INFECTION

CONTROL
 WHOA!

Every year, an estimated 722,000 health care–

associated infections (HAIs) occur that result
in 75,000 deaths. HAIs are infections that
originate in healthcare facilities. An effective
infection control program must be established
in a health care setting to recognize and
prevent HAIs.
01. INFECTIOUS DISEASE 02. STANDARD PRECAUTION
SOURCE, SUSCEPTIBLE HOST,
MODE OF TRANSMISSION

03. TRANSMISSION BASED 04. STERILIZATION VS

PRECAUTION DISINFECTION
 INFECTIOUS DISEASES

Infectious diseases are caused by microscopic organisms that penetrate the body’s natural barriers
and multiply to create symptoms that can range from mild to deadly

EXAMPLE OF INFECTIONS:
● Measles
● Yellow fever
● Common cold
● Tuberculosis
● Mumps,
● Hepatitis
● Influenza
SOURCE
 SOURCE
Infectious agents transmitted during healthcare derive primarily from human sources but inanimate
environmental sources also are implicated in transmission.
Human reservoirs include:
● Patients
● Healthcare personnel
● Household members
● Visitors
Such source individuals may have active infections, may be in the asymptomatic and/or incubation
period of an infectious disease, or may be transiently or chronically colonized with
pathogenic microorganisms, particularly in the respiratory and gastrointestinal tracts.
 SOURCE

Inanimate environmental sources:

● Dry surfaces in patient care areas (e.g., bed rails, medical equipment, countertops,
and tables)
● Wet surfaces, moist environments, and biofilms (e.g., cooling towers, faucets and
sinks, and equipment such as ventilators)
● Indwelling medical devices (e.g., catheters and IV lines)
● Dust or decaying debris (e.g., construction dust or wet materials from water leaks)
SUSCEPTIBLE
PERSON
 SUSCEPTIBLE PERSON

A susceptible person is someone who is not vaccinated or otherwise immune, or a person with a
weakened immune system who has a way for the germs to enter the body. For an infection to occur,
germs must enter a susceptible person’s body and invade tissues, multiply, and cause a reaction.

Devices like IV catheters and surgical incisions can provide an entryway, whereas a healthy immune
system helps fight infection.

Recognizing the factors that increase patients’ susceptibility to infection allows providers to
recognize risks and perform basic infection prevention measures to prevent infection from occurring.
TRANSMISSION
 TRANSMISSION
Several classes of pathogens can cause infection,
including bacteria, viruses, fungi, parasites, and
prions. The modes of transmission vary by type of
organism and some infectious agents may be
transmitted by more than one Route
● Direct or indirect contact, (e.g., Herpes simplex virus
[HSV], respiratory syncytial virus, Staphylococcus
aureus)
● Droplet, (e.g., influenza virus, B. pertussis)
● Airborne routes (e.g., M. tuberculosis)
● Bloodborne viruses (e.g., hepatitis B and C
viruses[HBV, HCV] and HIV)
 Contact
transmission
The most common mode of transmission, contact transmission is
divided into two subgroups: direct contact and indirect contact.
 DIRECT TRANSMISSION

Direct transmission occurs when microorganisms are transferred from one

infected person to another person without a contaminated intermediate
object or person.
● Blood or other blood-containing body fluids from a patient directly enters a caregiver’s body through
contact with a mucous membrane or breaks (i.e., cuts, abrasions) in the skin

● Mites from a scabies-infested patient are transferred to the skin of a caregiver while he/she is having
direct ungloved contact with the patient’s skin

● A healthcare provider develops herpetic whitlow on a finger after contact with HSV when providing oral
care to a patient without using gloves or HSV is transmitted to a patient from a herpetic whitlow on an
ungloved hand of a healthcare worker
 INDIRECT TRANSMISSION
Indirect transmission involves the transfer of an infectious agent through a contaminated intermediate object or
person. In the absence of a point-source outbreak, it is difficult to determine how indirect transmission
occurs.

● Hands of healthcare personnel may transmit pathogens after touching an infected or colonized body site on one patient or a
contaminated inanimate object, if hand hygiene is not performed before touching another patient.
● Patient-care devices (e.g., electronic thermometers, glucose monitoring devices) may transmit pathogens if devices
contaminated with blood or body fluids are shared between patients without cleaning and disinfecting between patients
● Shared toys may become a vehicle for transmitting respiratory viruses (e.g., respiratory syncytial virus or pathogenic bacteria
(e.g., Pseudomonas aeruginosa) among pediatric patients.
● Instruments that are inadequately cleaned between patients before disinfection or sterilization (e.g., endoscopes or surgical
instruments) or that have manufacturing defects that interfere with the effectiveness of reprocessing may transmit bacterial
and viral pathogens.

Clothing, uniforms, laboratory coats, or isolation gowns used as personal protective equipment (PPE), may
become contaminated with potential pathogens after care of a patient colonized or infected with an infectious
agent, (e.g., MRSA, VRE, and C. difficile
 DROPLET
transmission
Droplet transmission is, technically, a form of contact transmission, and some infectious agents
transmitted by the droplet route also may be transmitted by the direct and indirect contact routes
 DROPLET TRANSMISSION

In contrast to contact transmission, respiratory droplets carrying infectious pathogens transmit infection when
they travel directly from the respiratory tract of the infectious individual to susceptible mucosal surfaces of the
recipient, generally over short distances, necessitating facial protection.

Respiratory droplets are generated when an infected person:

● Coughs
● Sneezes
● Talks

During procedures such as:

● Suctioning
● Endotracheal intubation
● Cough induction by chest physiotherapy
● Cardiopulmonary resuscitation

Studies have shown that the nasal mucosa, conjunctivae and less frequently the mouth, are susceptible portals of
entry for respiratory viruses.
 airborne
transmission
 AIRBORNE TRANSMISSION

Airborne transmission occurs by dissemination of either airborne droplet nuclei or small particles in
the respirable size range containing infectious agents that remain infective over time and distance
(e.g., spores of Aspergillus spp, and Mycobacterium tuberculosis). Microorganisms carried in this
manner may be dispersed over long distances by air currents and may be inhaled by susceptible
individuals who have not had face-to-face contact with (or been in the same room with) the
infectious individual.
 SUMMARY OF TRANSMISSION
Microorganisms are spread in health care facilities through
several modes:
● Direct contact—for example, in contaminated food or
intravenous solutions
● Indirect contact—for example, from patient to patient
on the hands of health care workers (MRSA, rotavirus)
● Droplet contact—for example, inhalation of droplets
(.5 µm in diameter) that cannot travel more than 3 feet
(pertussis)
● Airborne contact—for example, inhalation of droplets
(.5 µm) that can travel large distances on air currents
(tuberculosis)
● Vector-borne contact—for example, disease spread by
vectors, such as mosquitoes (malaria) or rats (rat-bite
fever); this mode of transmission is rare in hospitals
within developed countries
 STANDARD
PRECAUTION
There are two tiers of HICPAC/CDC precautions to prevent transmission of infectious agents, Standard
Precautions and Transmission-Based Precautions.
 STANDARD PRECAUTION

Standard Precautions are intended to be applied to the care of all patients in all healthcare settings, regardless of
the suspected or confirmed presence of an infectious agent. Implementation of Standard Precautions constitutes
the primary strategy for the prevention of healthcare-associated transmission of infectious agents among
patients and healthcare personnel.

Standard Precautions combine the major features of Universal Precautions (UP) and Body Substance Isolation
(BSI) and are based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact
skin, and mucous membranes may contain transmissible infectious agents.

Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of
suspected or confirmed infection status, in any setting in which healthcare is delivered.

Standard Precautions are also intended to protect patients by ensuring that healthcare personnel do not carry
infectious agents to patients on their hands or via equipment used during patient care.
 Standard precautions

01 02 03 04

Personal Protective Follow respiratory Ensure appropriate patient

Hand Hygiene
Equipment hygiene/cough etiquette placement

05 06 07 08

Clean and disinfects the Handle textiles and laundry Follow safe injection Ensure health worker safety
environment appropriately carefully practices. including proper handling of
needles and other sharps
Hand hygiene
 HANDWASHING

01 02 03 04

Start by wetting Apply some Rub your hands Lather the back
your hands soap carefully palm to palm of your hands
 HANDWASHING

05 06 07 08

Rub the back of Clean your

Scrub between Clean your
your opposing thumbs
your fingers fingernails and
palms’ fingers repeatedly fingertips
 HANDWASHING

09 10 11 12

Rinse your hands Dry them with a Use the towel Your hands are
thoroughly disposable to turn off the now clean!
hand towel faucet
 hand rubbing

01 02 03 04

60% alcohol Fingers Palm to palm Fingernails

 Hand rubbing

05 06 07 08

Wrists Thumbs Rub until dry Disinfected!

Personal protective
equipment
 PERSONAL PROTECTIVE EQUIPMENT

01 Surgical masks and 03 Safety gloves (must

respirators be worn to the wrist)

Lab coat or apron Eye or face protection

(wear it correctly) 02 (such as glasses) 04
 Respiratory
hygiene/cough etiquette
 Elements of respiratory hygiene

● education of healthcare facility staff, patients, and visitors;

● posted signs, in language(s) appropriate to the population served, with instructions to patients and
accompanying family members or friends;
● source control measures (e.g., covering the mouth/nose with a tissue when coughing and prompt
disposal of used tissues, using surgical masks on the coughing person when tolerated and
appropriate);
● hand hygiene after contact with respiratory secretions; and
● spatial separation, ideally >3 feet, of persons with respiratory infections in common waiting areas
when possible.
Patient placement
 Hospitals and long-term care settings
Options for patient placement include single patient rooms, two patient rooms, and multi-bed wards. Of
these, single patient rooms are preferred when there is a concern about transmission of an infectious
agent. However, most hospitals and long-term care facilities have multi-bed rooms and must consider
many competing priorities when determining the appropriate room placement for patients:
● Reason for admission
● Patient characteristics (age, gender, mental status)
● Staffing needs
● Family requests
● Psychosocial factors
● Reimbursement concerns

Cohorting is the practice of grouping together patients who are colonized or infected
with the same organism to confine their care to one area and prevent contact with other
patients.
 Ambulatory settings
Patients actively infected with or incubating transmissible infectious diseases are seen frequently in
ambulatory settings and potentially expose healthcare personnel and other patients, family members
and visitors.

● Outpatient clinics
● Physicians’ offices
● Emergency departments

Signs can be posted at the entrance to facilities or at the reception or registration desk requesting that
the patient or individuals accompanying the patient promptly inform the receptionist if there are
symptoms of a respiratory infection
 Ambulatory settings
Patients actively infected with or incubating transmissible infectious diseases are seen frequently in
ambulatory settings and potentially expose healthcare personnel and other patients, family members
and visitors.

● Outpatient clinics
● Physicians’ offices
● Emergency departments

Signs can be posted at the entrance to facilities or at the reception or registration desk requesting that
the patient or individuals accompanying the patient promptly inform the receptionist if there are
symptoms of a respiratory infection
 SOCIAL DISTANCING

ONE mETER

symptomatic nonsymptomatic
 Home care

In home care, the patient placement concerns focus on protecting others in the home from
exposure to an infectious household member. For individuals who are especially vulnerable
to adverse outcomes associated with certain infections, it may be beneficial to either
remove them from the home or segregate them within the home. Persons who are not part
of the household may need to be prohibited from visiting during the period of infectivity.
Safe injection practices
 Safe injection practices

The investigation of four large outbreaks of HBV and HCV among patients in ambulatory care
facilities in the United States identified a need to define and reinforce safe injection
practices. The primary breaches in infection control practice that contributed to these
outbreaks were:
• reinsertion of used needles into a multiple-dose vial or solution container (e.g., saline
bag) and
• use of a single needle/syringe to administer intravenous medication to multiple patients.

In one of these outbreaks, preparation of medications in the same workspace where

used needle/syringes were dismantled also may have been a contributing factor.
TRANSMISSION
BASED
PRECAUTIONS
 CONTACT
PRECAUTION
Use Contact Precautions for patients with known or suspected
infections that represent an increased risk for contact transmission.
 Contact precaution
Contact Precautions are intended to prevent transmission of infectious agents, including
epidemiologically important microorganisms, which are spread by direct or indirect contact with the
patient or the patient’s environment. Contact Precautions also apply where the presence of excessive
wound drainage, fecal incontinence, or other discharges from the body suggest an increased potential for
extensive environmental contamination and risk of transmission.

● A single-patient room is preferred for patients who require Contact Precautions. When a single-patient
room is not available, consultation with infection control personnel is recommended to assess the
various risks associated with other patient placement options.
● In multi-patient rooms, ≥3 feet spatial separation between beds is advised to reduce the
opportunities for inadvertent sharing of items between the infected/colonized patient and other
patients.
Healthcare personnel caring for patients on Contact Precautions wear a gown and gloves for all
interactions that may involve contact with the patient or potentially contaminated areas in the patient’s
environment.
 Droplet
PRECAUTION
 droplet precaution
Droplet Precautions are intended to prevent transmission of pathogens spread through close respiratory
or mucous membrane contact with respiratory secretions. Because these pathogens do not remain
infectious over long distances in a healthcare facility, special air handling and ventilation are not required
to prevent droplet transmission.
● A single patient room is preferred for patients who require Droplet Precautions.
● When a single-patient room is not available, consultation with infection control personnel is
recommended to assess the various risks associated with other patient placement options.
● Spatial separation of ≥3 feet and drawing the curtain between patient beds is especially important for
patients in multi-bed rooms with infections transmitted by the droplet route.

Healthcare personnel wear a mask for close contact with infectious patient; the mask is generally donned
upon room entry. Patients on Droplet Precautions who must be transported outside of the room should
wear a mask if tolerated and follow Respiratory Hygiene/Cough Etiquette.
 airborne
PRECAUTION
 AIRBORNE precaution
Airborne Precautions prevent transmission of infectious agents that remain infectious over long
distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], M.
tuberculosis, and possibly SARS-CoV)
● The preferred placement for patients who require Airborne Precautions is in an airborne infection
isolation room (AIIR).
● An AIIR is a single-patient room that is equipped with special air handling and ventilation capacity
that meet the American Institute of Architects/Facility Guidelines Institute (AIA/FGI) standards for
AIIRs. (i.e., monitored negative pressure relative to the surrounding area, 12 air exchanges per hour for
new construction and renovation and 6 air exchanges per hour for existing facilities, air exhausted
directly to the outside or recirculated through HEPA filtration before return).
A respiratory protection program that includes education about use of respirators, fit testing, and user
seal checks is required in any facility with AIIRs. In settings where Airborne Precautions cannot be
implemented due to limited engineering resources (e.g., physician offices), masking the patient, placing
the patient in a private room (e.g., office examination room) with the door closed, and providing N95 or
higher level respirators or masks.
STERILIZATION &
disinfection
 Sterilization vs disinfection
The scientific use of disinfection and sterilization methods originated more than 100 years ago when
Joseph Lister introduced the concept of aseptic surgery using carbolic acid, now called phenol. Since
then, the implementation of effective sterilization and disinfection methods has remained crucial in the
control of infections in the laboratory and health care facilities (health care–associated infections)

● Sterilization refers to the destruction of all forms of life, including bacterial spores. By definition,
there are no degrees of sterilization—it is an all-or-nothing process.
● Disinfection refers to a process that eliminates a defined scope of microorganisms, including some
spores
● A substance applied to the skin for the purpose of eliminating or reducing the number of bacteria
present is referred to as an antiseptic.
 Factors that
affects degree of
killing
 Factors that affects degree of killing

01 02 03 04 05

Type of Number of Concentration of Presence of Nature of surface to

organisms organisms disinfecting agent organic material be disinfected
(e.g., serum, blood)

06 07 08 09 10

Contact time Temperature pH Biofilms Compatibility of

disinfectants and
sterilants
 Types of Organisms
Organisms differ greatly in their ability to withstand chemical and physical treatment. This variability is
due to the biochemical composition of microorganisms and various mechanisms that they can use to
protect themselves.

● For example, bacterial endospores have coats rich in proteins, lipids, and carbohydrates as well as
cores rich in dipicolinic acid and calcium, all of which protect the spores.
● Cell walls of mycobacteria are rich in lipids, which may account for their resistance to chemical and
environmental stresses, particularly desiccation.
● Viruses containing lipid-rich envelopes are more susceptible to the effects of detergents and wetting
agents.
● The organisms known today to be the most resistant to the actions of heat, chemicals, and radiation
are prions. These infectious agents are extremely resistant to chemical and physical methods of
destruction. Prions can withstand temperatures exceeding 121° C for several hours while immersed
in acid or basic solutions.
 Number of Organisms
Another factor to consider is the total number of organisms present, referred to as
the microbial load (bioburden). The microbial load determines the exposure time that
is necessary for 99.9% elimination of the microorganisms. In general, higher
numbers of organisms require longer exposure times.
 Concentration of Disinfecting Agent

The concentration of a disinfecting agent is also important. The amount of disinfectant needed
to destroy microorganisms varies with the different agents. Manufacturers' instructions on
preparation, dilution, and use must be followed very carefully.

Concentrated disinfectants, such as povidone-iodine, may actually allow microorganisms to

survive because there is not enough free iodine to kill microorganisms. Proper concentrations
of disinfecting agents ensure the inactivation of target organisms and promote safe and cost-
effective practices.
 Presence of Organic Material

Organic material, such as blood, mucus, and pus, affects killing activity by
inactivating the disinfecting agent. In addition, by coating the surface to be treated,
organic material prevents full contact between object and agent. Bleach (sodium
hypochlorite) is easily inactivated by organic material. For optimal killing activity,
instruments and surfaces should be cleansed of excess organic material before
disinfection
 Nature of Surface to Be Disinfected

Certain medical instruments are manufactured of biomaterials that exclude the use
of certain disinfection or sterilization methods because of possible damage to the
instruments. For example, endoscopic instruments are readily damaged by the heat
generated in an autoclave. Alternative methods must be used for this class of
instruments.
 Contact Time

The amount of time a disinfectant or sterilant is in contact with the object is critical. Too little contact time
does not allow the agent to work properly. The contact time is a function not only of the agent itself but also
of the bioburden on the object, the type of microorganism that is to be killed, and the presence of organic
material and the temperature at which the agent is being used. When disinfecting or sterilizing a
contaminated object, it is critical to know what organisms may be present and the contact time to use,
which is based on the microorganism that is most resistant. The amount of time that an agent is in contact
with an object can also determine whether it is disinfecting or sterilizing the object.

• For example, glutaraldehyde can be used as a disinfectant or a sterilant, with the difference being the amount of
time the glutaraldehyde is in contact with the contaminated object. When glutaraldehyde is used as a sterilant,
the contact time is much longer than when it is used as a disinfectant.

• Alcohol and iodine preparations (e.g., Betadine) must be in contact with an object for at least 1 to 2 minutes for
them to kill microorganisms. The spores of both bacteria and fungi must be in the presence of disinfectants or
sterilants for a much longer time than their vegetative counterpart before they are killed
 Temperature

Disinfectants are generally used at room temperature (20° to 22° C). Their activity is generally
increased to some degree by an increase in temperature and decreased by a decrease in
temperature. A disinfectant that is used on the workbench generally works faster than if the
disinfectant is used on a cold surface such as the walls of a refrigerator. Disinfection of blood spills
in a refrigerator can take longer than disinfection of blood spills on a room temperature countertop.
Disinfectants and sterilants can be rendered inactive by too high or too low a temperature.
 pH
The pH of the material to be disinfected or sterilized can affect the activity of the
disinfecting or sterilizing agent. It is critical to make sure at what pH the agent is
active and what the pH of the material to be exposed to the agent is at the time the
process will be done.
 Biofilms

Biofilms are considered a community of bacteria or other microorganisms. These communities are
generally layers of microorganisms that often have a protective material over them that shields them
from outside environmental factors. These communities of microorganisms can be on the surface of
either inanimate or animate objects.
• A critical place where biofilms are seen in the hospital is on catheters.
• Other places may be inside pipes that carry water and on deionizing columns used to make processed
water.

When dealing with the disinfection of objects that may have a biofilm, it is critical to realize that the
presence of the biofilm makes disinfection more difficult. To disinfect materials that may have a
biofilm present, the concentration of the disinfectant may need to be increased, the contact time may
need to be increased, or both.
 Compatibility of Disinfectants

A common mistake is to believe that two disinfectants are better than one. This is not
necessarily incorrect, but when more than one disinfectant is used, the compatibility of the
disinfectants must be taken into consideration. Some disinfectants may inactivate other
disinfectants.

• For example, the use of bleach and a quaternary ammonium compound together may
negate the activity of both disinfectants.
 sterilization

A process that kills all forms of microbial life, including bacterial endospores.
Physical
method
 incineration

Incineration is a method of treating infectious waste. Hazardous material is literally

burned to ashes at temperatures of 870° to 980°C. Incineration is the safest method to
ensure that no infective materials remain in samples or containers when disposed.
Prions, infective proteins, are not eliminated using conventional methods. Therefore
incineration is recommended. Toxic air emissions and the presence of heavy metals in
ash have limited the use of incineration in the United States.
 MOIST HEAT

Moist heat (steam under pressure) is used to sterilize biohazardous trash and heat-stable
objects; an autoclave is used for this purpose. An autoclave is essentially a large pressure
cooker. Moist heat in the form of saturated steam under 1 atmosphere (15 pounds per square
inch [psi]) of pressure causes the irreversible denaturation of enzymes and structural proteins.
The most commonly used steam sterilizer in the microbiology laboratory is the gravity
displacement autoclave. The two common sterilization temperatures are 121°C and 132°C.
Moist heat is the fastest and simplest physical method of sterilization.
 DRY HEAT

Dry heat requires longer exposure times (1.5 to 3 hours) and higher
temperatures than moist heat (160° to 180°C). Dry heat ovens are used to
sterilize items such as glassware, oil, petrolatum, or powders.
 FILTRATION

Filtration is the method of choice for antibiotic solutions, toxic chemicals,

radioisotopes, vaccines, and carbohydrates, which are all heat sensitive. Filtration of
liquids is accomplished by pulling the solution through a cellulose acetate or cellulose
nitrate membrane with a vacuum. Filtration of air is accomplished using high-
efficiency particulate air (HEPA) filters designed to remove organisms larger than 0.3
mm from isolation rooms, operating rooms, and biologic safety cabinets (BSCs).
 RADIATION

Radiation may be used in two forms—ionizing and nonionizing. Ionizing radiation, in the form of gamma
rays or electron beams, is of short wavelength and high energy. This method of sterilization is used by the
medical field for the sterilization of disposable supplies such as syringes, catheters, and gloves.

Nonionizing radiation in the form of ultraviolet rays is of long wavelength and low energy. It damages
deoxyribonucleic acid (DNA) by forming thymine and cytosine dimers. Because of its poor penetrability,
usefulness is limited; it can be used to disinfect surfaces, although the parameters (distance to surface,
potential microorganisms to be destroyed) under which it is to be used need to be determined.
CHEMICAL METHOD
 CHEMOSTERILIZERS

The most common chemical sterilant is ethylene oxide (EtO), which is used in gaseous form for
sterilizing heat-sensitive objects. The main disadvantages of EtO use are the lengthy cycle
times and the potential health hazards it produces.

Vapor-phase hydrogen peroxide (an oxidizing agent) has been used to sterilize HEPA filters in
BSCs, metals, and nonmetal devices such as medical instruments (e.g., scissors). There are no
toxic byproducts produced using vapor-phase hydrogen peroxide. Hydrogen peroxide gas plasma
is another method that uses hydrogen peroxide and generates plasma by exciting the gas in an
enclosed chamber under deep vacuum with the use of radiofrequency or microwave energy
DISINFECTION
Physical
method
 PHYSICAL METHOD

The three physical methods of disinfection are:

• Boiling at 100°C for 15 minutes, which kills vegetative bacteria
• Pasteurizing at 70°C for 30 minutes, which kills food pathogens without damaging the nutritional value
or flavor
• Using nonionizing radiation such as ultraviolet (UV) light

UV rays are long wavelength and low energy. They do not penetrate well, and organisms must
have direct surface exposure, such as the working surface of a BSC, for this form of
disinfection to work.
CHEMICAL METHOD
 CHEMICAL METHOD
Chemicals used to destroy all life are called chemical sterilants, or biocides; however,
these same chemicals, when used for shorter periods, act as disinfectants.
Disinfectants used on living tissue (skin) are called antiseptics.

Chemical disinfectants comprise many classes, including:

• Alcohols
• Aldehydes
• Halogens (chlorine and chlorine compounds)
• Peracetic acid
• Hydrogen peroxide
• Quaternary ammonium compounds
• Phenolics
 ALCOHOLS
The two most effective alcohols used in hospitals for disinfection purposes are ethyl
alcohol and isopropyl alcohol. Alcohols have excellent in vitro bactericidal activity against
most gram-positive and gram-negative bacteria. They also kill Mycobacterium tuberculosis
various fungi, and inactivate certain enveloped viruses; however, they are not sporicidal and
have poor activity against nonenveloped viruses. Any solution of an alcohol that is used as
an antiseptic or disinfectant should be filtered through a 0.22-µm filter to remove any
spores that may be present.
 aldehyde

• Formaldehyde is generally used as formalin, a 37% aqueous solution, or formaldehyde gas. Formaldehyde gas
is often used to disinfectant biosafety hoods. This type of procedure should be left to professionals.
• Glutaraldehyde is a a saturated five-carbon dialdehyde that has broad-spectrum activity and rapid killing
action and remains active in the presence of organic matter. Glutaraldehyde is extremely susceptible to pH
changes and is active only in an alkaline environment. When used as a 2% solution, it is germicidal in
approximately 10 minutes and sporicidal in 3 to 10 hours.. Because it does not corrode lenses, metal, or
rubber, it is the sterilizer of choice for medical equipment that is not heat-stable and cannot be autoclaved
as well as for material that cannot be sterilized with gas. It is a safe, high-level disinfectant for most plastic
and rubber items, such as items used for administering anesthetic agents or respiratory therapy
 halogens

• Iodine can be used as a disinfectant in one of two forms: tincture or iodophor. Tinctures
are alcohol and iodine solutions, used mainly as antiseptics. An iodophor is a combination
of iodine and a neutral polymer carrier that increases the solubility of the agent.
• Chlorine and chlorine compounds are some of the oldest and most commonly used
disinfectants. They are usually used in the form of hypochlorite, such as the liquid sodium
hypochlorite (household bleach) and solid calcium hypochlorite. Solutions should be
allowed a contact time of a least 3 minutes, and longer if organic material is present
 Detergents: Quaternary
Ammonium Compounds

They are cationic, surface-active agents, or surfactants, that work by reducing the
surface tension of molecules in a liquid. Their action is mediated through disruption of
the cellular membrane, resulting in leakage of cell contents. Because they are not
sporicidal or tuberculocidal, the use of quaternary ammonium compounds is limited to
disinfection of noncritical surfaces such as benchtops and floors.
 Phenolics

The most common phenolics are ortho-phenylphenol and ortho-benzyl-para

chlorophenol. Phenolics have a fairly broad spectrum of activity but are not
sporicidal. The addition of detergents to the phenol formulation makes products
that clean and disinfect in one step. Their main use is in the disinfection of
hospital, institutional, and household environments. They are also commonly
found in germicidal soaps.
 Heavy Metals
Disinfectants
Disinfectants containing heavy metals are rarely used in clinical applications; they
have been replaced by safer and more effective compounds. Heavy metal
disinfectants are slowly bactericidal; their action is primarily bacteriostatic. Copper
and copper alloys (e.g., brass, bronze) are the first solid surface materials ever to get
approval by the EPA to be considered antimicrobial for health care use. They are being
evaluated for use lining rails and door handles in health care facilities to mitigate the
spread of microorganisms.
 THANKS!
Do you have any questions?

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