GENERAL CONCEPTS

WELCOME TO THE WORLD OF COLD CHEMICAL STERILIZATION

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INFECTIONS

INTRAHOSPITALARIES

It is an infection contracted in the hospital by an inpatient for a reason other than that infection ¹ . An infection that occurs in a patient admitted to a hospital or other health care setting in whom the infection had not developed or was not in the incubation period at the time of admission. It includes infections contracted in the hospital, but manifested after hospital discharge and also occupational infections of the establishment staff ².

In-hospital infections, or also called nosocomial infections, are an important public health problem due to the frequency with which they occur, the morbidity and mortality they cause, and the burden they impose on patients, health personnel and health systems ³.

The most common nosocomial infections are those of surgical wounds, the urinary tract, and the lower respiratory tract. The WHO study and others have also shown that the highest prevalence of nosocomial infections occurs in intensive care units and in surgical and orthopedic wards for acute illnesses. Infection prevalence rates are higher in patients with greater vulnerability due to advanced age, underlying disease, or chemotherapy.
Consequences of hospital infections:
Functional disability, emotional stress and even the death of the patient
Prolonged stays in health centers that generate costs for both the patient, the payer and the health center
Diversion of funds from primary diseases to potentially preventable secondary diseases ⁴

Biosafety

It is defined as the set of preventive measures, aimed at maintaining control of occupational risk factors from biological, physical or chemical agents, achieving the prevention of harmful impacts, ensuring that the development or end product of said procedures does not harm health and safety of healthcare workers, patients, visitors and the environment

Risk Agent: when the cause of the risk is known and clearly individualized. Example: bacteria, iodine, formaldehyde, etc. ⁵.

Risk factor: condition or situation that can cause harm to the health of workers. Example: inappropriate postures during work, routinization, personal demotivation ⁵.

Sepsis: state of putrefaction

Asepsis: total absence of pathogenic microbial form

Antisepsis: gr. Anti, against and sepsis, putrefaction

Risks of Occupational Disease in Health Centers

Biological agents such as body fluids: blood, secretions, feces, urine among others
Punctures: cuts, lacerations, scrapes, punctures, among others
Bad antisepsis - Pollution - Diseases
Handling chemical carrier agents
Exposure to ionizing radiation

Technical Conditions that help Biosafety

Prevention
Clean and neat
Knowledge and proper handling of antiseptic techniques
Multidisciplinary team: transporters, nurses, waitresses, operators among others
Use of personal and general protection barriers
Constant education and training

Biofilm: Complex communities of microorganisms and extracellular polymers fixed on the surface, which can present a single species or a range of different species ⁶.

ORDER OF RESISTANCE OF MICROORGANISMS FROM DISINFECTION TO STERILIZATION ⁷

OTHERS

Critical Articles: They are those that confer a high risk of infection if they are contaminated with any microorganism. Therefore, objects that have contact with tissue or vascular system must be sterile, since any microbial contamination could transmit disease. This category includes surgical instruments, cardiac and urinary catheters, implants and ultrasound probes used in body cavities ⁹.

Semi-Critical Articles: are those that have contact with mucous membranes or skin that is not intact. This category includes respiratory therapy and anesthesia equipment, some endoscopes, esophageal manometry probes, cystoscopes, etc. These medical devices must be free of all microorganisms. Some mucous membranes, such as those of the lungs and gastrointestinal tract, are generally resistant to infection by common bacterial spores but susceptible to other organisms, such as bacteria, mycobacteria, and viruses. ⁹.

Decontamination: process that removes pathogenic microorganisms from objects so that they are safe to handle, use or dispose of ⁴.

Cleaning: is the process of removing visible dirt from objects and surfaces and is usually carried out manually or mechanically using water with detergents or enzymatic products ⁴.

CARACTERÍSTICAS DESINFECTANTE IDEAL

Characteristics of the ideal disinfectant according to the WHO⁴

Comply with the established criteria for the elimination of microorganisms
Have a detergent effect
Act independently of the number of bacteria, the degree of hardness of the water or the presence of soap and proteins
Be easy to use
Not be volatile
Not be harmful to equipment, staff or patients
Be free from unpleasant odors
Be effective within a relatively short period of time.

Characteristics of the Ideal Disinfectant according to APIC ⁸

Spread spectrum
Fast action
Not affected by environmental factors
Not toxic
No smell
Easy to use
No toxic residues on surfaces
Soluble in water
Not Corrosive

STERILIZATION

It describes a process that destroys or eliminates all forms of microbial life (bacteria, fungi, viruses, mycobacteria, spores) that are carried out in health facilities through physical or chemical methods. When chemicals are used to destroy or eliminate microbial life, they can be called chemical sterilants. Those same germicides if used for short periods of time can also be part of the disinfection process ⁹.

Chemical Cold Sterilization: Only some disinfectants can lyse spores when exposed for long periods of time (they vary depending on the product of 30 min or 3-12 hours) ^9,10.

DESINFECCIÓN

Describes the process of eliminating some or all pathogenic microorganisms, with the exception of spores, on inanimate objects ⁹.

High Level Disinfectant: those products that lyse all microorganisms with the exception of some spores ⁹.

Intermediate Level Disinfectant: those products that lyse bacteria, most viruses and fungi, but do not eliminate any type of spores ⁹.

Low Level Disinfectant: This level allows the elimination of almost all bacteria and some viruses and fungi, but it is not safe to eliminate the most resistant bacteria such as M. tuberculosis or bacterial spores. ⁴.

References:

(1) CDC guidelines for infection control in hospital personnel. Am J Infect Control, 1998, 26: 289–354 or Infect Control Hosp Epidemiol 1996; 17: 438-473.

(2) Bouvet E. Risk for health professionals of infection with human immunodeficiency virus Current knowledge and developments in preventive measures. Médecine et Maladies Infectieuses, 1993, 23: 28-33

(3) Epidemiological surveillance of infections associated with health care Module III. Pan American Health Organization, 2012.

(4) Prevention of nosocomial infections PRACTICAL GUIDE 2nd edition. WHO 2003.

(5) Bioseguridad.Ino.org.pe

(6) Costerton, 1995; Davey or Toole, 2000; Kraigswley et in 2002

(7) Modified from Plasmids and bacterial resistance to biocides. Russell AD. Plasmids and bacterial resistance to biocides. J. Appl. Microbiol. 1997; 83: 155-65

(8) APIC Guideline for Selection and use of Disinfectants American Journal of Infection Control. Vol 24 nº4 pp 313-342August 1996

(9) Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. CDC

(10) Made by "Mycobacteria Laboratory - Institute of Biomedical Sciences University of Sao Paulo, in Brazil, within the framework of the conditions of the standards of" Fundação Oswaldo Cruz - National Institute of Control of Qualidade em Saúde "- Manual da Qualidade - Method for evaluating the sporadic activity of the K-LLER® ® product, number 53.3204.005

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