Sterile Procedures
LESSON 2: Medical asepsis
2-4
2-4. DISINFECTION
Disinfectants are used as a means for destroying harmful organisms with the exception of the spore forms of bacteria. In the emergency medical treatment situation, the spore-forming organisms of importance are those that cause tetanus and gas gangrene. Tetanus, in the absence of preventive antitetanus inoculation, and gas gangrene are serious infections which threaten wounded patients, especially those with deep, dirty wounds in which oxygen supply is very limited.
a. Boiling. Boiling is considered only when saturated steam under pressure (autoclave) is not available. Articles should be well cleaned before boiling and then must be totally immersed, with surfaces opened to the solution, for 30 minutes of vigorous boiling. Needles, metal cannulas, surgical instruments, glassware (including hypodermic syringes), and similar items may be boiled. Rubber goods may not be boiled.
b. Chemical Disinfectants. Various chemical preparations are effective as disinfectants. Chemical disinfectants in common use today include Cidex, Wescodyne, isopropyl alcohol 70 percent, and certain phenol preparations specifically designed as disinfecting solutions for inanimate objects. Materials not harmed by water will not be harmed by disinfectant solutions of these chemicals. Use of liquid chemical disinfectant should be severely limited to those occasions when saturated steam under pressure (autoclave) is not available or when steam sterilization would damage articles so processed.
(1) Instruments and supplies not adversely affected by the chemicals may be disinfected by immersion in a solution of chemical disinfectants for the time specified by the label on the container, by established procedure such as that of a hospital or aid station, or by a person having knowledge of the disinfecting properties of the various chemical solutions.
(2) When the articles have been disinfected, the treated articles must be flushed well with sterile normal saline and dried before being used on the patient. Except for alcohol (isopropyl 70 percent), chemicals of disinfecting strength are not applied to the patient since they could damage the patient's skin.
c. Antiseptics. Antiseptics interfere with the growth and development of pathogens without necessarily destroying these agents. Antiseptics are milder than chemical disinfectants, either by nature or by strength, and may be applied directly to patients. Antiseptics included in your aid kit are povidone-iodine topical
solution and ointment, surgical detergent 7 1/2 percent povidone, and isopropyl alcohol 70 percent. If immediately available, an antiseptic solution may be applied around a superficial wound when hemorrhage is not severe and when surgery, if indicated, is expected to be delayed longer than six hours after wounding.
d. Cleansing Agents. Cleansing or skin degerming agents may include soap and water or surgical detergent preparation and water. Mixtures of soaps or skin detergents, with or without antiseptic properties, mechanically bind dirt, grime, and pathogens that are then floated away with rinse water.
NOTE: Only disinfectants, antiseptics, and detergents approved by the Infection Control Committee (or other similar group on the local level) should be used.
