STERILIZATIONS & DISINFECTANTS

HOSPITAL WASTE MANAGEMENT

Q1. History of Sterilization
History of Sterilization
•Joseph Lister pioneered
antiseptic techniques in surgery.
•He used carbolic acid sprays to
decontaminate surgical wounds
•The phenol in these sprays
irritated surgeon's hands
•To protect themselves they
started wearing rubber gloves.
•This practice continues today,
But carbolic acid is not used
Early Disinfection
Phenol being
spread
over an
operation
wound by 19th
Century
Surgeons
Q2. Define Sterilization and
Disinfectant!
(No, they are not synonymous)
 Sterilization
• Process where all living microorganisms are
killed.
• Sterilization can be achieved by physical,
chemical and physiochemical means.
• Chemicals used as sterilizing agents are called
chemisterilants.
• Sterilization is an absolute condition.
 Disinfection
• Process of elimination of most pathogenic
microorganisms (excluding bact spores) on inanimate
objects.
• Disinfection can be achieved by physical or chemical
methods.
• Chemicals used in disinfection are called disinfectants.
• Different disinfectants have different target ranges,
whereby not all disinfectants can kill all
microorganisms.
• Some methods of disinfection (eg: filtration) do not kill
bacteria, they separate them out.
• Disinfection is not an absolute condition.
Q3. Methods Of Sterilization
And Disinfectants
Natural agents
1. Sunlight
• Direct and continuous exposure to sunlight is
destructive to many disease producing
organism.
• UV rays of sunlight (these do not penetrate
through glass) are particularly lethal to
bacteria and some viruses.
• Linen, bedding and furniture can be
disinfected by exposure to direct sunlight.
2. Air
• Exposure to open air acts by drying or
evaporation of moisture which is lethal to
most bacteria.
Physical agents
1. Burning
• Burning/ incineration is an excellent method of
disinfection.
• Contaminated dressings, rags, swabs and faeces can be
disposed by burning.
• Burning is best done in incinerator.
2. Hot air
• Sterilize glassware, syringes, swabs, dressings, oil,
vaseline and sharp instruments.
• It do not have penetrating power therefore not suitable
for disinfection of bulky articles such as mattress.
• Done in a hot air oven.
• Hot air oven should maintain at temp 160-180 degree
for at least 1 hour to kill the spores.
3. Boiling
• Effective method of disinfection.
• Boiling for 5-10 min will kill bacteria, but not spores or
viruses.
• Boilers provide temperature well above 90 deg C in an
atmosphere of steam, which is exposed to open air.
• To ensure destruction of spores, temperatures above 100
deg C would be required.
• Suitable for disinfection of small instruments, tools which
are not used subcutaneous insertion, linen and gloves.
• Boiling for about 30 min is adequate to disinfect linen,
utensils and bedspans.
• Drawbacks: slow process, unsuitable for thick beddings
and woollen materials as they shrink , and it fixes
albuminous sains.
4. Autoclaving
• Sterilizers which operate at high temperature and
pressure.
• Two categories: inner and outer chambers (double
chamber autoclaves)
• : single chambers
• Widely used in hospital and laboratory practice
• Steam attains a higher temperature under pressure, and
has greater powers of penetration than ordinary system.
• Eg: it attains temperature of 122deg C under 15 Ibs/sq
(1kg/sq.cm) pressure.
• Effective for sterilization of linen, dressings, gloves,
syringes and culture media.
• Not suitable for plastics and sharp instruments.
5. Radiation
• Ionizing radiation used for sterilization of
bandages, dressings, catgut and surgical
instruments.
• Has great penetrating powers with little or no
heating effect.
• Most effective but costly
• Carried out by gamma radiation
Chemical agents
1. Phenol and related compound
a) Pure phenol or carbolic acid
• Pure phenol not an effective disinfectant
b) Crude phenol
• Commonly used in disinfection (effective against
gram +ve and gram –ve bacteria, but slow effective
against spores and acid fast bacilli)
c) Cresol
• Excellent coal-tar disinfectant
• 3-10 times more as powerful as phenol and no more
toxic
• 5-10% strength for disinfection of faeces and urine.
d) Cresol emulsions
• Lysol, izal and cyllin
• Disinfection of faeces
e) Chlorhexidine
• Skin antiseptics
• Highly active against vegetative gram +ve
organisms and moderately active against
gram+ve microbes.
• Inactivated by soap and detergent
f) Dettol
• Non-toxic antiseptic and used safely in high
concentrations.
• Active against streptococci
• Suitable for disinfection of instruments and
plastic equipment
2. Quaternary ammonia compounds
a) Cetrimide
• Actively bactericidal against vegetative
gram+ve organisms but less against gram-ve
organisms
b) Savlon
• Plastic appliances like lippes loop maybe
disinfected by keeping them in normal
strength savlon for 20 min
3. Alcohol
• Ethyl and isopropyl alcohol are commonly
used as antiseptics and disinfectants.
• Ethyl alcohol is most commonly used for skin
disinfection and hand washing
• 70% of alcohol is lethal in a period seconds
to all types of non-sporing bacteria, but
when applied to the skin and other surfaces,
its activity disappears as the alcohol dries
off.
4. Halogens and their compound
a) Bleaching powder
• Widely used in the public health practice for
disinfection of water, faeces and urine, and
as a deodorant.
• Drawback: unstable compound and loses its
chlorine content on storage.
• Action is rapid but brief
b) Sodium hypochlorite
• Acts in the same way as bleaching powder, but
is stronger, containing 80,000 to 180,000 ppm
of available chlorine.
• Sterilizing infant’s feeding bottles
c) Halozone tablets
• 1 tablet of halozone contain 4mg of halozone
which is sufficient to disinfect about 1 litre of
water in about ½ to 1 hour.
Halozone tablet

savlon

Sodium hypochlorite
Q4. Uses of Sterilization And
Disinfectants
 Uses Of Sterilization

• Heat Methods ( Moist heat, Dry Heat)

– Moist Heat Method

 Boiling – Used for metallic devices like surgical scissors, scalpels,

needles, etc. Here substances are boiled to sterilize them.

 Pasteurization - Alternative heating and cooling kills all the

microbes and molds without boiling the milk.

 Using Steam (autoclaving) - used for drugs as it is powerful

enough even to kill bacterial spores.
 Uses Of Sterilization
– Dry heat methods
 Flaming - fire burns the microbes and other dust on the
instrument directly.
 Incineration - kills all the germs.
 Hot Air Oven- suitable for dry material like powders, metal
devices, glassware, etc.
 Radiations - used even at the door entrances to prevent entry
of live microbes through the air.
 Uses Of Sterilization
• Chemical Methods of Sterilization
• EtO/EO – This method uses Ethylene Oxide gas to sterilize items
that cannot withstand the high temperatures or humidity created
using other methods. This is commonly used for electric
components, plastics, and cardboard

• Hydrogen Peroxide Plasma - Materials and devices that

cannot tolerate high temperatures and humidity, such as some
plastics, electrical devices, and corrosion-susceptible metal alloys.
 Uses Of Sterilization
• Filtration Method
– used to remove bacteria from thermolabile
pharmaceutical fluids that cannot be purified by
any other means.
 Uses of Disinfectants
• Chemical Disinfectants
– Alcohol - used to sterilize surgical instruments contaminated with
bacterial spores .
– Chlorine - Used to disinfect swimming pools, and is added in small
quantities to drinking water to reduce waterborne diseases.
– Chloramine - Used in drinking water treatment instead of chlorine
because it produces less disinfection byproducts.
– Chlorine dioxide - Used as an advanced disinfectant for drinking water
to reduce waterborne diseases.
– Ozone- a gas that can be added to water for sanitation.
 Uses Of Disinfectants
• Formaldehyde - used in the health-care setting to prepare viral vaccines
(e.g., poliovirus and influenza); as an embalming agent; and to preserve
anatomic specimens; and historically has been used to sterilize surgical
instruments, especially when mixed with ethanol.

• Iodophors - used for disinfecting blood culture bottles and medical

equipment, such as hydrotherapy tanks, thermometers, and endoscopes.

• Phenolics - disinfectants for use on environmental surfaces (e.g., bedside

tables, bedrails, and laboratory surfaces) and noncritical medical devices.

• Hydrogen peroxide - Used in hospitals to disinfect surfaces. Also used in

the food packaging industry to disinfect foil containers
 Hospital Waste Management

Q1. Explain What Is Hospital Waste

Management
• The waste produced in the course of health-care
activities carries a higher potential for infection and
injury than any other type of waste. Therefore it is
essential to have safe and reliable method for its
handling.

• Inadequate and inappropriate handling of health-care

waste may have serious public health consequences and
a significant impact on the environment.

• Appropriate management of health-care waste is thus a

crucial component of environmental health protection,
and it should become an integral feature of health-care
services.
• According to Bio-Medical Waste ( Management and
Handling) Rules, 1998 of India, “ Bio-medical waste”
means any waste, which is generated during the
diagnosis, treatment or immunization of human-beings
or animals, or in research activities pertaining thereto or
in the production or testing of biologicals.

• Improper disposal practices results in reuse of discarded

syringes, IV tubes, blood bags and other equipment
which is not designed for either sterilization or reuse.

• If hospital waste is not properly managed and disposed

of, it can result in injury by contaminated sharps and
infection with Hepatitis B, C, and HIV.
Q6. Types Of Hospital Waste And
Management
 Type of waste
Clinical Waste • Non clinical
•Infectious • Domestic garbage and
•Pathological presents no greater risk,
•Sharps • Waste from a normal
• Pharmaceutical home i.e.
•Radioactive Paper
Packaging
Food Waste
 Classification of health care waste
• Infectious waste: waste suspected to contain pathogens e.g. laboratory
cultures, waste from isolation wards; tissues (swabs), materials, or
equipment that have been in contact with infected patients; excreta.

• Pathological waste: Human tissues or fluids e.g. body parts; blood and other
body fluids; fetuses.

• Sharps: Sharp waste e.g. needles; infusion sets; scalpes; knives; blades;
broken glass.

• Pharmaceutical waste: waste containing pharmaceutical e.g.

pharmaceuticals e.g. pharmaceuticals that are expired or no longer needed;
items contaminated by or containing pharmaceuticals (bottles, boxes)
• Genotoxic waste: Waste containing substances with genotoxic properties e.g.
waste containing cytostatic drugs (often used in cancer therapy); genotoix
chemicals.

• Chemical waste: Waste containing chemical substances e.g. laboratory reagents;

film developer; disinfectants that are expired or no longer needed; solvents

• Wastes with high content of heavy metals: Batteries; broken thermometers;

blood-pressure gauges; etc.

• Pressurized containers: Gas cylinders; gas cartriges; aerosol cans.

• Radioactive waste: Waste containing radioactive substances e.g. unused liquids

from radiotherapy or laboratory research; contaminated glassware, packages, or
absorbent paper; urine and excreta from patients treated or tested with
unsealed radionucleides; sealed sources.
 Infectious Waste Containers
• Ideal infectious waste containers are those that have
– Lids that remain closed except when waste is discarded
– Pedal-operated devices to open the lids
– Color-coded bags inside the containers
 Infectious Waste Collection
• Wastes should be transported to the designated
central or interim storage area
• Waste bags and containers should be labeled with
the date, type of waste, and point of generation so
that it can be correctly and easily tracked through to
disposal
• Do not redistribute the waste contents by shaking
the bag as this could cause liquids or aerosols to be
released.
 Waste Labeling
• Should be established as part of a healthcare waste
management plan
• Recommended waste label content:
– Date
– Type of waste
– Point of generation Infectious Waste
(to allow tracking) Date __________

Department _________________
• Weight should be routinely Contact ____________________

recorded, where possible. AB Hospital, City

 Waste Handling
• Should be established as part of a healthcare
waste management plan
• Waste handling
– Requires use of proper PPE
– Requires use of good
body mechanics
 MEDICAL WASTE HANDLING

There are three methods for transporting

regulated medical waste, including sharps,
to a permitted regulated medical waste
treatment or storage facility.
1. By a healthcare professional employed by
the facility.
2. By contract with a transporter registered
with the state.
3. By mail, parcel post, or courier service
(sharps only).
 Waste disposal
Treatment:
• Incineration
• Chemical Disinfection
• Autoclaving
• Encapsulation
• Microwave irradiation etc.,
Final Disposal (For domestic ONLY)
• Landfill
• Burying inside Premises
• Discharge into Sewer etc.,
• *Radioactive need to be sent back to manufacturer
 Waste not to be Incinerated
• Pressurized gas containers
• Large amounts of reactive chemical waste
• Radioactive waste
• Silver salts or radiographic waste
• Halogenated plastics (e.g. PVC)
• Mercury or cadmium
• Ampoules of heavy metals
Q7)importance Of Hospital
Waste And Its Management.
By Tiruckumari Pandithavan
 Importance of hospital waste
Health risks
• Health-care waste contains potentially harmful
microorganisms which can infect hospital patients, health
workers and the general public. Other potential infectious
risks may include the spread of drug-resistant
microorganisms from health facilities into the environment.
• Health risks associated with waste and by-products also
include:
• radiation burns;
• sharps-inflicted injuries;
• poisoning and pollution through the release of
pharmaceutical products, in particular, antibiotics and
cytotoxic drugs; and
• poisoning and pollution through waste water; and by toxic
elements or compounds such as mercury or dioxins that are
released during incineration.
Sharps-related
• Worldwide, an estimated 16 billion injections are administered every
year. Not all needles and syringes are disposed of safely, creating a risk
of injury and infection and opportunities for reuse.

• Injections with contaminated needles and syringes in low- and middle-

income countries have reduced substantially in recent years, partly due
to efforts to reduce reuse of injection devices. Despite this progress, in
2010, unsafe injections were still responsible for as many as 33 800
new HIV infections, 1.7 million hepatitis B infections and 315 000
hepatitis C infections.
• The management of medical waste in
developing countries poses a major health
problem, inviting serious health implications.
When visiting health care facilities, patients
should not become more ill then they already
are, hence it is vitally important to ensure
patient safety by keeping the health centre
clean and environmentally sound. Waste
collection service providers also have to be
looked at meticulously.
• Additional hazards occur from scavenging at
waste disposal sites and during the manual
sorting of hazardous waste from health-care
facilities. These practices are common in many
regions of the world, especially in low- and
middle-income countries. The waste handlers
are at immediate risk of needle-stick injuries
and exposure to toxic or infectious materials.

• In 2015, a joint WHO/UNICEF assessment found that just over half (58%) of
sampled facilities from 24 countries had adequate systems in place for the
safe disposal of health care waste.
Environmental Impact
• Treatment and disposal of healthcare waste may pose health risks
indirectly through the release of pathogens and toxic pollutants into
the environment.
• Landfills can contaminate drinking-water if they are not properly
constructed. Occupational risks exist at disposal facilities that are
not well designed, run, or maintained.
• Incineration of waste has been widely practised, but inadequate
incineration or the incineration of unsuitable materials results in
the release of pollutants into the air and of ash residue. Incinerated
materials containing chlorine can generate dioxins and furans,
which are human carcinogens and have been associated with a
range of adverse health effects. Incineration of heavy metals or
materials with high metal content (in particular lead, mercury and
cadmium) can lead to the spread of toxic metals in the
environment.
• Only modern incinerators operating at 850-
1100 °C and fitted with special gas-cleaning
equipment are able to comply with the
international emission standards for dioxins
and furans.
• Alternatives to incineration are now available, such
as autoclaving, microwaving, steam treatment
integrated with internal mixing, and chemical
treatment.
 Management of Medical Waste
Waste threats and disposal
• Effective medical waste disposal is the first and foremost
way to prevent unwanted disease and prevent untoward
infection from medical wastes. All staff in any hospital or
laboratory are equally responsible in housekeeping. Good
housekeeping can reduce the infection to a great extent.

• It also cuts down on the spreading of microorganisms and

bacteria. The advantages of proper medical waste disposal
include the creation of a healthy atmosphere that is free
from microbes, thus minimizing the risk of infection to staff,
visitors and other people, cutting off unpleasant sights and
bad odors, and the reduction of fleas and insects.
• In an ideal world, staff disposing of medical
waste must be well-trained and must be
observed by a supervisor. In addition, every
hospital must follow the segregation
guidelines.
Bin varieties
• Some hospitals have installed fire retardant bins in many
places that are required by the rules of safety and hygiene.

• There are many medical waste bins, community waste bins

and waste collection bins in hospitals that are colour-coded
and are available in different areas throughout the health
care facility. This helps prevent any kind of contaminated
diseases making its way to a conventional landfilling during
the collection process. There are also simple sack holder
bins that have pedals or even sensors to prevent
mishandling of the bin. Mishandling of bins is a serious
issue as this is where most transfer of infections occurs.
• When installing the medical waste bins, litterbins
and waste collection bins, another important
factor to consider is size. All bins should ideally be
roughly the same size. If one type of bin is filled
before another, then there is an increased chance
that people will fill the wrong bins with the wrong
products – and may lead to improper disposal
methods thereof. The hospital bin is a very
important tool that helps ensure that health care
facilities remain hygienic for a long period, and it
is ultimately the responsibility of the authorities
in question to take care of this fact.
 Q8. Prevention Of Hospital
Infection
( Nosocomial Infection )
Nosocomial infection
• Hospital Acquired
infections
• Appears 48 hours after
• admission
• Or within 30 days after
• discharge
• Very resistant to
treatment
• Eg. Pseudomonas, MRSA,
• Staphylococcus Aureus
etc.

Pseudomonas aeruginosa bacteria