and their spores.

➢ Although liquid sterilization is not as effective as gaseous sterilization, it is

appropriate in conditions where a low level of contamination is present.
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Chemical method
2.Liquid sterilization
❑ Hydrogen peroxide
➢ It is a liquid chemical sterilizing agent which is a strong oxidant and can destroy a wide range of
microorganisms.

➢ It is useful in the sterilization of heat or temperature-sensitive equipment like endoscopes.

➢ In medical applications, a higher concentration (35-90%) is used.

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➢ The biggest advantage of hydrogen peroxide is the short cycle time (28 minutes). Whereas the cycle
time for ethylene oxide may be 10 to 15 hours.
➢ However, hydrogen peroxide has drawbacks like lower capacity of penetration, and associated health
risks.
➢ Vaporized hydrogen peroxide (VHP) is used to sterilize largely enclosed and sealed areas, such as entire
rooms and aircraft interiors.
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Chemical method
2.Liquid sterilization
❑ Glutaraldehyde solution

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➢ It is commonly used in many hospitals.
➢ This preparation is regarded by many as the disinfectant of choice for lenses instruments such as
endoscopes.
➢ Used in 2% solution.
➢ Non-irritant as compared with formaldehyde.
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Chemical method
2.Liquid sterilization
❑ Hypochlorite
➢ It is also called liquid bleach, that can be used as a disinfectant, even though sterilization is difficult to
obtain with this chemical.

➢ Submerging devices for a short period (20 ms) in liquid bleach might kill some pathogenic organisms

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but to reach sterilization submersion for 20-24 hours is required.
➢ It is an oxidizing agent and thus acts by oxidizing organic compounds.
➢ Household bleach consists of 5.25% sodium hypochlorite.
➢ It is usually diluted to 1/10 immediately before use; however to kill Mycobacterium tuberculosis it
should be diluted only 1/5, and 1/2.5.
➢ It is also highly corrosive.
➢ Bleach decomposes over time when exposed to air, so fresh
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Chemical method
2.Liquid sterilization
❑ Alcohol

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➢ Ethyl alcohol and isopropyl alcohol kill bacteria by the coagulation of protein, Ethanol is generally
used as 70% solution, and isopropyl alcohol is effective in concentration up to 99%
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Chemical method
2.Liquid sterilization
❑ Phenol or (carbolic acid)

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➢ Carbolic acid was used by Joseph Lister as one of the first disinfectant to sterilize medical equipment.
➢ Phenol or carbolic acid may be divided into two groups. Cresol used as disinfectants on environmental
surface, and bisphenol are used as antiseptics .
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Chemical method
2.Liquid sterilization
❑ Quaternary ammonium compounds

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➢ These products are neutralized by even the smallest residue of soap on the skin.

➢ The Cetavlon, Dettol and benzalkonium chloride are an examples of quaternary

ammonium compounds.
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Chemical method
2.Liquid sterilization
❑ Iodine

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➢ Inorganic iodine are good bactericidal agents but stain fabrics and tissue.

➢ Iodine such as tincture of iodine in 2-5% is a strong antiseptic used on site of

operation.
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Chemical method
2.Liquid sterilization
❑ Acriflavine

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It is used in a concentration of 1:1000 as a slight antiseptics used for both
instruments and surgical team.
 Gen eral s u rger y

Thanks for Listening

Sept. 2024

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