hsm 2433 mikrobiologi, penyakit berjangkit dan … · “prinsip sterilisasi ... contaminated...
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Pengenalan Terma-terma
Teknik Pensterilan – satu teknik untuk membunuh SEMUA mikroorganisma pada sesuatu bahan/permukaan objek (termasuk endospora)
○ Dperlukan utk smua peralatan/cecair yg dmasukkan kdlm badan
Teknik Disinfektan – satu teknik untuk MENGURANGKAN BILANGAN mikroorganisma pada sesuatu bahan (tidak termasuk endospora) yg bertujuan mengurangkan jangkitan.
○ Antiseptik: agen kimia yg digunakan pada TISU HIDUP
○ Agen Disinfektan: agen kimia/fizikal yg dgunakan utk objek BUKAN HIDUP seperti lantai, peralatan hospital dll.
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• Cleaning/pbersihan – Mbuang semua bhn asing (i.e., dirt, body fluids,
lubricants) pd sesuatu objek dgn mgunakan air + pluntur/ sabun mlalui teknik pcucian (washing) / pberusan (scrubbing)
– WAJIB dlakukan sblm mlakukan teknik disinfeksi atau pensterilan supaya bhn asing pd sesuatu objek tiada sms proses disinfeksi/ pensterilan dilakukan.
• Pasteur – Teknik utk mbuang/ mgurangkan patogen termasuk
mikrob) terutama dlm pyediaan susu dan jus buah.
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• Teknik Aseptik – teknik yg mhalang kontaminasi, terutama mlibatkan
– Peralatan pembedahan,
– Kakitangan perubatan,
– Pesakit semasa pembedahan,
– Penyediaan ubat-ubatan,
– Industri makanan.
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DISINFEKTAN
Mbuang mikrob, ttp tidak sesempurna dlm pensterilan
Mgunakan kaedah fizikal atau kimia Mudah digunakan Tidak merbahaya kpd peralatan/ kakitangan/ psakit. Tidak mhakis/ mengewap (volatile) Tiada bau busuk
Cecair Disinfektan: Applied to inanimate objects (bukan hidup) spt alkohol, gluteraldehyde
Antiseptic: Applied to living tissue
Pgunaan kaedah mgikut arahan pengeluar sesuatu peralatan/ prosedur prubatan yg ingin dilakukan
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• Tahap teknik disinfektan tbahagi kpd 3 kump mgikut prosedur kpd psakit
– High level (Kritikal): mbunuh smua jenis mikrob (endospora, virus, fungus, bakteria tmasuk Mycobacteria) kecuali endospora tertentu = mcapai kesan pensterilan
– Intermediate level (semi- kritikal): menyahaktif/ mbunuh Mycobacteria, bakteria, virus, fungus ttp tidak mbunuh endospora
– Low level (tidak kritikal): mbunuh kbanyakan bakteria, virus dan fungus ttp tidak berupaya pada Mycobacteria/ spora bakteria
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• Pbezaan tahap disinfektan berasaskan;
– Kepekatan
– Masa dedahan
– Suhu
– Bhn organik tertentu
– pH
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Critical
Enters Sterile tissue or Vascular System
Examples: Implants, Scalpels needles, surgical and dental equipments, endoscopic accessories
PROCESS: Sterilization & High level disinfection
Sterilization: (follow manuf. Instructions for cycle/time)
○ Autoclave
○ Dry heat
○ ETOgas
○ Chemical gas sterilizers
High level disinfection : (pbezaan kepekatan)
○ Gluteraldehyde 2%
○ Hydrogen peroxide 6% ○ Paracetic acid
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Semi-critical
myentuh membran mukosa or kulit tbuka/ luka:
Examples: gastroscopy, endoscopy, termometer (do not mix oral and rectal thermometers)
Process: intermediate level disinfection (exposure time =/<20 min)
Contoh
Ethyle or isopropyle alcohol (70% - 90%)
Phenol
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Non-Critical
• Touches intact skin • Ex: Stethoscopes, tabletops, floors, bedpans,
furniture • Process: low level disinfection (exposure time <10
min) • Contoh
– Ethyle or isopropyle alcohol (70% - 90%) – phenolic or Iodophore germicidal detergents (dilute
according to manf.inst) – Quaternary Ammonium germicidal detergents – Household bleach (Sod. Hypochlorite 5.25% 1000ppm
available chlorine= 1:50 dilution)
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PENSTERILAN
• Proses yg membunuh semua mikroorganisma termasuk endospora
• Mgunakan kaedah fizikal/ kimia
• Dgunakan bg semua peralatan yg memerlukan kmasukan kdalam badan yg steril, spt darah
• Sblm dilakukan, semua peralatan perlu dibersihkan (cleaning) dan dibungkus utk mmastikan kesterilan dan diletakkan pita pnunjuk (biological indicator tape) bg mmastikan kaedah djalankan dgn sempurna.
• Bungkusan yg TKOYAK, BASAH atau ROSAK dianggap TIDAK STERIL.
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• Alat pbungkus (kalis dgn kaedah yg ingin digunakan) – Kertas tertentu
– Plastik polyethylene dan polypropylene (mgunakan bhn kimia etylene oksida)
– Kain bukan tenunan yg pakai buang
– Botol kaca (steril cecair)
• Smua peralatan yg disteril perlu diletakkan tarikh teknik dilakukan
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• Teknik sterilisasi
– Fizikal • Permanasan basah: Autoklaf (121oC slm 30 min)
• Permanasan kering: utk peralatan perubatan yg bsalur (160oC slm 120 min)
• Radiasi: Gamma & UV
• Penurasan/ filtration
• Suhu rendah (plasma sterilization)
– Chemicals (in liquid or gaseous phase) • Liquid: gluteraldehyde, Peracetic acid
• Gas: Ethylene oxide, Formaldehyde
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Autoklaf
Direct exposure to steam (wet) at the required temperature and pressure for
a specific time: 30 min
121o C - 123o C (250o F - 254o F)
Bhn yg boleh diautoklaf
Culture and stocks of infectious agents (bacteria, mold, viruses)
Contaminated solids (paper towel, cloth, plastic pipette tips, glassware)
Discarded live and attenuated vaccines
Bhn yg x boleh diautoklaf
Cecair yg mhakis, volatile
Radioactive material
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Kimia • Utk bhn yg tidak boleh diautoklaf: sensitif dgn pemanasan
– Material biologi (tisu-tisu kultur)
– Fiber optics
– Plastik
• Mgunakan fasa cecair/ gas
– Gas etelena oksida: most common sterilization method, used for over 70% of total sterilizations, and for 50% of all disposable medical devices.
– Glutaraldehyde and formaldehyde solutions: tisu manusia
• volatile, and toxic by both skin contact and inhalation.
• Many vaccines, such as the original polio vaccine, are sterilized with formaldehyde.
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Radiasi Mgunakan radiasi mlli electron
beams, X-rays, gamma rays, or subatomic particles.
Gamma rays: disposable medical equipment, such as syringes, needles, cannulas and IV sets.
Electron beam processing: medical device sterilization.
Ultraviolet light : useful only for sterilization of surfaces and some transparent objects..
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Disinfectants that Inactivate Hepatitis B Virus (HBV)
The following common disinfectants have been shown to inactivate HBV:
• glutaraldehyde (2%),
• glutaraldehyde-phenate (0.13% glutaraldehyde/.44% phenol),
• iodophor,
• isopropyl alcohol (70%), and
• sodium hypochlorite
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Disinfectants that Inactivate Human Immunodeficiency Virus (HIV)
The following common disinfectants have been shown to inactivate HIV:
• glutaraldehyde (2%),
• hydrogen peroxide (.3%),
• ethyl alcohol (50%),
• isopropyl alcohol (70%),
• phenolics, and
• sodium hypochlorite (50 ppm).
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Disinfection-Hand Washing
• Handwashing frequently is called the single most important measure to reduce the risks of transmitting organisms from one person to another or from one site to another on the same patient.)
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Dishes, Glasses, Cups, and Eating Utensils
• No special precautions are needed for dishes, glasses, cups, or eating utensils. Either disposable or reusable dishes and utensils can be used for patients on isolation precautions. The combination of hot water and detergents used in hospital dishwashers is sufficient to decontaminate dishes, glasses, cups, and eating utensils.
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Pathological Waste
• Human pathological wastes - tissues, organs, body parts, containers of body fluids
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Sharps
• Any article that can puncture or cut, and have been used in animal/human patient care or treatment
• Examples: needles, syringes, scalpel blades, razors, forceps
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Animal Waste
• Contaminated animal carcasses, body parts, animal bedding known to have been exposed to infectious agents during research
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