Guideline for Disinfection and Sterilization in Healthcare ...

1 Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 William A. Rutala, , ,2, David J. Weber, , ,2, and the Healthcare Infection Control Practices Advisory Committee (HICPAC)3 1 Hospital Epidemiology University of North Carolina Health Care System Chapel Hill, NC 27514 2 Division of Infectious Diseases University of North Carolina School of Medicine Chapel Hill, NC 27599-7030 1 Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 3 HICPAC Members Robert A.

2 Weinstein, MD (Chair) Cook County Hospital Chicago, IL Jane D. Siegel, MD (Co-Chair) University of Texas Southwestern Medical Center Dallas, TX Michele L. Pearson, MD (Executive Secretary) Centers for Disease Control and Prevention Atlanta, GA Raymond Chinn, MD Sharp Memorial Hospital San Diego, CA Alfred DeMaria, Jr, MD Massachusetts Department of Public Health Jamaica Plain, MA James T. Lee, MD, PhD University of Minnesota Minneapolis, MN William A. Rutala, PhD, MPH University of North Carolina Health Care System Chapel Hill, NC William E. Scheckler, MD University of Wisconsin Madison, WI Beth H.

3 Stover, RN Kosair Children s Hospital Louisville, KY Marjorie A. Underwood, RN, BSN CIC Mt. Diablo Medical Center Concord, CA This Guideline discusses use of products by Healthcare personnel in Healthcare settings such as hospitals, ambulatory care and home care; the recommendations are not intended for consumer use of the products discussed. 2 Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Disinfection and Sterilization in Healthcare Facilities Executive Summary Introduction Methods Definition of Terms Approach to Disinfection and Sterilization Critical Items Semicritical Items Noncritical Items Changes in Disinfection and Sterilization Since 1981 Disinfection of Healthcare Equipment Concerns with Implementing the Spaulding Scheme Reprocessing of Endoscopes Laparoscopes and Arthroscopes Tonometers.

4 Cervical Diaphragm Fitting Rings, Cryosurgical Instruments, Endocavitary Probes Dental Instruments Disinfection of HBV, HCV, HIV or Tuberculosis-Contaminated Devices Disinfection in the Hemodialysis Unit Inactivation of Clostridium difficile OSHA Bloodborne Pathogen Standard Emerging Pathogens (Cryptosporidium, Helicobacter pylori, E. coli O157:H7, Rotavirus, Human Papilloma Virus, Norovirus, Severe Acute Respiratory Syndrome Coronavirus) Inactivation of Bioterrorist Agents Toxicological, Environmental, and Occupational Concerns Disinfection in Ambulatory Care, Home Care, and the Home Susceptibility of Antibiotic-Resistant Bacteria to Disinfectants Surface Disinfection : Should We Do It?

5 Contact Time for Surface Disinfectants Air Disinfection Microbial Contamination of Disinfectants Factors Affecting the Efficacy of Disinfection and Sterilization Number and Location of Microorganisms Innate Resistance of Microorganisms Concentration and Potency of Disinfectants Physical and Chemical Factors Organic and Inorganic Matter Duration of Exposure Biofilms Cleaning Disinfection Chemical Disinfectants Alcohol Overview Mode of Action Microbicidal Activity Uses Chlorine and Chlorine Compounds Overview Mode of Action Microbicidal Activity 3 Guideline for Disinfection and Sterilization in Healthcare Facilities.

6 2008 Uses Formaldehyde Overview Mode of Action Microbicidal Activity Uses Glutaraldehyde Overview Mode of Action Microbicidal Activity Uses Hydrogen Peroxide Overview Mode of Action Microbicidal Activity Uses Iodophors Overview Mode of Action Microbicidal Activity Uses Ortho-phthalaldehyde Overview

7 Mode of Action Microbicidal Activity Uses Peracetic Acid Overview Mode of Action Microbicidal Activity Uses Peracetic Acid and Hydrogen Peroxide Overview Mode of Action Microbicidal Activity Uses Phenolics Overview Mode of Action Microbicidal Activity Uses Quaternary Ammonium Compounds Overview Mode

8 Of Action Microbicidal Activity Uses Miscellaneous Inactivating Agents Other Germicides Ultraviolet Radiation Pasteurization Flushing- and Washer-Disinfectors Regulatory Framework for Disinfectants and Sterilants Neutralization of Germicides 4 Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Sterilization Steam Sterilization Overview Mode of Action Microbicidal Activity Uses Flash Sterilization Overview Uses Low-Temperature Sterilization Technologies Ethylene Oxide Gas Sterilization Overview Mode of Action

9 Microbicidal Activity Uses Hydrogen Peroxide Gas Plasma Overview Mode of Action Microbicidal Activity Uses Peracetic Acid Sterilization Overview Mode of Action Microbicidal Activity Uses Microbicidal Activity of Low-Temperature Sterilization Technology Bioburden of Surgical Devices Effect of Cleaning on Sterilization Efficacy Other Sterilization Methods Ionizing Radiation Dry-Heat Sterilizers Liquid Chemicals Performic Acid Filtration Microwave Glass Bead Sterilizer Vaporized Hydrogen Peroxide Ozone Formaldehyde Steam Gaseous Chlorine Dioxide Vaporized Peracetic Acid

10 Infrared radiation Sterilizing Practices Overview Sterilization Cycle Validation Physical Facilities Cleaning Pa